Now is the time for a paradigm shift in how we treat mental ill health
This week, Prime Minister Scott Morrison announced the findings of the Productivity Commission report into mental health. It estimated that the economic cost of mental ill-health and suicide in Australia was up to $70 billion a year, and that disability and early death caused by it cost a further $151 billion a year.
If there has ever been time for a paradigm shift in the way we conceptualise mental health and mental illness, it must be now. As we battle with a global rising tide of mental illness, there should be recognition that radically new approaches are needed to treat these diseases.
Part of the reason that the incidence of mental illness is increasing in the community is because we're now more aware of it, and also because there's far less stigma attached to it than in the past.
But despite more people seeking help, there are also more people, globally, committing suicide, with an alarming increase over the past three years after some stability in these figures since the 1970s. And that was before COVID-19 brought its isolation, unemployment, anxiety and illness to our world.
In the same way we now routinely offer personalised precision medicine for cancer treatment – with the genetic makeup of an individual’s tumour determining treatment rather than broad-brush diagnoses such as lung cancer or breast cancer – it's time to look at psychiatric illness in the same way.
Disorders such as schizophrenia and depression are not single diseases, but labels used to cluster symptoms.
In the case of depression, these symptoms include constant sadness, irritability, hopelessness, decreased energy, and sleeping problems. Schizophrenia has numerous disabling symptoms, including delusions, hallucinations, memory and thinking problems, and depression.
Both these conditions have a strong link with family heredity. Depression has a genetic link of approximately 40-70% ,and schizophrenia a genetic link of between 50-80%. The problem is that these disorders, like others such as bipolar disorder and autism, have multiple genes that are in play, which makes fanciful the approach of targeting a single gene with a drug or therapy and hoping to treat everybody.
Taking a cue from cancer treatment
But what if we had a similar program to that for cancers, which also have multiple genetic causes, dedicated to mental health issues?
Fifty years ago, only one in three people diagnosed with the blood cancer leukaemia would survive a year with the disease. Now, that statistic has been flipped, with at least half surviving up to 10.
The changes are even more remarkable for other cancers, but it was a long slog determining the genes associated with each disease, and developing treatments that targeted each genetic mutation. Then there was the enormous task of being able to determine that genetic mutation, and tailoring treatment for every person diagnosed with cancer.
It was predicted, decades ago, that such an approach might work, but it would be enormously costly. And yet here we are – with personalised medicine one of the backbones of oncology.
Of course, psychiatric illness is harder to tackle than cancer. We can’t just sample bits of people’s brains to look for genetic mutations. Instead we have to rely on family histories, brain imaging and electrical recordings, blood assays, and the use of animal models to link a disease to a gene(s), and then find a drug that targets that gene.
Melbourne is one of the few places in the world that has these sorts of programs. In 2018, a global study led by University of Melbourne’s Professor Sam Berkovic examined the DNA of more than 45,000 people with epilepsy, leading to the discovery of 11 genes associated with the disorder, paving the way for drugs that could benefit millions of patients who didn't respond to existing treatments.
At Monash, we have similar programs looking at the genes and proteins that cause schizophrenia and other psychotic disorders, with a view to individualising treatments for people with different types of the disease.
We're amid a mental illness epidemic, and quicker recognition and providing more treatment for those in need is extremely important. But we need a paradigm shift in the way we tackle mental illness, in the same way those leukaemia researchers did 40 years ago.
Professor Suresh Sundram is a speaker at the From the Front Line: Rethinking Mental Health webinar, at 11.30am on Wednesday, 25 November. You can register for the event here.