imagine you had a really bad headache
and a cold and you decided you had to go
and see a few doctors about this after
visiting three different doctors they
asked you the right questions they did
the tests they wanted to do and then one
of them told you it was just a flu the
second one said you had malaria and the
last one said you had a brain tumor
sounds a bit far-fetched doesn’t it you
might be thinking this could never
happen probably should never happen
however this is analogous to what might
happen if instead of a fever and a cold
you had you’re suffering from symptoms
of low mood anxiety of feeling suicidal
in other words if you are suffering from
mental health difficulties rather than
physical health difficulties and to try
and understand why this is let’s look at
what a mental health diagnosis
represents so imagine you had your fever
headache and vomiting you went to a
doctor they did a blood test they said
you had malaria and this diagnosis or
label of malaria gives you information
about the cause in this case a
Plasmodium virus which you probably
caught from a mosquito bite so we have
symptoms you get a diagnosis and the
diagnosis gives you information about
the cause which is then what is treated
or the why it gives you information
about why you’re suffering from these
symptoms diagnosis in mental ill-health
don’t give you any information about the
cause the very circular why are you
suffering from low mood hopeless and
tired because I’m depressed why are you
depressed because I’m feeling low mood
hopeless and tired so we have all these
different diagnoses and mental
ill-health and they don’t give us any
information about cause what they do do
is they give a description for a set of
symptoms you might be struggling with to
see where these sets of or where these
sets of symptoms are described and
assigned to these different diagnoses
let’s take a look at the classification
systems so here are examples of various
and mental health disorders some more
common than others and the most common
are widely used classification systems
where sets of symptoms are assigned to
these specific diagnoses the Diagnostic
and Statistical Manual of the American
Psychiatric Association and the ICD that
is developed by the World Health
Organization and essentially what these
enormous books give us infamy
now websites give us information on is
they give a detailed profile of the
sorts of symptoms and the severity of
symptoms which you should be suffering
from to be given a certain diagnosis now
you might be wondering why do these
diagnoses not give us any information
about the why and this is where my
research says so I am interested in the
development of mental health problems
but also understanding the risk and
protective factors and the causes of
mental health problems and for the most
part scientists or as researchers study
mental health problems in the silos that
correspond to these different diagnoses
so some people study depression other
studies schizophrenia and so on but when
we take a step back and we try to look
at what we’ve discovered about the
possibly unique risk factors biomarkers
and causes of these different disorders
what we find is they aren’t any so for
the most part the risk factors that
we’ve identified so for example let’s
take suffering from abuse this could be
the form of either child maltreatment
sexual abuse or being bullied these are
all risk factors for most mental health
problems
similarly stress whether in the form of
poverty or work stress or you know
experiencing war or violence are again
all risk factors for several mental
health problems similarly with
biomarkers we have nothing in the blood
or the brain like we can’t do a blood
test to tell you you have depression at
least not yet so if we know nothing or
we don’t have specific causes or risk
factors that tell us about these
disorders and they’re just descriptions
of symptoms then surely shouldn’t we be
understanding or looking at how these
symptoms relate to each other more
closely so in the last couple of
yes this is where my research has taken
me from trying to understand risk
factors and causes to looking at the
symptoms more closely let’s take an
example here we have some symptoms of
depression with the DS next to them and
some symptoms of anxiety with the AIDS
next to them these are common symptoms
of depression and anxiety and let’s try
and imagine what these symptoms would
look like in their relationship to each
other in space so if you could imagine
these symptoms as a nodes in a network
you have you’d expect them as distinct
depth separate disorders to form two
different clusters in space you would
expect some symptoms to be related more
strongly to each other than others so
the thickness of the lines here is
giving an indication of the strength of
the symptoms so for example feeling very
tired and not sleeping well you could
imagine as more closely related than
loss of pleasure and you could argue
that like in physical health how for
example hypertension diabetes and
obesity are still related although
they’re different things there are some
symptoms of depression anxiety are
probably related logically this probably
makes sense however when we look at
actual data this is what we find first
of all there’s no clustering in space so
