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An ounce of prevention

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The prevalence of mental health illness remains high, regardless of the amount of money dedicated to research and treatment. Now, professionals are looking for new ways to direct mental health research. 

Mental illness has seen an increased profile over the last couple of years, featuring heavily in the 2010 election campaign, as well as being made a health priority in the recently released federal budget.

Despite increased exposure and spending, mental health issues are still on the rise, with mental-health related services costs rising to $6.9 billion in 2010–11, an increase of approximately $450 million from the previous year.

A recent survey of stakeholders in the field revealed that research priorities are now turning towards prevention. “Prevention is the Cinderella of mental health, not receiving the same attention as treatment and services, even though it has greater potential to reduce human suffering in the long term,” said professor Tony Jorm, professional fellow at the University of Melbourne.

“In Australia, we have made great strides in providing primary and specialist care for people with mental disorders. However, prevention is the missing element that remains neglected.”

CEO of Australian Rotary Health Joy Gillet agrees, suggesting that if the nation continues spending money on treatment at the same rate, we will go broke.

Convening at a symposium last month, a group of Australia’s top mental health researchers agreed that the billions Australia spends on mental health could shrink significantly if greater emphasis was placed on prevention.

The group considered mental disorders across fives stages of life including prenatal and early childhood, childhood, adolescence, adulthood and old age.

Dr Nicolas Cherbuin, director, Neuroimaging and Brain Lab at ANU College of Medicine, Biology and Environment was one of the speakers specifically addressing prevention for the elderly.

He said there were a lot of risk factors for mental health in older age; but confirmed the major challenge was dementia.

“We have tried to develop treatments for dementia for two decades, there have been billions invested in these types of research projects and they have all failed.”

Risk factors for dementia later in life however have been identified, with effects often accumulating across the lifespan – some starting in childhood or teen years.

“We already know a lot about modifiable risk factors, and projections from the World Health Organisation suggest that if we could reduce exposure to the major modifiable risk factors for dementia and Alzheimer’s [education level, obesity, cholesterol, social engagement, depression, anxiety, exposure to pesticides, fish consumption, physical activity, cognitive activity, alcohol, smoking] it would lead to an annual decrease in dementia cases of 3.3 per cent while a decrease of 25 per cent would reduce dementia cases by 10 per cent annually,” Cherbuin said.

“Given the incidence of dementia in Australia it would lead to thousands of people being spared from the disease nationally, and many more internationally while saving billions of dollars.”

Cherbuin, along with professor Kaarin Anstey also from ANU, have progressed with research into prevention of cognitive decline using a three-pronged approach that began with the identification of risk factors for brain ageing and dementia.

The second step was to identify people at risk of developing dementia later in life by developing a risk assessment tool called the ANU-Alzheimer’s Disease Risk Index – which has been built into a website that will be made freely available later in the year.

The third step is the development of an intervention called Body, Brain, Life or BBL. The purpose of this third element, according to Cherbuin, is “to decrease exposure to known modifiable risk factors for dementia in middle age individuals”.

This intervention is currently the focus of a randomised controlled trial that will be completed by September 2013.

Dr Lee-Fay Low, senior research fellow, Dementia Collaborative Research Centre at the University of New South Wales, put forward a preventative measure that involves encouraging people to start thinking about mental health as part of their retirement plan.

“People plan for the first five or ten years of retirement, which is when you are travelling and looking after the grandkids. But what actually happens when you are frail – even if you don’t get dementia? How are you going to protect yourself from negative consequence of physical frailty?”

Low suggests there are two elements that should be considered as part of this approach. First is for the individual to realise that ageing generally comes hand-in-hand with losing some physical health – so it should really be addressed as part of one’s lifestyle.

Main considerations include locality of residency to public transport, friends, and family, the size of the building – how will you maintain it?

Second is looking at communities, and how at a societal level we can protect peoples’ mental health by everyone being aware of ageing issues.

Currently, WHO is doing work around creating aged friendly communities, and Low believes that models presented at the symposium could work her in Australia, as long as they were implemented at community/ council levels.

At this level, she suggests schools, libraries, cafes etc can run special promotions or events for the elderly to reduce stigma and keep elderly involved within the communities.

“It’s about not just doing things for older people, but giving them opportunities to be part of society.”

An alliance on prevention of mental health disorders was formed at the event, which will advocate, promote and lobby to make prevention a key policy focus for health and government entities.

Risk factors

According to beyondblue, a not-for-profit organisation aiming to promote awareness and understanding of depression and anxiety in the Australian community, risk factors that can increase an older person’s risk of developing depression or anxiety include:

• an increase in physical health problems/ conditions e.g. heart disease, stroke, Alzheimer’s disease

• chronic pain

• side-effects from medications

• losses: relationships, independence, work and income, self-worth, mobility and flexibility

• social isolation

• significant change in living arrangements e.g. moving from living independently to a care setting

• admission to hospital

• particular anniversaries and the memories they evoke.

Change and illness

The health and social changes experienced by elderly people, including death of loved ones, illness and isolation, can often lead to mental health issues later on in life.

According to the 2012 Mental Health Services In Brief in 2010/2011, there were 13.9 million mental health-related GP encounters in year 2010-11 – one in four of which were for patients aged 65 and over.

Furthermore, depressive symptoms affect in between 10-15 per cent of people aged 65 and over, with just over 10 per cent of the same age bracket affected by anxiety. For those living in aged care facilities, the figure jumps much higher – with in excess of 35 per cent of residents believed to suffer from mental health issues.

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