Mental health in an unequal world. World Mental Health Day 2021

Mental health in an unequal world. World Mental Health Day 2021

by | Oct 9, 2021

Mental illness, why bother if all goes well? Because the day it hits you or your loved ones, you may be faced with the harsh reality of “Mental Health in an unequal world”. Close to 1 billion people globally are living with a mental disorder. Yet, countries spend on avg. 2% of their national health budgets on mental health leaving a disproportionate gap between demand for mental health services and supply. Each year, October 10th marks the “World Mental Health Day”. This year the theme is “Mental Health in an Unequal World”. 

Originally chosen by the World Federation for Mental Health, the theme Mental Health in an Unequal World” refers to the inequality in access to health services in low- and middle-income countries, where between 75% and 95% of patients with mental disorders have no access to mental health services at all. Despite the universal nature and the magnitude of mental illness, the gap between demand for mental health services and supply remains substantial.

The global pandemic along with the climate crisis and social disarrangement lead the world to a difficult place. To date, the pandemic is impacting people of all ages and backgrounds: Illness, economic impact, job insecurity, and most importantly, physical distancing leading to social isolation and millions of people facing mental health issues.

  • Close to one billion people have a mental disorder and anyone can be affected.
  • Depression is a leading cause of disability worldwide and a major contributor to the global burden of disease. Globally, an estimated 5% of adults suffer from depression.
  • Globally, one in seven 10-19-year-olds suffers from a mental disorder. Half of all such disorders begin by the age of 14, but most go undiagnosed and untreated.
  • People with severe mental disorders like schizophrenia typically die 10-20 years earlier than the general population.
  • One in 100 deaths is by suicide. It is the fourth leading cause of death among young people aged 15-29.
  • The COVID -19 pandemic has had a significant impact on people’s mental health.

The World Federation for Mental Health also addresses the disparity between mental health investment and overall health. On average, countries spend only 2% of their national health budgets on mental health. This has changed little in recent years. Despite the scale of mental illness, the gap between demand for mental health services and supply remains substantial. Unaddressed mental health issues are now a leading global cause of disability and suffering. Yet only 10% receive “adequate” treatment – 75% receive no treatment at all.

The limited global availability of effective mental health treatments and a lack of objective measures of response to treatment, are some of the barriers in advancing patient outcomes. To reduce burden, it is critical to diagnose and monitor mood disorders using widely accessible, less costly, and scalable methods, which can enable a higher degree of specificity in mental health diagnoses and timely detection of clinical deterioration.

Building on the widespread adoption of smartphones, mobile health (mhealth) has gained significant interest as a means for capturing continuous, objectively observable and measurable data of patients’ behaviour and mental state. The data collected on smartphones and sensors represent a new approach aimed at measuring human behaviour and mental health, and thus an opportunity of detecting, assessing, and monitoring psychiatric disorders in a less costly and less burdensome way for the clinician.

The data collected on the smartphone are also referred to as digital biomarkers. These can be collected both passively through inbuilt sensors on the smartphone (physical activity and geolocation, social activity, text messages usage, phone usage, voice and speech pattern or wearables (sleep and activity), and actively via user engagement through self-monitored data/self-assessment data (mood, sleep, stress, medicine adherence).

By collecting this data between physician visits, clinicians can see fluctuations in patients’ mental states, providing a more holistic representation of the patient’s functioning over time. The data hereby offer the opportunity for clinicians to predict relevant outcomes in mood disorders and can thus serve as a tool of triage enabling to provide timely and preventative support to the individuals in critical need.

This approach, also known as digital-enabled psychiatry, has gained considerable interest and been extensively researched over the past decade to offer more people access to high-quality health and social care.

To learn more, visit our Research section here or watch a video on the opportunity of digital-enabled psychiatry from the Week of Health and Innovation conference 2021 in Denmark.

