Can  we reduce the risk of mental illness?

Each year 1 in 4 people in the UK experience a mental health problem. This can have big implications for themselves, their families, their employers, the NHS and society.   

Most people know what they can do to reduce the risk of physical illness (like not smoking, eating healthily and getting enough exercise) – even if they don’t always act on what they know. However, do they know what can be done to reduce the risk of mental illness? That’s a gap we’re hoping to help fill.

We’ve started by reviewing research findings into the causes of different types of mental illness and into initiatives to reduce mental illness. Here are some of our initial findings:

More research is needed

One of our first findings is that there seems to have been more research into treating mental illness than into reducing the risk. If we assume that prevention is better than cure, this is a gap that needs to be filled, as a matter of urgency.

Genes may predispose – but other factors often trigger

Some mental illnesses, in particular Bipolar Disorder, Schizophrenia and Borderline Personality Disorder seem to be largely inherited/genetic. However, sometimes their prevalence or the prevalence of common symptoms seems to vary from one country/region to another. This suggests other factors may be at work i.e. genes predispose but other factors, like the environment people grow up in for instance, may trigger the onset/symptoms.

This is potentially important, as it may be possible to influence factors that trigger mental illness in those genetically predisposed. In practice, the windows of opportunity may be limited where mental illnesses manifest in adolescence or early adulthood. This suggests there needs to be a focus on parenting, schools and other early intervention. As the human brain isn't believed to be fully developed until we are in our mid twenties, there is also a case for intervention to reduce factors triggering mental illness up to and including university. 

Also, if we find that the incidence of a mental illness changes significantly over the course of a few decades (as with the increase in mental illness among children in the developed world, already evident by the 1990’s and a trend that has continued) then, because human genes don’t change so rapidly, this suggests other factors that do change more quickly, like the environment and social norms, may be responsible for triggering what may have remained latent for many people in previous generations.

For example, the growing pressure from testing in schools and the rise of online pressure, via social media, are two factors which have been suggested as contributing to the rise in mental health problems among children and young adults – with the number of university drop-outs due to mental health problems reported to have tripled in recent years.

The importance of the early years

Research into neurodevelopment indicates that the human brain grows and develops particularly rapidly during the first two years of life. This is a time when the brain may be especially open to positive (or negative) development. We also know that stress can impact perinatal mental health and adversely affect parent-child bonding – and that positive Parent-Child bonding appears to be important for the long-term mental health and resilience of children. This suggests that the early years (and encouraging and supporting good parenting in the early years) are important for long term mental health.

It may be possible to encourage resilience and adaptive coping

A study of sisters in ‘at risk’ families has suggested a number of protective factors which enabled some of the sisters in some families to respond with greater resilience. These protective factors included social support networks outside the family and individual factors (such as emotion differentiation and acceptance of the past).

Where similar serious adverse life experiences can trigger mental illness in some people but not in others, this suggests a possible role for interventions to encourage resilience and adaptive coping, including social support networks.

There may also be greater scope for working with families. For instance, the Venture Early Intervention Prevention Services (VIPS) Programme in California aims to help treat schizophrenia before it turns into a full-blown condition – by examining and helping fix negative family dynamics that may exacerbate schizophrenia symptoms in the identified patient, with a focus on problem-solving, and reducing stress in the family household.

The importance of social factors

Some mental illnesses are seen as being caused by chemical imbalances in the brain and therefore requiring medication, for instance prescribing anti-depressants to treat depression. Might this underestimate the importance of social factors, including the way we live our lives in the modern world, and the value of both social and cultural factors? A number of studies, for instance, have suggested the value of the creative arts in maintaining mental health. Other studies have suggested that physical activity can help protect mental health, particularly in relation to depression.

Investing in a Resilient Generation

Since publishing our initial findings we have been encouraged by a new report from the Mental Health Policy Commission - Investing in a Resilient Generation. This explains, ‘The early years are a time of rapid brain development and ‘plasticity,’ where successful support and interventions can result in life-long positive impacts.’ This is very much in line with our own findings, currently due for publication in a peer reviewed journal. The report also identifies the value of both school and work-based interventions, again in line with our findings - including from our separate Health at Work research project.  

Conclusions

  • Research into reducing the risk of mental illness needs to be given higher priority.
  • While genes may predispose some people to mental illness, the onset often seems to be triggered by events in people’s lives – so if the triggers can be reduced or avoided this should reduce the risk of illness.
  • The early years appear to be particularly important for long term mental health, suggesting the importance of initiatives to encourage and support good parenting.
  • Some people at risk of mental illness seem better able to avoid becoming ill, suggesting the value of more work to understand and encourage resilience.
  • We probably shouldn’t underestimate the importance of protective social factors – and some studies suggest that activities ranging from exercise to the creative arts can also help maintain mental health.

Michael Baber, Alice Gough, Sophie Izzard, Jennifer Jamieson, Ellen Ji, Robert Milne, Hong Pham, Elizabeth Walters 

 

Our findings in more detail