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Fenno Outen (Head Occupational Therapist for Newham at East London NHS Foundation Trust)

Mental health needs more research

By Fenno Outen (Head Occupational Therapist for Newham at East London NHS Foundation Trust)

This article forms part of a School Resource Pack created by the Progress Educational Trust (PET) as part of its project Spectrum of Opinion: Genes. The article incorporates links to an accompanying Glossary of terms, and is followed by a list of 10 key words, phrases and names and a set of Questions to consider. A more extensive version of the article can be found on PET's BioNews website.

Useful research in mentalhealth care has historically been in short supply. Whether the issue is accurate diagnosis of problems, understanding their causes, or delivering reliable treatment, there remains plenty of room for progress. For example, it is common for clinicians to disagree about diagnoses, or for diagnoses to be changed on a regular basis. Furthermore, a diagnosis provides a relatively poor guide to effective treatment.

Controversies around psychiatricmedication continue. Trial and error is often the only way to arrive at a satisfactory combination of drugs. Side-effects still cause unhappiness, impairfunctioning, and put people off taking medication at all. A greater range of non-drug treatments are now becoming available, but the application of these treatments to those most severely affected remains unsatisfactory.

Anyone seeking some kind of explanation for their difficulties remains likely to hear a vague reference to imbalanced brainchemicals, or a biopsychosocialmodel that covers all the bases but explains little. If they do get something more specific, it may well be contradicted by the next professional they see. In this respect, mental health compares badly with other areas of healthcare.

At present there is little discussion, at a practical level, of the latest advances in genetic research into mental health. This is not surprising, since this research is still in its early stages.

It has become clear that the interaction of genes and other factors is a complex process. For the major mental health problems, there are not single genes that determineoutcomes. New research demonstrates this, as well as suggesting how multiple genetic and environmental factors might interact.

Better ways of understanding geneexpression provide rich ground for thinking about possible future improvements to care. Genetic research could help clarify diagnostic issues, for example the distinction between schizophrenia and bipolar disorder. If this helps avoid confusion about diagnosis, so that we can focus on reducing symptoms instead, then so much the better.

There are more general benefits to discussing research into mental health. Such research helps stimulate debate about, and understanding of, mental health problems and their causes. A clearer understanding of genetic factors provides a challenge to produce a clearer understanding of non-genetic factors as well.

While successful treatment remains elusive, direct benefits of new genetic research for people with mental health problems will be scarce. However, there may be indirect benefits. The possibility of treatment and recovery will sustain hope, both for those with mental health problems and for healthcare providers. Furthermore, prominent discussion could help to reduce the stigma associated with mental health problems.

Perhaps we might arrive at a situation where we have a full understanding of the relationship between stress and gene expression. We would still then need to understand, perhaps at the very specific level of the individual's experience, how the stress came about.

It seems likely that whatever the genetic research outcomes, we will continue to need to intervene at the many levels that we already do - biological, psychological and social - although we may be better guided as to what is likely to work. At the level of culture, we also need to examine how developments such as medicalisation sit with new genetic understandings.

If, for example, we accept that there are cultural factors that make it more likely that people experience problems in the form of psychological distress, then we need to find a way of reconciling this with the genetics. The fact that conditions associated by some people with medicalisation (for example, autism and attention-deficit hyperactivity disorder) are being investigated at the genetic level should provide fertile ground for new ideas.

    Questions to consider

  1. Once someone is diagnosed with a mental health condition, it does not necessarily become any easier to treat them. Why not?

  2. If someone is diagnosed with a mental health condition and their diagnosis is later changed, why might this be?

  3. Biological causes of mental health problems can be tackled with medical diagnosis and treatment. What can be done to tackle environmental, social or cultural causes of mental health problems?