References:

https://wfmh.global/2021-world-mental-health-global-awareness-campaign-world-mental-health-day-theme/

https://www.who.int/publications/i/item/9789240031029

https://www.who.int/campaigns/world-mental-health-day/2021

https://www.who.int/key-messages

[1] https://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf

[2] The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011

[3] OECD – 2015

[4] Economist Intelligence Unit – 2015

A smartphone app that can help psychiatrists diagnose mental illness

A smartphone app that can help psychiatrists diagnose mental illness

by | Jul 27, 2020

“A smartphone app that can help psychiatrists diagnose mental illness” –  Peter Hagelund, a Monsenso user, speaks about his experience using the Monsenso mobile health solution to support his treatment, and how it has helped  him improve the communication with his psychiatrist.

Prior to using the Monsenso smartphone app, Peter and his psychiatrist followed the typical therapeutic setting, they would schedule an appointment every two-three weeks, and they would have a conversation to discuss Peter’s previous weeks.  Peter would usually say that he had been doing fine for each appointment, but sometimes he forgot important details that he wanted to discuss.

“It can be pretty tricky to remember, two weeks later [between appointments] how you actually felt that day. With the app it’s really easy to go back and see if your mood has been pretty stable over the last two months, or if you had had some ups and downs over a period,” says Peter Hagelund.

Now, instead of relying on Peter’s memory during the appointment, his psychiatrist can access his data and see how he has been doing, as it happened. He can view how much he has been sleeping, how much he exercises, how much he drinks, how much anxiety he has, and other relevant aspects to his treatment and his disorder.

“My psychiatrist now says things like You say you’ve been doing fine, but I can actually see that you’ve had a few ups and downs. I think the app helps him get a real view of how I have been doing,” says Peter Hagelund.

In his Danish documentary series “Jeg savner min sygdom” (which translates to “I miss my illness”), Peter Hagelund talks about his experience of getting the wrong diagnosis and how finally after six years he got the right diagnosis and treatment. 

In 2014, he was diagnosed with Bipolar Disorder Type 2.

During his whole life, he knew there was something different about him. He always struggled with depression and anxiety, and what eventually turned out to be hypomania. When he was 22, he had his first big episode of depression and began taking antidepressants. However, it took six more years before he was officially diagnosed with Bipolar Disorder Type 2.

He says that one of the trickiest things about having this diagnosis is that he does not experience the typical manic episode where a person feels over-energetic and nearly psychotic. Instead, he feels hypomanic, which means that he is socially well functioning. He is not psychotic. He just feels really well; the problem with this, was that he didn’t feel the need to inform his psychiatrist the fact that he was feeling too well. 

His psychiatrist found out that he had Bipolar Disorder was because he couldn’t come out of his depression. At first, he was diagnosed with depression and ADD. But these diagnoses didn’t seem to fit because he still had strong mood swings and a lot of anxiety. When he was diagnosed with Bipolar Disorder Type 2, it actually made sense to him. Suddenly, he could see why he had felt the way he had most of his life.

“I really believe that the Monsenso smartphone app could have helped my psychiatrist give me the right diagnosis at an earlier stage because the app helps me to keep track of my mood and to become more aware of how I feel. With the app, I have to pause and take a moment to think about how I’ve actually been doing before entering my answers. Keeping track of all this information has helped my treatment. My psychiatrist and I can plan better on how to avoid my future depressive or hypomanic episodes because we can clearly identify when I am having mood swings”. says Peter Hagelund.  

In August 2018, his documentary about living with Bipolar Disorder aired on national Danish television and the response was overwhelming. Many people contacted him, to thank him for talking about his illness. He made the documentary so other people who have this illness, do not feel ashamed of it.

“My hope is that in the future people are diagnosed at an earlier stage than I was and I truly believe the Monsenso app is one of the things that can help. I really hope that other psychiatrists and their patients will start using the app,” he added.

Click here to read this story in Danish.

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The top cause of insurance claims is mental illness

The top cause of insurance claims is mental illness

by | May 16, 2017

The top cause of insurance claims is mental illness. According to a new study conducted in the UK, two-thirds of British adults said they have experienced mental ill-health at some point in their lives. The survey revealed that on average 70% of people between the ages of 18 and 54 have experienced a mental health problem. In all, 65% of all the people surveyed, said they had experienced some form of mental health problem. [1]

Britain’s high stress, long-hours work culture has led to a higher level of people out of work with mental health problems than any other country in the developed world. [2]

