Mental health vital in all health

MENTAL health researchers have a clear message for the federal Minister of Health, Peter Dutton — treat mental health as central to all health, and outcomes will improve and money will be saved.

Associate Professor Felice Jacka, president of the Alliance for the Prevention of Mental Disorders, told MJA InSight that “there is no health without mental health”.

She was responding to an MJA article calling for greater national action on the prevention of mental disorders. (1)

The authors of the article referred to a recent survey that “highlighted the gap between mental health-related research funding and the priorities of stakeholders such as researchers, policymakers, health care consumers and carers”. (2)

“The divergence was most pronounced in the area of prevention and promotion, which, despite being the top-ranked priority for stakeholders, received low and diminishing amounts of funding over the past 10 years.”

Professor Jacka agreed, saying: “Promotion and prevention are critical in addressing the burden of disease attributable to mental disorders, but health service funding is almost completely focused on treatment.

“Many prevention interventions are both effective and cost-effective. It is much less expensive to avert mental disorders than to treat them.”

Professor Helen Christensen, executive director of the Black Dog Institute, told MJA InSight that there was a misunderstanding about the difference between the prevention of mental health disorders and early intervention approaches.

“I think people don’t understand what prevention is”, she said. “It’s not early intervention. Prevention is intervening before anyone develops any symptoms.

“It’s about mental health awareness, including literacy of the population — targeted interventions and specific programs for specific diagnoses at a particular time in the life cycle.”

Dr Lesley Russell, from the Australian Primary Health Care Research Institute at Australian National University, said mental health should be viewed as a public health issue. “It’s difficult because it is really hard to measure the effectiveness of preventive interventions and it takes a long time to measure them, but it’s important that we do so.”

Professor Jacka said when a person developed mental health disorders at an early age it had a significant impact on their participation in society.

“If Peter Dutton were sitting in front of me I would tell him the prevention of mental disorders needs a comprehensive, cross-sectoral approach because there are so many varied risk factors, for example, childhood abuse, poverty, violence, illness and disability.

“A large body of research now strongly suggests that lifestyle behaviours that are risk factors for non-communicable diseases — poor diet, physical inactivity, smoking — are also risk factors for mental health problems, including dementia.

“Mental health and general health have been artificially separated in approaches to public health, but there is no health without mental health”, Professor Jacka said.

Professor Christensen said her message for Peter Dutton was a simple one.

“Prevention works but people don’t believe it. There is plenty of evidence that prevention is cheap, better than cure, and it’s a no-brainer that it should start in school”, she said.

“Mental health is core to good health. The problem is we know a lot but we’re not implementing what we know.

“[It’s time] we [refocused our attention] from the pointy end of hospital beds and into prevention.”

1. MJA 2013; 199: 527
2. Aust NZ J Psychiatry 2013; 47: 355-362