there’s no two separate clusters and
even if you look closely at this one
single cluster and you try to say are
all the depression symptoms on one side
and all the anxiety on the other they’re
not it’s just a jumble of symptoms and
obviously in science we try to replicate
our findings we try to study this in
various ways so in my particular
research group we looked at looked at
this at various different ages so the
rationale was maybe this changes as
children develop into adults other
people have looked at them in adults and
we find the same thing depression and
anxiety do not cluster separately in
space then you might argue these are
mainly general population samples by
this I mean it’s a group of the
population across the board so most
people will have low to moderate
symptoms and there’ll be a small
proportion that has severe symptoms and
that maybe if we actually
looked at this in a clinical sample that
is individuals actually receiving mental
health support for this these problems
we wouldn’t see this picture so we went
and looked at around 38,000 individuals
who had these symptom data for mental
health services and still it’s one
cluster so this is important because
when we diagnose somebody with a
particular disorder that gives
information to whoever decides to treat
them about how best to treat them so if
you had a diagnosis of depression the
guidelines or the sort of recommended
treatments are different than if you had
anxiety or if you had psychosis and so
on this is also a problem because
depression and anxiety are two of the
most common mental health disorders at
the moment depression alone is one of
the leading causes of disease burden
worldwide and depression and anxiety
together are already the leading cause
of disease burden in countries like the
UK so to understand the scale of the
mental health problems in the world and
why better classifying them is important
let’s look at the global disease burden
so this is the disease burden this is a
big black box of all the disease burden
in our lives across the bottom we have
AIDS across our lives there’s different
problems that cause the most disease
burden and in this big black box we have
everything infectious diseases like
malaria and HIV non-infectious diseases
like fit and physical health problems
like diabetes and cancer and mental
health problems as well and this is the
disease burden across our lives that
mental health account or mental
ill-health accounts for so it is a
substantial proportion and if you think
about people in this room most of us on
our 20s and 30s in our 20s and 30s about
a third of the disease burden is because
of mental illness in the UK one in six
of us at any time are expected to be
suffering from a mental health problem
and through our lives or the lifetime
expectancy approach of prevalence is
almost half so almost one in two of us
will suffer from a mental
at some point in our lives so all of us
here will feel the impact of mental
health problems either because we will
face them ourselves or because they will
somebody we love will suffer from mental
health problems so mental health
problems have not only an enormous
impact on the individuals who suffer
from them their family’s wider society
they also have a much larger cost so
just to give you the estimate of the
cost to the economy just in the lot
so the most recent assessment is that in
one year the UK economy suffers up to 99
billion pounds cost to the economy due
to mental illness so just to reiterate
that in just one year the cost to the UK
economy of mental illness is 99 billion
pounds and this problem it’s not going
away so this is comparisons with so
we’ve just finished analysis and
fourteen-year-olds just a few years ago
the 2014-15 compared to 14 year olds
just 10 years previously and similarly
on the mother’s side you have 42 year
olds around 12 years apart and in both
cases you can see the prevalence has
increased substantially in just this
fairly short period of time it’s about 6
percent in the 14 year old so it goes
from around the prevalence of 9% to 15%
and just to reiterate how big how much
of a change this is this in just 10
years is the equivalent of almost 2 more
teenagers in every secondary school
classroom suffering from more mental
health problems than just 10 years
before that so the problem is not going
away what are we doing about it so as
researchers were making progress all the
time so going back to the classification
systems the classification system that
we currently use are not even a century
old and they tweaked all the time so you
can see that we’re on a few versions on
for both these classification systems
but so far the tweaks that all the
changes to the system tend to be in the
form of tweaks so we adjust the system
which
we create a few new diagnoses a few
diagnoses get taken away but there’s
growing consensus based on the sorts of
information I gave you earlier that
maybe we need a system overhaul instead
of trying to tweak a system that’s not
really working optimally and this has
consequences for how we study both
causes of mental illness but also how we
try and understand treatments because
for the most part we try and understand
the causes and treatment based on these
diagnostic classification systems that
doesn’t have to be the case but that’s
