Offline: The message of mental health

Abstract

One entirely avoidable and indefensible tragedy of the global response to non-communicable diseases has been its extraordinary failure to embrace mental health. Instead, advocates and international institutions, such as WHO, have preferred to emphasise the simple (and simplistic) message of “four-by-four”—four key diseases (heart disease, cancer, diabetes, and chronic respiratory diseases) and four key risk factors (tobacco use, alcohol, unhealthy diets, and physical inactivity). It is not that those who preside over global health today have been ignorant of the mental health crisis befalling our world. The importance of anxiety and depression, for example, as major causes of disability has been understood ever since the first efforts to measure the global burden of disease in the 1990s. But the wise eminences of global health thought that death mattered more than disability, and so they chose to exclude mental health from their manifestos and strategies. To be fair, WHO has recently been trying to remedy its original error. World Health Day this year was dedicated to the ravages of depressive illness: over 300 million people worldwide living with depression, a number that continues to rise. But the frequently cited idea of parity of esteem between mental and physical health remains just that—an idea, yet to be realised through serious investment and political commitment. A symbolically important step to take the study of mental health more seriously was celebrated this past week. One of the quaint traditions of British medicine is the existence of Regius Professors. The first ever Regius Professor of Psychiatry has been awarded to King's College London, where Simon Wessely was justly praised for being its founding Chair. 26 Regius Professors have been granted since the time of Queen Victoria. The honour goes to the institution, not the individual. King's is the home of the Maudsley Hospital and the Institute of Psychiatry, Psychology and Neuroscience, two of the world's leading centres for the care and study of those with mental ill-health. Simon's inaugural lecture was typically unconventional. His subject was monarchs, mental health, and medical students. He reminded his audience that King George III is famous for two reasons—he lost America and went mad. But one of his particular achievements was to have appointed 11 Regius Professors. The very first Regius was created by James IV in 1497. It was awarded to Aberdeen University, and for medicine. The goal of this royal patronage was to bring the benefits of the Renaissance to Scotland. In other words, the bestowal of a Regius Chair was supposed to send an important political and social signal. In 1540, Henry VIII added a further six Regius Professors to Oxford and Cambridge. It wasn't a wholly welcome gift. One recipient was John Story, who became Regius Professor of Civil Law at Oxford. He was hung, drawn, and quartered in 1571 during the reign of Queen Elizabeth I. Perhaps falling into disrepute, the last Regius Chair to be established was in 1870. Then along came Queen Elizabeth II. For her Diamond Jubilee and 90th birthday, more Regius Professors were bestowed beyond Oxbridge. King's College London won a Regius in Psychiatry. The Maudsley has a well deserved reputation for a string of firsts—understanding the neuropathology of epilepsy, the birth of psychiatric epidemiology and genetics, the advent of cognitive behavioural therapy, and the development of global mental health. The Maudsley also stood for a new model of care: combining compassion with research, education, and a mission to reintegrate patients back into society. But now the contours of mental health in our communities are changing. The rates of mental disease have remained remarkably stable over time. But recently a worrying signal has been detected—rising numbers of women aged 18–24 years with mental health problems. Why? Nobody is quite sure. Online bullying? Constant societal scrutiny? The disappearance of places for peace, solitude, and personal reflection? There is a further concern. At a time when psychiatry has never possessed more knowledge, recruiting young doctors into psychiatry seems to be getting more and more difficult. The message being sent by the creation of this Regius Chair at King's is therefore important—mental health matters, the discipline has never been more significant, and it's time to encourage a new generation of young health professionals to reinvigorate its work.