Post by Former NIMH Director Thomas Insel: Mental Health in Davos
Just returning from the World Economic Forum (WEF) in Davos, Switzerland. While media reports covered speeches from some of the 40 heads of state attending or skewered the over-the-top parties of the rich and famous associated with this annual meeting, they missed a remarkable story: this was the year that mental health became a hot topic at the WEF. There were over 20 sessions on health, many of them focused on mental illness, dementia, or mindfulness. Philip Campbell, editor-in-chief of Nature, moderated a session on the “Mental Health Imperative.” An unprecedented health summit began with the Prime Minister of Norway declaring that mental health was her leading health care priority. And celebrities from Goldie Hawn to Arianna Huffington argued for the need to focus on mental health. One Davos regular compared mental health in 2014 to AIDS in 1994, when the WEF declared the need for a global focus on an emerging, heavily stigmatized, frequently misunderstood disorder.
Why did mental health get so much attention at a global economic meeting, dedicated to “improving the state of the world”? I heard three answers to this question. First, the WEF focuses on the developing world, or in WEF-speak “emerging markets” as well as the developed world. Health problems have become a major speed bump to development, with chronic, non-communicable diseases (diabetes, heart disease, cancer, pulmonary diseases, mental disorders) the major economic and public health threat. In a study commissioned by the WEF, mental disorders emerged as the single largest health cost with global projections increasing to $6 trillion annually by 2030, more than diabetes, cancer, and pulmonary diseases combined. Perhaps that should not be surprising since mental disorders, which usually start before adulthood, greatly increase the risk for other chronic, non-communicable diseases throughout the lifespan. Hence, the expression “no health without mental health.”
Second, for employers, mental illnesses, especially anxiety and mood disorders, are a threat to productivity. Research has shown that the high rates of absenteeism and presenteeism (at work despite illness) associated with depression cost, on average, $250,000 for every 1000 workers each year.1 An NIMH-funded study showed that even a low-intensity intervention, cognitive behavior therapy delivered by telephone, could offset these costs.2 While Davos extols compassionate leaders dedicated to the well-being of their employees, for many CEOs the business case for detecting and treating depression was also compelling.
Third, the Davos meeting is a place for identifying macroeconomic and social trends. This year we heard about big data, the “internet of things” (sensors for mobile devices and wearable computers), and robotics. But an even bigger trend was the recognition that the 21st century will belong to brain-based economies. This explains, in part, the brain initiatives that have been launched in the European Union and the United States (both featured at this meeting) and it explains the concern with policies for brain health, from promoting resources for child development to preventing dementia. In the same way that infectious diseases were understood and curtailed in the 20th century, WEF speakers stressed that research and better care must reduce the public health challenge of brain disorders in the 21st century for nations to succeed. Importantly, one of the recurrent comments in sessions at Davos was the importance of including social factors in both research and treatments for brain disorders. In addition to “no health without mental health,” we can add from Davos “no wealth without mental health.”
Like the rarefied atmosphere in Thomas Mann’s The Magic Mountain (thought to be set in Davos), the WEF is famous for big ideas that might not survive at sea level. But the emergence of mental health as a hot topic at this year’s meeting is just one example of the increasing recognition that the time has come to focus on this profound public health problem that has received too little attention. Recent articles in the New York Times (see for example “For the Mentally Ill, It’s Worse,” by op-ed columnist Joe Nocera, January 24, 2014), new legislation in Congress, and the White House meeting last year all point to a trend: the time is now. It will be important to use this moment to focus on science as well as services, to aspire for outcomes measured by well-being and not just symptom reduction, and to put people with mental disorders at the center of our efforts.
1 Kessler RC, Merikangas DR, Wang PS. The prevalence and correlates of workplace depression in the national comorbidity survey replication. J Occup Environ Med. 2008 Apr;50(4):381-90. doi: 10.1097/JOM.0b013e31816ba9b8.
2 Wang PS et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA. 2007 Sep 26;298(12):1401-11.