how it’s currently done so we try to
understand the causes for depression we
try to understand the best treatment for
depression and the other issue here is
also about prevention so when we try to
focus on causes of treatment of specific
disorders however the risk factors and
causes are common across most disorders
in terms of focusing on prevention
actually it makes sense to focus on
prevention for mental illness more
broadly speaking than specific mental
health problems so in I’m just going to
talk about two problems or things that
are preventing us I think from making
the progress we need to make with this
sort of huge public health issue
the first one is stigma mental
ill-health still has a large stigma
associated with it this ranges from
people not believing it’s real illness
to just the sort of social stigma that
people face when they sort of experience
mental health problems or talk about it
and sigma has been improving so the
attitudes towards mental illness in the
last few decades have phenomenally
improved however it’s still a problem
and if you don’t believe it’s still a
problem let’s just think about an
example you’re feeling really bad and
you don’t want to get out of bed one day
and that’s because you have the flu
you’re quite happy to bring your
colleagues and say I have the flu don’t
want to come into work today but imagine
you were feeling really bad and didn’t
want to get out of bed because you just
didn’t you’re feeling really anxious I
didn’t want to see anybody that day
people would probably have more qualms
about bringing their colleagues or think
twice before in their colleagues and
saying actually can I have a feeling can
I have a mental health day please but
the other big problem is investment so
this is how
immersed in mental illness combines all
mental illnesses combined compared to in
this case just a comparison as cancer
and dementia
to take the bigger picture of all health
research funding in the UK if this is
all the health research funding in the
UK the tiny red sliver you see there is
how much we spend on all mental health
research so contrast this with what we
saw earlier this is a substantial cause
of disease burden it has enormous cost
to the economy it affects most of us at
some point in our lives but we do very
little about it and herein lies the real
paradox mental health is a staggering
public health problem and is only
increasing and as a society we’re doing
staggeringly little to improve our
understanding the prevention and
treatment of this big public health
problem so I’d like to leave you on the
question what are we going to do about
it [Applause]
and a cold and you decided you had to go
and see a few doctors about this after
visiting three different doctors they
asked you the right questions they did
the tests they wanted to do and then one
of them told you it was just a flu the
second one said you had malaria and the
last one said you had a brain tumor
sounds a bit far-fetched doesn’t it you
might be thinking this could never
happen probably should never happen
however this is analogous to what might
happen if instead of a fever and a cold
you had you’re suffering from symptoms
of low mood anxiety of feeling suicidal
in other words if you are suffering from
mental health difficulties rather than
physical health difficulties and to try
and understand why this is let’s look at
what a mental health diagnosis
represents so imagine you had your fever
headache and vomiting you went to a
doctor they did a blood test they said
you had malaria and this diagnosis or
label of malaria gives you information
about the cause in this case a
Plasmodium virus which you probably
caught from a mosquito bite so we have
symptoms you get a diagnosis and the
diagnosis gives you information about
the cause which is then what is treated
or the why it gives you information
about why you’re suffering from these
symptoms diagnosis in mental ill-health
don’t give you any information about the
cause the very circular why are you
suffering from low mood hopeless and
tired because I’m depressed why are you
depressed because I’m feeling low mood
hopeless and tired so we have all these
different diagnoses and mental
ill-health and they don’t give us any
information about cause what they do do
is they give a description for a set of
symptoms you might be struggling with to
see where these sets of or where these
sets of symptoms are described and
assigned to these different diagnoses
let’s take a look at the classification
systems so here are examples of various
and mental health disorders some more
common than others and the most common
are widely used classification systems
where sets of symptoms are assigned to
these specific diagnoses the Diagnostic
and Statistical Manual of the American
Psychiatric Association and the ICD that
is developed by the World Health
Organization and essentially what these
enormous books give us infamy
now websites give us information on is
they give a detailed profile of the
sorts of symptoms and the severity of
symptoms which you should be suffering
from to be given a certain diagnosis now
you might be wondering why do these
diagnoses not give us any information
about the why and this is where my
research says so I am interested in the
development of mental health problems
