With the start of a new year, we all engage in some form of accounting – taking stock of the last twelve months and setting resolutions for those on the horizon. In doing so, almost universally, we focus on aspects of our lives that are intimately associated with our mental health and wellbeing.
Here are five mental health priorities that were in the news in 2018 and that will need ongoing attention in 2019.
1. Substance use, abuse and addiction. The United States is in the midst of a public health crisis when it comes to opioid abuse and addiction. The good news is that national funding and state efforts are in high gear to expand treatment options and improve pain management strategies that prevent addiction and overdose, including for example The Helping to End Addiction Long-term (HEAL) initiative. Some other good news is that tobacco smoking is down in many places around the world, including France, the United States, and Russia. Teenage drinking is also down across the European continent, with Britain reporting the largest decline.
Given declining rates of tobacco use in high-income countries, low and middle-income countries are increasingly becoming commercial targets. The opportunity going forward is to share information and learnings globally. Access to evidence-based strategies that have been effective in one part of the world so that they can be considered and adapted in other parts of the world will ensure that we are not wasting time and resources reinventing the wheel. Researching and employing innovative technologies like crowdsourcing will also help us benefit from knowledge that is held in the community, leading to more efficiently deploying resources, as illustrated by this pioneering initiative in Boston.
2. Gender, Sexuality and Mental Health. We have witnessed tremendous progress in terms of enhanced understanding of gender and human sexuality: India‘s highest court decriminalized gay sex in 2018, a century-old law that they described as “irrational, indefensible, and manifestly arbitrary.” Similar policy changes occurred in other parts of the world, including Costa Rica, Lebanon, and Trinidad and Tobago. And Pakistan passed a law guaranteeing basic rights for transgender citizens and outlawing discrimination by employers. However, many countries still criminalize homosexuality and transgender people. Human rights violations, prejudice and discrimination follow, and this leads to serious mental health problems, including increased rates of suicide among the LGBTQ community. Research on gender and sexuality – from basic biology to social policy – needs to be a priority going forward so that we can advance evidence-based policymaking, promote mental health and achieve basic human rights for all.
3. Technology and Mental Health. Thanks to technology, we are more connected than ever, but the same technology that connects us is also associated with mental health problems. Increased rates of depression associated with social media hit the news in 2018 in a big way. Another technology-related disorder is Gaming Disorder, which was announced in 2018 as a newcomer to the ICD-11. The upside of technology and mental health is equally awesome. We now have the capacity to conduct research that has never been possible before. Two examples include the Genome Wide Association Study that is helping us understand the genetics of mental health conditions as well as other disorders. Another example is the Global Clinical Practice Network that now has over 15,000 clinicians who engage in research and contribute input to the development of the ICD-11 guidelines for mental health and substance use disorders.
The arrival of the automobile was associated with an explosion of accidents and deaths that had never occurred before. We are at a similar point of inflection with technology and mental health today. It is not without risk, but we have also barely tapped its potential. Consider the paradoxical truth that today’s technology will enable us to amass enormous amounts of data, which is exactly what is necessary to treat the specific needs of the person sitting in our offices seeking care. Such big data strategies are already informing cancer treatments; it is a huge opportunity for mental health in 2019 and beyond.
4. Mental Health Awareness and Education. It has been a longtime coming, but there is no doubt that mental health is now part of the story of global heath and development. In 2015, mental health was included in the Sustainable Development Goals. In the United States, New York and Virginia became the first two US states to enact laws in 2018 that require mental health education in schools. The United Nations, USAID, Wellcome Trust and other such organizations have identified mental health as integral to public health and economic development. I believe we have reached a tipping point in terms of awareness. The challenge going forward is how to translate greater knowledge into action.
5. Generations X, Y, Z and Beyond. We need to focus on youth if we are to improve public mental health. The majority of mental disorders emerge by the time we are in our mid-twenties. Mental disorders, particularly depression and anxiety, are common among youth. Suicide, which is often associated with depression and substance use, is one of the leading causes of death in adolescents in all regions of the world. Existing models of care are not sufficient to meet the demand for services. The good news is that young people are talking about their mental health needs and seeking support at higher rates than previous generations. And not to portray an oversimplified or bleak story, I should highlight findings from a recent survey indicating that around the world young people tend to be more optimistic than adults in their own countries. In Kenya, Mexico, China, Nigeria and India, nine in 10 teenagers reported feeling positive about their future. And optimism is key to mental health.
Youth are presenting with more mental health needs; they are also more open to pursuing treatment, and they are technology natives. Bringing youth into designing solutions that include technology has the potential to produce innovative strategies that transform how we prevent and treat mental health conditions that those of us with more years and less optimism cannot possibly imagine on our own.
When it comes to mental health, we’ve come a long way, and we have a long way to go. Hello 2019; Goodbye 2018!
