Elsevier

The Lancet Psychiatry

Volume 2, Issue 11, November 2015, Pages 1036-1042
The Lancet Psychiatry

Personal View
Mental health research priorities for Europe

https://doi.org/10.1016/S2215-0366(15)00332-6Get rights and content

Summary

Mental and brain disorders represent the greatest health burden to Europe—not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5–10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.

Introduction

A strong need exists for parity in service provision and research between mental and physical disorders. Mental and brain disorders represent the single largest contributor to disease burden in Europe.1 More than one in three Europeans experience mental health problems each year,1 and even more will be affected indirectly, including family members, health systems, and the wider society. The increasing age of the European population means that the long-term mental health burden is greater now than it has ever been.2 As of 2010, the estimated yearly cost of mental disorders in Europe is €461 billion,3 excluding any costs of dementia and other neurological disorders. Beyond direct costs to health services, this figure is mainly due to indirect costs to social welfare, employment, wellbeing, and economic output. These costs are not decreasing. For example, disability benefits in the UK and Germany have been fairly stable, but the proportion accounted for by mental health disorders continues to rise.4, 5

People with mental health problems experience earlier death6 by as much as 20 years.7 Such a reduction in lifespan might be due to an increased risk for physical health problems such as cardiovascular disease,8 or because individuals with mental health problems do not seek early treatment for their mental or physical health.9 Alongside evidence of early mortality is the shocking statistic that, in Europe, an estimated 1·5 million people attempt suicide each year, and 100 000 complete it.10 In England and Wales, suicide is the top cause of death for women and men aged 20–34 years and for men aged 35–49 years,11 and it is a leading cause of death in men aged 19–30 years in Europe and worldwide.12

Most mental health problems are chronic and begin early in life (50% before the age of 15 years and 75% before the age of 18 years),13 and this realisation is fuelling calls for interventions in childhood to avert the development of long-term problems. However, the best possible interventions or which groups of children are most at risk of developing long-term problems are unknown.

The costs of care increase strikingly if individuals with physical disorders have a comorbid mental health problem, so cost estimates are conservative because they do not take this comorbidity into account. For people with rheumatoid arthritis, the costs of care nearly double if they have depression,14 and for asthma the increase is 140%.12 People with depression also face a higher risk of developing heart disease than individuals without depression; following a heart attack, each additional depressive symptom that develops increases the risk of another heart attack by 15%.15 Individuals with diabetes who develop a foot ulcer and also have depression have a high early-mortality rate (30% within 18 months of developing foot ulcer, three times higher than in those without depression).16 Therefore, successful treatment of mental health problems has potential advantages to individuals and to health services by reducing costs, morbidity, and mortality associated with a wide range of physical disorders, in addition to reducing the direct costs of mental disorders.

As well as mental disorder being increasingly associated with high costs, evidence also exists that research into mental health has demonstrable positive effects. For example, the RAND Mental Health Retrosight project shows that, over 20 years, developments in basic and clinical research in schizophrenia (eg, locating γ-aminobutyric-acid-A receptors in the brain, early-intervention research, and trials of supported employment) have a beneficial effect on patient care and positive wider social and economic effects.17

Section snippets

A good return on investment

Funding mental health research generates a good return on investment. For every pound sterling spent on mental health research in the UK, the yearly recurring return is estimated to be £0·37, which is similar to the return for research on cardiovascular disorders18 and cancer.19 Giant steps have been made in research into the mechanisms of and treatments for cardiovascular disease and cancer, and marked improvements have been reported subsequently to health services and lifestyle advice offered

Poised for action

Europe is now well placed to respond to the challenges resulting from mental health problems.

A comprehensive and inclusive priority development method

ROAMER (Roadmap for Mental Health Research in Europe)42, 43 was set up to develop the agenda for mental health research with immediate and long-term priorities (panel 1). It covers the mental disorders named in the 2010 Global Burden of Disease study21 but not neurodegenerative disorders (eg, Alzheimer's disease and other types of dementia).21 ROAMER was given ethical approval by the European Commission's FP7 ethics review process.

The ROAMER programme consisted of multidisciplinary work

Where next?

Many issues highlighted by the ROAMER project will be familiar to individuals who are concerned with mental health for either personal or professional reasons. Other governments and scientific communities—including WHO53 and the US National Institute for Mental Health54—have developed priorities for mental health, some of which overlap with the ROAMER priorities—eg, the development of new interventions, and lifespan and aetiological research. However, the content of the ROAMER priorities

References (54)

  • Analysis of new claims for Disability Living Allowance and Attendance Allowance by main disabling condition: 2011/2012

    (2012)
  • DAK-Gesundheitsreport 2013

    (2013)
  • M De Hert et al.

    Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

    World Psychiatry

    (2011)
  • M Nordentoft et al.

    Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden

    PLoS One

    (2013)
  • PS Wang et al.

    Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication

    Arch Gen Psychiatry

    (2005)
  • Mortality statistics: deaths registered in England and Wales (series DR), 2013

  • Chief Medical Officer's annual report 2012: our children deserve better: prevention pays

    (2013)
  • C Naylor et al.

    Long-term conditions and mental health. The cost of co-morbidities

    (2012)
  • M Zuidersma et al.

    An increase in depressive symptoms after myocardial infarction predicts new cardiac events irrespective of depressive symptoms before myocardial infarction

    Psychol Med

    (2012)
  • K Ismail et al.

    A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality

    Diabetes Care

    (2007)
  • S Wooding et al.

    Mental Health Retrosight: understanding the returns from research (lessons from schizophrenia)

    (2013)
  • Medical research: what's it worth? Estimating the economic benefits from medical research in the UK

    (2008)
  • M Glover et al.

    Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes

    BMC Med

    (2014)
  • R Siegel et al.

    Cancer statistics, 2013

    CA Cancer J Clin

    (2013)
  • The global burden of disease: generating evidence, guiding policy—Europe and Central Asia regional edition

    (2013)
  • Global health estimates 2014 summary tables: DALY by cause, age and sex, by WHO region, 2000–2012

    (2014)
  • Sixth FP7 monitoring report (monitoring report 2012)

    (2013)
  • Cited by (155)

    View all citing articles on Scopus

    These authors contributed equally

    View full text