but also understanding the risk and
protective factors and the causes of
mental health problems and for the most
part scientists or as researchers study
mental health problems in the silos that
correspond to these different diagnoses
so some people study depression other
studies schizophrenia and so on but when
we take a step back and we try to look
at what we’ve discovered about the
possibly unique risk factors biomarkers
and causes of these different disorders
what we find is they aren’t any so for
the most part the risk factors that
we’ve identified so for example let’s
take suffering from abuse this could be
the form of either child maltreatment
sexual abuse or being bullied these are
all risk factors for most mental health
problems
similarly stress whether in the form of
poverty or work stress or you know
experiencing war or violence are again
all risk factors for several mental
health problems similarly with
biomarkers we have nothing in the blood
or the brain like we can’t do a blood
test to tell you you have depression at
least not yet so if we know nothing or
we don’t have specific causes or risk
factors that tell us about these
disorders and they’re just descriptions
of symptoms then surely shouldn’t we be
understanding or looking at how these
symptoms relate to each other more
closely so in the last couple of
yes this is where my research has taken
me from trying to understand risk
factors and causes to looking at the
symptoms more closely let’s take an
example here we have some symptoms of
depression with the DS next to them and
some symptoms of anxiety with the AIDS
next to them these are common symptoms
of depression and anxiety and let’s try
and imagine what these symptoms would
look like in their relationship to each
other in space so if you could imagine
these symptoms as a nodes in a network
you have you’d expect them as distinct
depth separate disorders to form two
different clusters in space you would
expect some symptoms to be related more
strongly to each other than others so
the thickness of the lines here is
giving an indication of the strength of
the symptoms so for example feeling very
tired and not sleeping well you could
imagine as more closely related than
loss of pleasure and you could argue
that like in physical health how for
example hypertension diabetes and
obesity are still related although
they’re different things there are some
symptoms of depression anxiety are
probably related logically this probably
makes sense however when we look at
actual data this is what we find first
of all there’s no clustering in space so
there’s no two separate clusters and
even if you look closely at this one
single cluster and you try to say are
all the depression symptoms on one side
and all the anxiety on the other they’re
not it’s just a jumble of symptoms and
obviously in science we try to replicate
our findings we try to study this in
various ways so in my particular
research group we looked at looked at
this at various different ages so the
rationale was maybe this changes as
children develop into adults other
people have looked at them in adults and
we find the same thing depression and
anxiety do not cluster separately in
space then you might argue these are
mainly general population samples by
this I mean it’s a group of the
population across the board so most
people will have low to moderate
symptoms and there’ll be a small
proportion that has severe symptoms and
that maybe if we actually
looked at this in a clinical sample that
is individuals actually receiving mental
health support for this these problems
we wouldn’t see this picture so we went
and looked at around 38,000 individuals
who had these symptom data for mental
health services and still it’s one
cluster so this is important because
when we diagnose somebody with a
particular disorder that gives
information to whoever decides to treat
them about how best to treat them so if
you had a diagnosis of depression the
guidelines or the sort of recommended
treatments are different than if you had
anxiety or if you had psychosis and so
on this is also a problem because
depression and anxiety are two of the
most common mental health disorders at
the moment depression alone is one of
the leading causes of disease burden
worldwide and depression and anxiety
together are already the leading cause
of disease burden in countries like the
UK so to understand the scale of the
mental health problems in the world and
why better classifying them is important
let’s look at the global disease burden
so this is the disease burden this is a
big black box of all the disease burden
in our lives across the bottom we have
AIDS across our lives there’s different
problems that cause the most disease
burden and in this big black box we have
everything infectious diseases like
malaria and HIV non-infectious diseases
like fit and physical health problems
like diabetes and cancer and mental
health problems as well and this is the
disease burden across our lives that
mental health account or mental
ill-health accounts for so it is a
substantial proportion and if you think
about people in this room most of us on
our 20s and 30s in our 20s and 30s about
a third of the disease burden is because
of mental illness in the UK one in six
of us at any time are expected to be