Furthermore, a different study has shown that approximately 53% of NHS patients displayed clinical symptoms of depression and anxiety within a year after completing psychological treatments. Over half of these were found to have suffered a relapse event, with up to 79% of events occurring within the first six months after treatment.[3]


The economic cost

According to an OECD report, people unable to work because of mental health issues cost the UK economy £70 billion each year with 40% of all people claiming disability benefits is due to psychological issues.[2]

Top cause of insurance claims

The top cause of insurance claims are mental health issues, which have remained at the top of the list since 1999, far above other claims such as back injury or stroke.[4]

According to an analysis by the Institute for Fiscal Studies, nearly half of all people claiming disability benefit are doing so because they have a mental illness rather than a physical condition. [5]

The analysis reveals that the proportion of disability claims which are related to mental illness has risen from 27 per cent to 41 per cent since 1999. [5]

In fact, six in ten claims by those aged between 25 and 34 are now related to mental illness, up from half in 1999. [5]

In a recent interview, Vanessa Sallows, Benefits and Governance Director at Legal & General’s Group Protection, said: “Mental health continues to be the main reason for absences on our group income protection. [4]

mHealth technology is here to help

Smartphones and wearables
In the UK alone, there are over 40 million smartphone users over 3 million people utilise some type of wearable device.

Mobile health technology
mHealth technology uses connected devices to help prevent illness, improve compliance and get people back to health.

Customer centricity
mHealth technology puts customers at the centre, where they want to be, and helps them to live the lives they want.

The Monsenso mHealth solution for mental health can be used by insurance companies to offer a preventive, mental wellness programme.

Policyholders can use the Monsenso smartphone app to enter their daily levels of stress, anxiety, irritability, physical activity and number of hours they slept. This information is gathered and stored electronically so it can be accessed by a coach or telehealth consultant, anytime, anywhere.

In this way, the coach or telehealth consultant can remotely monitor policyholders and follow up with those users who present any triggers or warning signs. For example, the the coach or telehealth consultant will be notified when a policyholder indicates a high level of stress, anxiety and irritability for more than five consecutive days or when someone sleeps less than six hours for more than three consecutive days. These two actions would be considered indicators that the individual needs to be contacted for a “wellness check” and implement the necessary measures to prevent the person from going on long-term leave, or become affected by other physical conditions such as heart disease.

References:

[1] Two-thirds of Britons have had mental health problems. The Guardian. Haroon Siddiqi. (2017, May 8)
https://www.theguardian.com/society/2017/may/08/two-thirds-of-britons-have-had-mental-health-problems-survey?CMP=share_btn_tw

[2] British workers among the most stressed in the world. The Telegraph. Georgia Graham. (2014, Feb 14)
http://www.telegraph.co.uk/news/health/10629374/Over-a-million-people-with-mental-health-issues-are-out-of-work-and-claiming-benefits.html

[3] More than half of NHS patients display symptoms of relapse after depression treatments, study finds. News Medical Life Science. (2017 May 3)
http://www.news-medical.net/news/20170503/More-than-half-of-NHS-patients-display-symptoms-of-relapse-after-depression-treatments-study-finds.aspx?showform=printpdf

[4] Legal & General group protection payouts rise. FT Adviser. Simoney Kyriakou. (2017, May 2).
https://www.ftadviser.com/protection/2017/05/02/legal-general-group-claim-payouts-rise/

[5] Nearly half disability benefit claimants have a mental illness. The Telegraph. (2015, May 21)
http://www.telegraph.co.uk/news/health/11622166/Nearly-half-disability-benefit-claimants-have-a-mental-illness.html

Clinicians to monitor cardiovascular disease markers for teens suffering from mental illness

Clinicians to monitor cardiovascular disease markers for teens suffering from mental illness

by | Jun 21, 2016

According to a recent statement by the new American Heart Association (AHA),  major depressive disorder and bipolar disorder should be recognized as moderate risk factors for atherosclerosis and early cardiovascular disease.  [1]

In 2011, the National Heart, Lung and Blood Institute identified four conditions (chronic inflammatory disease, human immunodeficiency virus, Kawasaki disease, and nephritic syndrome) that lead youths to a mild risk of developing cardiovascular disease before they reach 30. [2]

The statement released a few days ago, reveals that depression and bipolar disorder meet the same criteria as these conditions. Moreover, these two behavioural disorders are more widespread than the previous mentioned conditions combined.

