Public Health and the Prevention of Mental Illness in Populations.

This year the School of Public Health has chosen mental health as its area of focus, informing a myriad of events, presentations, and educational material. I found this “Spotlight on Mental Health” a heartening recognition of a real, and frequently underappreciated, challenge to the health of the public. Reflecting this focus, it seems worthwhile to ponder for a moment both why we might consider mental health a core part of a public health agenda, and how public health can fruitfully contribute to the improvement of population mental health.

Why Mental Health?

The reasons why mental health should be at the core of a concern with the health of populations are legion. I find two observations, both of which are simple, compelling, and amply sufficient for a call to action.

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Public Health and Mental Health

A sobering observation when considering the burden of mental illness in populations is that the relative dent we have made in the consequences of many forms of mental illness remains small. What is perhaps most striking about the suicide is how unyielding the suicide rate in the US has been over the past decades. [See Figure 1].

The challenge has not gone unnoticed, and there are two dominant strands in current thinking about approaches to mitigating the consequences of mental illness.

Thomas Insel, the director of the National Institutes of Mental Health, has spoken at length on this issue, suggesting that we start viewing mental illnesses as brain disorders in order to target risk factors in the brain before they manifest in behavior. Insel’s approach is grounded in, and concordant with, the dominant National Institutes of Health’s interest in an ever greater focus on personalized or precision medicine. This approach argues for a focus on genetics or other molecular approaches to detect brain disorders and mental illness earlier in their course. I will comment on the promise, and perils—as I see them—of this approach to health in general in a future Dean’s Note, although, for anyone interested in an advance preview, I have spoken before on this topic.

A broader approach argues for the embedding of mental illness in the social structures that produce health generally and mental health specifically. Martin Prince and colleagues argue similarly for a focus on prevention, and additionally for a greater emphasis on the connectedness between physical and mental health. We have ample reason to be reminded that social conditions are inextricably linked to behavioral disorders. In some of our own work we have shown that behavioral disorders broadly are much more sensitive to social conditions than are other disorders, suggesting that an effort to mitigate the harm of mental illness must lie in the improvement of social conditions that shape the burden of mental disorders.

Prevention as a Key Element of Public Mental Health

Irrespective of potential approaches adopted, it seems clear to my mind that a prevention approach can be a critical component of a public health engagement with mental health. In many ways prevention is at the beating heart of pubic health, and an embrace of a population-based approach to the prevention of mental illness gives us both the remit and the charge to focus our efforts. To this end, together with a colleague, I have recently argued that a focus on prevention can catalyze a public health approach to mental health.

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I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Professor, Boston University School of Public Health
@sandrogalea

Acknowledgement: I would like to acknowledge the help of Laura Sampson on this Dean’s Note.