suffering from a mental health problem
and through our lives or the lifetime
expectancy approach of prevalence is
almost half so almost one in two of us
will suffer from a mental
at some point in our lives so all of us
here will feel the impact of mental
health problems either because we will
face them ourselves or because they will
somebody we love will suffer from mental
health problems so mental health
problems have not only an enormous
impact on the individuals who suffer
from them their family’s wider society
they also have a much larger cost so
just to give you the estimate of the
cost to the economy just in the lot
so the most recent assessment is that in
one year the UK economy suffers up to 99
billion pounds cost to the economy due
to mental illness so just to reiterate
that in just one year the cost to the UK
economy of mental illness is 99 billion
pounds and this problem it’s not going
away so this is comparisons with so
we’ve just finished analysis and
fourteen-year-olds just a few years ago
the 2014-15 compared to 14 year olds
just 10 years previously and similarly
on the mother’s side you have 42 year
olds around 12 years apart and in both
cases you can see the prevalence has
increased substantially in just this
fairly short period of time it’s about 6
percent in the 14 year old so it goes
from around the prevalence of 9% to 15%
and just to reiterate how big how much
of a change this is this in just 10
years is the equivalent of almost 2 more
teenagers in every secondary school
classroom suffering from more mental
health problems than just 10 years
before that so the problem is not going
away what are we doing about it so as
researchers were making progress all the
time so going back to the classification
systems the classification system that
we currently use are not even a century
old and they tweaked all the time so you
can see that we’re on a few versions on
for both these classification systems
but so far the tweaks that all the
changes to the system tend to be in the
form of tweaks so we adjust the system
which
we create a few new diagnoses a few
diagnoses get taken away but there’s
growing consensus based on the sorts of
information I gave you earlier that
maybe we need a system overhaul instead
of trying to tweak a system that’s not
really working optimally and this has
consequences for how we study both
causes of mental illness but also how we
try and understand treatments because
for the most part we try and understand
the causes and treatment based on these
diagnostic classification systems that
doesn’t have to be the case but that’s
how it’s currently done so we try to
understand the causes for depression we
try to understand the best treatment for
depression and the other issue here is
also about prevention so when we try to
focus on causes of treatment of specific
disorders however the risk factors and
causes are common across most disorders
in terms of focusing on prevention
actually it makes sense to focus on
prevention for mental illness more
broadly speaking than specific mental
health problems so in I’m just going to
talk about two problems or things that
are preventing us I think from making
the progress we need to make with this
sort of huge public health issue
the first one is stigma mental
ill-health still has a large stigma
associated with it this ranges from
people not believing it’s real illness
to just the sort of social stigma that
people face when they sort of experience
mental health problems or talk about it
and sigma has been improving so the
attitudes towards mental illness in the
last few decades have phenomenally
improved however it’s still a problem
and if you don’t believe it’s still a
problem let’s just think about an
example you’re feeling really bad and
you don’t want to get out of bed one day
and that’s because you have the flu
you’re quite happy to bring your
colleagues and say I have the flu don’t
want to come into work today but imagine
you were feeling really bad and didn’t
want to get out of bed because you just
didn’t you’re feeling really anxious I
didn’t want to see anybody that day
people would probably have more qualms
about bringing their colleagues or think
twice before in their colleagues and
saying actually can I have a feeling can
I have a mental health day please but
the other big problem is investment so
this is how
immersed in mental illness combines all
mental illnesses combined compared to in
this case just a comparison as cancer
and dementia
to take the bigger picture of all health
research funding in the UK if this is
all the health research funding in the
UK the tiny red sliver you see there is
how much we spend on all mental health
research so contrast this with what we
saw earlier this is a substantial cause
of disease burden it has enormous cost
to the economy it affects most of us at
some point in our lives but we do very
little about it and herein lies the real
paradox mental health is a staggering
public health problem and is only
increasing and as a society we’re doing
staggeringly little to improve our
understanding the prevention and
treatment of this big public health
problem so I’d like to leave you on the
question what are we going to do about
it [Applause]
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