Top mental health issues to watch according to IHME experts

• Alize J. Ferrari, PhD, is the stream lead for the Epidemiology and Burden of Disease Research Stream based at the Queensland Centre for Mental Health Research, Queensland, Australia. She is an Affiliate Associate Professor at IHME. 
• Dr. Damian Santomauro is the deputy stream lead for the Epidemiology and Burden of Disease Research Stream based at the Queensland Centre for Mental Health Research, Queensland, Australia. He is also an Affiliate Assistant Professor at IHME for his work on the Global Burden of Disease study. 

IHME: Following the COVID-19 global health emergency, which caused a large jump in the number of people living with depression and anxiety according to your research, what trends are you watching for in the data that you analyze?   

Dr. Damian Santomauro: For COVID-19, we are not observing the same kind of risk factors for depression and anxiety now as we experienced during the peak of the pandemic, like lockdowns and job insecurity. We’re also looking toward future shocks, such as war and conflict. We have seen that war and conflict can increase the prevalence of mental disorders where it occurs. Another area that we are monitoring is the potential future impact of climate change, such as rise in temperature, food insecurity, and other impacts. How will that impact the mental health of the population?  

The last trend that we are watching is an emerging trend. There is preliminary evidence of an increasing prevalence of mental disorders in youth at the population level over the last 10 years. There have been a few sources suggesting this trend, and we need to confirm that it is there, and if so, identify potential causes. 

Dr. Alize Ferrari: In our capacity of understanding the global epidemiology and burden of mental disorders, our focus is to keep a close eye on emerging mental health threats. We learned as much as we could in estimating the impact of COVID-19 on mental disorders and are watching other potential risk factors that are emerging and how to best quantify their effects with the data that we have.   

IHME: How hopeful are you feeling about the new treatments for mental illness? Where we are based in the US, for example, we’ve seen headlines about quick-acting oral treatment for postpartum depression approved by the US FDA for the first time, and there are other treatments that periodically make headlines.  

Dr. Alize Ferrari: The peripartum period is a period when women are at a higher risk for depression and anxiety disorders, so it’s hopeful to see new medication available to support them. It’s also important to remember, though, that it is medication in combination with psychotherapy, such as cognitive behavioral therapy, that has the best potential to reduce and alleviate symptoms of depression. It’s important to think about the two in combination rather than just one or the other.  

I’m heartened to see how far we’ve come with mental health awareness... We now have to focus on how to deliver the most effective care to individuals in the population who most need this.

IHME: What are the biggest challenges surrounding mental health right now, in your opinion? 

Dr. Alize Ferrari: One of the challenges is increasing uptake of treatment. We still see governments lagging behind in their mental health response and how they organize mental health service systems. What that means is people are often not receiving treatment at the time when it can have the best impact in improving their mental health, and they are not receiving the right combination of treatment. We were just talking about medication in combination with psychotherapy. Those two things in combination have the best impact on increasing rates of remission, decreasing rates of severity, and decreasing your risk of early mortality from common mental disorders like depression. We still see very low rates of what we consider to be minimally adequate treatment for mental disorders across most countries. 

Dr. Damian Santomauro: It’s not just access to treatment; it’s also access to minimally adequate treatment. There might have been an uptick in people reporting seeing a psychologist or receiving some other form of mental health service. If they are not getting the minimally adequate treatment, however, it’s going to be perceived as not really helping the individual.  

IHME: What do you think is the best approach to combatting those challenges?   

Dr. Alize Ferrari: There are various resources available to health systems and service planners specifically around how to best respond and organize mental health services. The Disease Control Priorities Initiative, for example, provides very good technical advice around how best to put together essential care packages for countries in low- and middle-income settings for various diseases. They have good advice around how to formulate and operationalize a mental health response as well. That would be a good place to start.  

Dr. Damian Santomauro: Looking at the barriers there, what are the barriers to accessing mental health treatment at the population level? If they are financial, then it is necessary to make the services more affordable with subsidies. If it’s a capacity thing, it is about trying to increase the workforce to provide services.  

Dr. Alize Ferrari: Damian, you make a good point here because there are various barriers to accessing care. There are barriers to how to best organize services from the point of view of the service provider. But there are also barriers from the point of view of individuals in the community accessing treatment. Often those barriers include challenges such as “It’s hard for me to get to a service,” or “There’s no public transport route that I can take,” or “There’s no time in my day,” or “I don’t know which doctor I should see first and I get lost in the system.” The best place to get information on these barriers to care is by hearing directly from community members about the type of help they would like to receive. We can do this through mental health surveys of the general population. 

IHME: When it comes to addressing the burden of disease from mental disorders, what are you optimistic about?  

Dr. Alize Ferrari: I’m heartened to see how far we’ve come with mental health awareness. In the last decade, we’ve seen that at the community level, people want to talk about their mental health. They want to understand what treatments are available and how they can make things easier for their caregivers. At the service response level, people have much better awareness and appreciation for mental disorders as chronic and disabling illnesses. We now have to focus on how to deliver the most effective care to individuals in the population who most need this.  

IHME: Do you think the pandemic has catalyzed some of that awareness? 

Dr. Alize Ferrari: We do see more dialogue around mental health after shock events, yes, whether it’s the pandemic or conflict in a particular part of the world, or flooding and other natural disasters. However, we have also observed more dialogue in other contexts as well, such as in schools, at workplaces, as part of other health checks, for instance, for new mothers. We need to see more of this going forward.  

IHME: Do you feel like generationally things have changed as far as mental health being a taboo among older generations and seeing younger generations having more awareness?  

Dr. Alize Ferrari: I think so, yes, we’ve come a long way in trying to alleviate some of the stigma in talking about your mental health and encouraging people to seek help for their mental health. There are certainly more improvements to be made, but we do see younger populations more inclined to talk about their mental health and using words like depression and anxiety, concepts that our grandparents were not using as commonly.  

What we have observed, at least here in Australia, is that although we see more of that dialogue and more people accessing services for their mental health, we’re not always seeing an equivalent reduction in the prevalence of mental disorders. We’re pondering about what that means. Are the right treatment options not being made available, or are those seeking help not necessarily those with mental disorders? We are always trying to understand what best quantifies a population’s mental health need.  

IHME: If you could speak directly to policymakers who could implement mental health interventions in their communities, what would you say?  

Dr. Alize Ferrari: A lot. But if I had five minutes to say something, I would make a plea for our approach to mental health to be more proactive and not just reactive. We need better prevention strategies and a better plan to tackle the avoidable burden from mental disorders.  

We need to think about our youth and our children. We know that bullying victimization, child maltreatment, and other forms of interpersonal violence have a strong impact on one’s risk of getting severe mental health issues. We need to have better strategies to tackle these risk factors. 

Dr. Damian Santomauro: They say the same thing for physical disorders. It’s the same for mental disorders as well.  

IHME: is there anything that we didn’t ask you about in this interview that you think people should know? 
 
Dr. Alize Ferrari: The need to better understand and track emerging mental health threats is a strong focus for us at the moment. We are, however, restricted by the quality and availability of epidemiological data for mental disorders related to emerging threats like climate change, what happens at the tail end of the COVID-19 pandemic, and social media and the impact that has on mental health, for instance.