These studies showed evidence of a link between paediatric depression and bipolar disorder with premature cardiovascular mortality. Cardiovascular risk factors for these teens include obesity, insulin resistance and diabetes, dyslipidemia, and hypertension.[1]   According to the statement, depression and bipolar disorder are the first- and fourth-most disabling conditions, among adolescents worldwide.

After the report had been unveiled, researchers from schools around the U.S. and Canada looked at existing studies on mood disorders in people under the age of 30. Researchers looked specifically into youths suffering from depression or bipolar disorder with cardiovascular markers such as high pressure and cholesterol. They found a significant connection between having depression or bipolar disorder and increased odds of high blood pressure, high cholesterol, obesity (especially belly fat), type 2 diabetes, and hardening of the arteries. [3]

This discovery denotes that healthcare providers should track physical activity levels and food intake as well as metabolic monitoring is crucial for these young patients as a preventive measure.

However, to monitor cardiovascular markers, physical activity and food intake, of thousands of young patients who also suffer from mental illness is not an easy task. Although, there are hundreds of smartphone applications tracking physical activity and counting calories, these apps are personal, and clinicians do not have access to an individual’s data. Nevertheless, with the Monsenso mobile health (mHealth) solution, this cumbersome task becomes easy and achievable.

The Monsenso mHealth solution enables clinicians to access a patient’s data on a daily basis. Every day, youths would be reminded to fill in a self-assessment with important information that could include the number of hours they slept, the amount of unhealthy food they have eaten, and if they realized any physical activity throughout their day. Additionally, the smartphone can also collect physical activity and mobility data, based on the smartphone’s inbuilt accelerometer and GPS locator.

The Monsenso mHealth solution, especially designed to monitor behavioural data of patients suffering from mental illness, can in this way help clinicians monitor any unhealthy habits of patients with risk of developing cardiovascular disease.

Further, with the customisable action plans, each youth could follow “contingency plans” if they experience some symptoms related to their mental illness or if they have engaged in unhealthy activities. For example, a special trigger could set up if a youth has indulged in unhealthy food for several days in a row, or has had a low level of physical activity. The action plan listed for this trigger could then encourage individuals to engage in physical activities and and to try to avoid sugar and fat during the upcoming week.

References:

[1] Browser,D Medscape. Depression, Bipolar Disorder in Teens are CVD Risk Factors: AHA (2015, August 10)  http://www.medscape.com/viewarticle/849312

[2] American Heart Association. Young people with mood disorders have increased risk of developing early cardiovascular disease (2015, August 11)

http://blog.heart.org/young-people-with-mood-disorders-have-increased-risk-of-developing-early-cardiovascular-disease/

[3] Walton, A Forbes. Teens with depression, bipolar disorder, should be screened for heart disease, experts say. (2015, August 11) http://www.forbes.com/sites/alicegwalton/2015/08/11/depressed-teens-may-be-at-higher-risk-for-heart-disease/

Goldstein BI, Carnethon MR, Matthews KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation 2015.

Mental health a global priority- The WHO action plan

Mental health a global priority- The WHO action plan

by | Apr 26, 2016

“Making Mental Health a Global Priority”  is a two-day high-level meeting hosted  by the World Bank Group and World Health Organization (WHO) with the objective to include mental health as a global priority. This blog post is based on the report published after the meeting.

Mental health a global priority

  • Studies estimate that at least 10% of the world’s population is affected by mental illness
  • 20% of children and adolescents suffer from some type of mental disorder
  • Mental disorders account for 30% of the non-fatal disease burden worldwide and 10% of the overall burden of disease, including death and disability

It is a known fact that two of the most common mental disorders, anxiety and depression, respond well to treatment. However, due to a lack of funding, these disorders are not treated in most cases. For governments and healthcare authorities, investing in the treatment of mental illness may seem questionable; nevertheless, mental disorders have many ripple effects, including a strong economic impact on society.  In fact, mental disorders account for almost one in three years lived with disability globally. Additionally, there is a strong link between mental disorders and potentially fatal conditions including cancer, cardiovascular disease, diabetes, HIV and obesity.

