By: Thomas Insel at the National Institute of Mental Health*
May is Mental Health Month. This year, we are teaming up with the Substance Abuse and Mental Health Services Administration (SAMHSA) to celebrate and promote Children’s Mental Health Awareness Day on May 6th. Relevant information and materials can be accessed on NIMH’s Child and Adolescent Web page.
Our commitment to bringing the field together to unlock the mysteries of childhood mental illness is based on new paradigms and new scientific approaches. The time has come to “rethink” mental illness, particularly in young people, beyond the “chemical imbalance” explanation of
depression or the “blame and shame” approaches of the past.
Mental disorders are the chronic diseases of young people in our country. The World Health Organization (WHO) has said that mental disorders are the number one source of medical disability for people 15-44 years of age in the United States and Canada.
i There are mental disorders that we associate with childhood, such as
attention-deficit/hyperactivity disorder (ADHD) and
autism spectrum disorder (ASD). But 50 percent of patients describe mood and anxiety disorders, generally considered adult illnesses, as having an onset by age 14.
ii
We must address mental illnesses, from autism to
schizophrenia, as developmental brain disorders with genetic and environmental factors leading to altered circuits and altered behavior. Today’s state-of-the-art biology, neuroscience, imaging, and genomics are yielding new approaches to understanding mental illnesses, supplementing our psychological explanations. Understanding the causes and nature of malfunctioning brain circuits in mental disorders may make earlier diagnosis possible. Interventions could then be tailored to address the underlying causes directly and quickly, changing the trajectory of these illnesses, as we have done in ischemic heart disease and some forms of cancer. For serious mental illness, this is a new vision for prevention, based on understanding individual risk and developing innovative treatments to preempt disability.
While the onset of mental illness generally occurs early in childhood or adolescence, diagnosis is often delayed for years or even decades. Research focused on recognizing illness symptoms or intervening earlier can help address this problem. For example, the
NIMH Recovery After an Initial Schizophrenia Episode (RAISE) initiative is attempting to make fundamental changes in the treatment of psychosis presenting in youth. RAISE research teams seek to reduce the likelihood of long-term disability that people with schizophrenia often experience by developing treatment models focused on intervening as soon as possible after the first episode of the disease. Each treatment integrates medication, psychosocial therapies, family involvement, rehabilitation services, and supported employment. These interventions will be tested in real-world treatment settings that can be readily adopted and quickly put into practice should they prove successful. Also, through the North American Prodrome Longitudinal Study or NAPLS project, NIMH hopes clinical care can begin even earlier, by identifying the prodrome of schizophrenia and devising new treatments that preempt the psychotic phase of the illness.
Aggressive and early treatment is also being directed at children who are at risk for ASD. For example, NIMH-funded researchers at the University of California Davis are
developing and testing a parent-delivered preventive intervention for infants 6-11 months old who are at high risk of developing ASD because they have an older sibling with the disorder. The intervention will focus on reducing atypical behaviors and developmental delays to help lessen or prevent the disabling symptoms associated with ASD. As with so many developmental disorders, early intervention is an important strategy for best outcomes.
A hoped-for result of approaching mental disorders as brain disorders would be to reduce or eliminate the stigma associated with these illnesses. For generations, people with mental illness have experienced discrimination at work or school, and often do not seek diagnosis or treatment for fear of being “found out.” A scientific approach to mental disorders could allow those who struggle with these illnesses to receive full acceptance and the high-quality care they deserve at any age. That would be the true and long-lasting celebration of Mental Health Month.
iWHO. 2002. The world health report 2002—reducing risks promoting healthy life. WHO. Geneva, Switzerland
iiKessler, R.C., et. Al. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry. 62:593-602
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