The War on Mental Illness

My younger sister died in 1964 at age four of non-Hodgkin’s lymphoma, which was then uniformly fatal. Today, that type of childhood cancer is over 80 percent curable, thanks to the War on Cancer, which started in the United States in 1971, when President Nixon signed the National Cancer Act. The research tools available then were completely inadequate – there was no magnetic resonance imaging (MRI), no positron emission tomography (PET), very rudimentary molecular biology, no genetically modified animals, no automated genome sequencing, no personal computers, no universal databases, and limited access to bibliography. Yet, the enormity of task nand the technical limitations of the era did not stop the launch of that successful initiative. The much better tools that we have today give us an amazing advantage; therefore, we are now far better positioned to launch a ‘War on Mental Illness’ than our cancer colleagues of 1971 were to start their exceptionally successful `War on Cancer’. Psychiatric disorders represent a substantial burden to the world. As an example, depression is on average the second cause of disability in developed countries and the fourth in the world. According to the Centers for Disease Control and Prevention (CDC), in the US 11 percent of the population over age 12 is on antidepressants. In Australia, depression represents the largest cause of non-fatal disease burden. Moreover, suicide (which is in most cases an outcome of depression) was ranked by the CDC as the 10th leading cause of death among persons ages 10 years and older in the USA. A recent article by Chevreul and colleagues showed that France, with a population of 65 million, has an estimated 12 million inhabitants currently suffering from one or more mental disorders, which have a total cost of €109 billion, 20 percent of which is actual money spent and 80 percent the social value of disease consequences. The ‘War on Mental Illness’ should include the following: It is really important to sustain existing investigator-initiated funding mechanisms. We suggest that for a ‘War on Mental Illness’ to be successful, higher numbers of investigatorinitiated grants need to be funded. While investigator-initiated efforts are indispensable, advances accomplished in one single lab and funded by one grant will not resolve the problems related to psychiatric disorders. There is a need for well-structured and well-funded national and international consortia, which have been very successful in other areas of medicine. One of the major human right scandals of our era is the abysmal plight of the mentally ill in some low- and middle-income countries. Effective new efforts need to be set up for global mental health. There are very few dedicated translational psychiatry centres and institutes in the world. Those should be strengthened as national research programs, where new ideas can be tested and developed without the long delays caused by the search for external funding. Philanthropy is greatly needed to support new initiatives and innovative approaches. Some researchers, also known as ‘biohackers’, are becoming de facto sole proprietor businesses, engaged in non-institutional science and technology development. They lease their own infrastructure and operate like micro-companies. Private funding programs are needed to support such high-risk, high-reward independent ventures. Eventually, new treatment approaches need to be effectively commercialised in order to reach vast numbers of people and make a difference in their lives. This requires facilitation and support of start up incubators and efficient technology transfer. While a war on established mental illness is very much needed, according to Benjamin Franklin “an ounce of prevention is worth a pound of cure”. In that context, efforts to promote wellbeing, such as positive psychology and resilience building, as well as the adoptionof healthy lifestyles ought to be an integral part of the ‘War on Mental Illness’. It will be likewise crucial to develop and apply preventive strategies for those who are vulnerable to mental illness in childhood and adolescence, before psychiatric disorders become established chronic conditions. The rapid launch of the `War on Mental Illness’ represents medical, scientific, humanitarian, and moral imperatives. Hillel famously stated: “If I am not for myself, who will be for me? And if I am only for myself, then what am I? And if not now, when?” If we do not stand up, not only for ourselves, but also for the hundreds of millions afflicted by mental illness the world over, who will? And if not now, when? Professor Julio Licinio Head, Mind and Brain Theme, South Australian Health and Medical Research Institute (SAHMRI) and Strategic Professor of Psychiatry, School of Medicine, Flinders University