A recent analysis shows that treating anxiety and depression is a cost-effective way to promote well-being and prosperity in a community – and that failure to be treated can contribute to impoverishment at a household level and to reduced economic growth and social well-being at a national level.

To tackle today’s mental health challenges, governments and international development partners should work together to fund cost-effective alternatives to treat mental health. This funding will provide a strong return on investment, with scale-up leading to good returns in restored productivity as well as improved health.

Action plans proposed by the World Bank and WHO

1. A new mental health system

The effective care of depression and anxiety requires a comprehensive mental health system including governance, healthcare institutions and community settings to endorse holistic mental health plans. Mental health planners and policy makers need to develop, through public awareness and community engagement, care delivery systems that are sensitive to local social, economic, and cultural contexts; this will ensure that services are appropriately sought out and utilized.

2. Integrated care for depression in primary, maternal, and paediatric care

In addition to its impact on physical health, depression can affect the management of chronic co-occurring diseases, such as diabetes, hypertension, cardiovascular disease and cancer.

Collaborative care—an evidence-based approach to care for chronic illness applied in primary care settings—guides the effective use of resources for delivery of quality mental health care. It emerges as an effective way to address co-morbid conditions and commonly co-occurring risk factors while improving overall health outcomes. Collaborative care emphasizes systematic identification of patients, self-care, and active care management by clinical providers, blended with other medical, mental health, and community supports.

Anxiety and depression also play large roles in the health of expectant and new mothers and their children. A study conducted in 2007 revealed that more than 50% of pregnant women suffer from anxiety and more than 37% suffer from depression. Antenatal depression can increase the likelihood of preterm birth, low birth weight, and cognitive disturbances. In addition, 10-15% of new mothers suffer from post-partum depression. Studies have shown that antenatal and postnatal interventions are effective in reducing depression and anxiety, which improves infant outcomes.

Children and young adults are also affected by depression and anxiety, which causes a negative effect on their ability to learn and study. Besides, since 75% of all mental disorders have a first onset by the age of 18-24, integrating mental health treatment into standard paediatric health care would not only improve students’ learning outcomes, it would also allow children and young adults to obtain treatment at an early stage.

3. Information and communications technology (ICT)-based platforms

ICT-based platforms, such as the one offered by Monsenso, provide an alternative method of mental health care delivery when resources are scarce, while also addressing long-standing obstacles in mental health delivery, such as transportation barriers, stigma associated with visiting mental health clinics, clinician shortages and high costs.

These platforms, especially mobile mental health interventions, can offer remote screening, diagnosis, monitoring and treatment; remote training for non-specialist healthcare workers; and can be used to develop and deliver highly specific, contextualized interventions.

Cognitive Behavioural Therapy (CBT) has been successfully implemented through information technology platforms, demonstrating improvement in depressive symptoms, reduced costs, patient acceptance and enhanced primary care workflow. In addition, patient participation is rapidly expanding in peer-to-peer social networks where patients can access around the clock support with demonstrable improvements in depression symptoms.

4. Platforms outside the health sector

Anti-stigma campaigns

Stigma associated with mental disorders can result in social isolation, low self-esteem, and limited chances in education, employment, and housing. Therefore, anti-stigma campaigns are powerful tools to confront mental disorders.

School-based interventions

The key strength of school-based health screening and care is that it maximises outreach in school age children and adolescents. The potential benefits include the healthy development of students, improved academic performance, and opportunities to integrate school and clinic-based services.

Workplace interventions

There is a huge amount of evidence that investing in workplace wellness programs is good for employees and companies.

Workplace mental health interventions can be centred on treatment or mental health promotion such as cognitive-behavioural approaches targeting stress reduction. Organizational-level workplace interventions can include policies that address prevention and early intervention.

Interventions related to conflicts and natural disasters

Conflict exposes civilian populations and refugees to violence and high levels of stress, resulting in dramatic rises in mental illness that can continue for decades after armed conflict has ceased. Therefore, part of the rebuilding efforts in post-conflict and post-disaster societies should include building mental health services that are well integrated into primary care and public health efforts.

Reference:

Out of the Shadows: Making Mental Health a Global Development Priority. World Bank and World Health Organization. 2016