Page last updated at 10:46 GMT, Monday, 7 November 2011

On the brink of a mental health revolution

Watch Susan Watts' Newsnight film in full

By Susan Watts
Science editor, BBC Newsnight

 Depressed young man holding his face in his hands
One in four people will suffer mental illness in their lifetime

One in four of us will suffer some form of mental illness during our lifetimes. Historically, many of these conditions have been beyond our understanding, but now scientists believe we are on the verge of a revolution in how mental health problems are approached.

Professor Tom Insel, director of the $1.5bn National Institute of Mental Health in the United States, told Newsnight there is a profound change taking place, and science and technology is key to that change:

"We are really facing a tipping point here with research in mental illness. We have gone through a revolution in how we can look at the brain.

We can begin to understand which circuits are involved, and how the brain is wired. We have never had a full wiring diagram of the human brain. We are getting that now."

What this means, scientists say, is that mental health is rapidly becoming a field of medicine just like any other. If something goes wrong, clinicians will apply a battery of tests, make a diagnosis and decide on the best treatment for an individual.

Technological advancements

Prof Insel told us that until recently, research in mental health was dominated by a decades old, and pretty haphazard approach.

Drugs which happened to work in some patients were subject to scrutiny, to try to establish why they worked. There just were not the tools available to look at the fundamental mechanisms involved.

MRI scan of a healthy brain
Scientists are mapping the brain in ever greater detail

His peers in the UK agree. Professor Shitij Kapur, Dean of the Institute of Psychiatry at King's College London, explained:

"Up until now our approach to mental disorders has been very much at a surface level. A psychiatrist or a psychologist will talk to you and try and understand your problems very deeply, but largely based on what you say and what your family members say about your condition they will have to make up their mind about the diagnosis.

"There was no aid from clinical tests - lab tests or blood tests - that have been there for last 50 years in other aspects of medicine. So this is our first opportunity to take psychiatric diagnosis from the descriptive, to in some sense based on their deeper biology."

Technologies such as brain scans and rapid genetic analysis have changed everything. At last, those treating mental disorders have the tools they need to apply a more systematic approach, and it's already changing they way patients are treated.

In groundbreaking research seen by Newsnight, a London team taught computer software to recognise patterns in brain images. Those patterns predict which patients will go on to develop the most serious forms of psychosis.

Dr Paola Dazzan from King's College London carried out this research, at professor Kapur's institute:

"When people come to us with the first episode of psychosis we can already distinguish the people who will do better than from the people who will have a more severe type of illness course. And this will allow us to start thinking of using a different treatment for these different groups of people".

New compounds

And looking at the deeper biology of mental disorders is showing the way to new treatments too: "What's intriguing is the development of new compounds," Prof Insel told Newsnight. "We have one as a proof of concept called ketamine, which works in three hours rather than six weeks".

Yes, this is the same ketamine used as a horse tranquiliser, and as popular drug on the club scene.

"It's well known and has been around for decades, and was selected because it affected a particular target in the brain that seems to change after six weeks of treatment with conventional anti depressants.

"This is a potentially deadly illness for which you would want treatments that don't take six to eight weeks to work. This is a game changer in that sense."

Ketamine itself could not be used, it is not safe, long-term, and people relapse over a week or so. But it worked on the same part of the brain as conventional anti-depressants, and much faster - and it is that that has got scientists excited.

In the science of genetics too, results are coming in from large-scale studies with profound implications.

Human brain
The human brain is the largest and most complex of any primate

Neil Tinning, known as "Twink", once the official photographer for the band The Jam, has lived with bi-polar disorder for most of his life. And he is taking part in the world's largest study into its possible causes.

Twink told us what having bi-polar disorder is like: "It's like a black hole. You feel as if there's no way out and you convince your brain that you are better off dead."

The study's run by professor Nick Craddock. He has five thousand people on the books so far, and is still recruiting.

The aim is to gain a better understanding of some of the triggers of bipolar disorder, by identifying the genes involved.

The condition affects men and women equally, and usually starts between the ages of 15-25. The exact cause is still not understood.

New diagnoses

Prof Craddock believes research such as his will force a major change, not just in the way patients are treated, but in helping to remove the stigma that still goes with mental illness.

"People view mental illness as being somehow different from physical illness. In truth, the only difference is that we understand less about the workings of the brain, and we don't have laboratory tests that can back up diagnoses.

"What I foresee over the next generation is psychiatry becoming like cardiology and other medical specialities, where we have a range of tests - imaging tests of the way the brain functions, blood tests to know about susceptibility factors, other sorts of psychological tests. That will really help direct us to the diagnosis, and crucially - enable us to know how to help people."

It is hard to over-state the difference this revolution could make. One in six of those diagnosed with bi-polar disorder, like Twink, go on to kill themselves.

Twink took over as patron of MDF, the Bi-polar Organisation in 2002, when Spike Milligan died. Now, he wants to know what the latest science can offer people like him.

Luckily, his questions come just as science is coming up with some answers.

Watch Susan Watts' film in full on Monday 7 November 2011 at 2230 on BBC Two and then afterwards on the BBC iPlayer and Newsnight website.



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