October 10th is World Mental Health Day. The theme is “mental health and older adults” which is a bit odd given that mental health is a lifelong process and does not begin at age 17, 35 or 65.
No one suddenly wakes up one morning feeling depressed and anxious. Mental disorders can incubate for many weeks or even years before showing themselves.
Eating healthy food, exercise and immunisations promote physical health. Mental health, including thinking and emotional wellbeing, requires the same attention: self-esteem booster shots, thinking challenges and brain exercises, starting at birth and continuing throughout life. This holistic life-course approach to mental health is supported by a plethora of recent publications.
The latest report from Growing Up in Ireland (GUI), Development from Birth to Three Years, shows that children exhibit signs of emotional problems at a very young age.
The GUI study is based on a bio-ecological health model, meaning that all aspects of health – mental, social, physical and emotional – are inextricably linked to each other and to the overall environment.
Children’s socio-emotional development was measured at three years of age using the Strengths and Difficulties Questionnaire (SDQ).
Scale items include: "My child is rather solitary, tends to play alone"; "My child often fights with other children or bullies them"; "My child has many fears, is easily scared" and "My child is considerate of other people's feelings". Very high scores on the "total difficulties" scale predict a 15-fold increase in the probability of a psychiatric disorder diagnosis.
Problematic range
The study found that boys were more likely to be classified in the problematic range than girls, as were children in socially disadvantaged groups. Children whose parents were from professional groups were the least likely (8 per cent) to be in the problematic range, increasing to the highest rate (24 per cent) among children whose parents never worked.
“Such a strong class gradient in the prevalence of behavioural problems at three years of age is a worrying finding,” conclude the authors.
Infant temperament at nine months was highly predictive of social-emotional development problems. Babies who had high scores for behaviours such as: crying (fussy/difficult); responding to a new person (unadaptable); smiling and making happy sounds (subdued); and sleep patterns (unpredictable), were more likely to have emotional problems by three years.
The HBSC Ireland Trends Report 1998-2010: Child Health Behaviours, Outcomes and Contexts, published last month, shows that almost a quarter of young people aged 10-17, reported feeling low "at least weekly" in the past six months.
Lifetime prevalance
The lifetime prevalence of mental disorder is 30-50 per cent. This means that up to half of all adults will experience mental health difficulties at least once in their lives. Globally, over 10 per cent of the total burden of disease is attributable to mental health disorders, yet investment in mental health remains very low in all countries.
A 2013 report from the World Health Organization (WHO), Investing in Mental Health: Evidence for Action, concludes that mental health needs to be taken much more seriously. High-income countries, including Ireland, spend just over 5 per cent of the total health budget on the prevention and treatment of mental health disorders.
“This is not remotely proportionate to the burden they cause, and appears to place a very low value on the psychological or emotional wellbeing of populations.”
The HSE allocates €733 million to mental health services and exactly double that amount is needed to promote mental health and provide life-course holistic services for all age groups.
The WHO report suggests reasons as to why there is so little investment in mental health. First, mental health disorders are not a leading cause of mortality. Thirty-five times more people die from heart disease and cancer, than suicide, every year.
Treatments for these conditions are high-tech, visible, and excellent outcomes can be achieved in a short time. The public advocates for, and demands, the best services.
Mental distress is usually invisible. Treatments are low-tech – pills and talk therapies – and recovery can sometimes take a long time. The public do not advocate for, or demand, best practice mental health services. Big signs announce BreastCheck. There are no signs for MentalCheck. Until everyone understands that mental health disorders are as common as cancer and heart disease and start at birth, thousands of children from the age of three onwards and adults of all ages, including older people, will continue to live lives of quiet desperation.
Dr Jacky Jones is a former HSE regional manager of health promotion
drjackyjones@gmail.com