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It’s not airborne – lean in, not away.

By Emma Sutcliffe on May 17, 2016

Whenever I write articles with a disclosure about my mental health issues, I always receive two types of response; firstly, people will commend me for being ‘brave’ and then there will be a couple of people who ‘come out’ to me about their mental illness. I use the colloquialism carefully because there’s always a somewhat apologetic ‘confession’ where mental illness is concerned.  And a sense of fear that our relationship will now be forever tarnished because it isn’t ‘normal’.  Even though these reactions are ‘usual’, it still surprises me to be thought of as being courageous to say, ‘I have an anxiety disorder and I have had periods of clinical depression that have required pharmacotherapy and cognitive behavioral therapy’.

On reflection, however, I realize that it is usually accompanied by the phrase, ‘I’m sorry…’ and increasingly, I am making this statement in defence because I’ve been attacked. Which begs the question - when did it become acceptable to use someone’s illness as a beating stick? This is discrimination. We don’t attack someone with a chronic condition such as diabetes or cancer when their illness incapacitates them … we step closer and offer to help. However, when someone says ‘I have a mental illness’ … we edge that little bit further away. I’ve seen people hug their children closer. I’ve done this myself. Here’s the taboo; we treat mental illness as though it is an infectious disease or one which will always be accompanied with violent symptoms. Realistically, you cannot ‘catch’ my depression and the sense of fear and inadequacy that accompanies anxiety makes it more likely that I will be passive (read ‘petrified’) and an easy target for people to be verbally aggressive towards me than to start caterwauling in the street.

Better relationships mean better mental health

It is a medical oxymoron that poor mental health has the worst understanding and resource investment despite WHO's estimation that half a billion people are affected worldwide and the cost to global economies is on course to exceed $6 trillion per annum by 2030. Mental ill health is the world’s largest cause of disability and economic loss. In the UK alone, one in four adults experience at least one diagnosable mental health problem each year. The stigma and bullying remains pervasive in society about poor mental health because people continue to use a mental illness label as a slur. Being the subject of mocking or taunting such as "are you mental" or "are you losing it again" hampers people's willingness to disclose their condition causing people to feel like they are on the outside. Feelings of disempowerment due to being negatively evaluated in relation to a person's judgement making capacity and credibility further erode self-esteem. Many have described having their status undermined in their family whereby their opinions were no longer valued or were dismissed after they had been diagnosed with a mental health problem.

As you may be aware, it's Mental Health Awareness Week in the UK from May 16 - 23^rd and this year the theme is ‘relationships’ and the small things you might be able to do to improve the relationships that make up your life and help minds to be healthy. 

To this end, the commendation for bravery must surely go to the pharmaceutical industry; scepticism will always surround the commercial gain that industry makes for its profits from products – but industry has been remarkable in the field of mental health. Companies like Jansen, Pfizer, Lilly and GSK have persistently improved relationships between physicians and patients with mental health conditions because they have facilitated that key ingredient in any relationship – communication. There have been many excellent campaigns by these companies that have encouraged us to keep trying to break taboos in talk about poor mental health.  The ‘Time to change’ initiative highlights the startling challenges however that remain for people with mental health problems:

• >90% experience stigma and discrimination in personal relationships and in the workplace.
• 65% have stigma that affects friendships
• 60% wait more than a year to tell the people closest to them about it
• 45% have been are victims of crime annually in the UK.

Taboo-breaking technologies

One of the most promising solutions to ‘break’ taboos around mental health has come in the form of technology. In a digital age of social health sharing, the smartphone, social media platform and wearable sensors have become the ‘new best friend’ for people with mood and mental health disorders. Common mental health disorders such as dementia, depression and anxiety are characterized by symptoms that can fluctuate regularly. Until now, this has created difficulties for researchers and healthcare professionals as infrequent assessments in medical settings are unable to reflect a patient’s health between visits or in everyday life. Pharma and tech companies are now investing in wearable devices that can gather rich physical and neurological health data during everyday life. Cambridge Cognition, for example, has software that ‘learns’ each individual's mood and cognitive performance varies moment-by-moment together with the factors that contribute to their wellness, such as sleep, stress and physical activity. This understanding creates a more natural and accurate profile of a person's mental health helping people track their wellbeing, intervene if their health declines and lead fuller, more active lives.

Products will be licensed initially to pharmaceutical partners and healthcare providers to enrich drug development and patient wellbeing. Leaders in pharma are excited about how these technologies will foster better relationships and information for new solutions; Irina Osovskaya, Digital Manager at Janssen UK & Ireland says “being able to monitor somebody's adherence to medication using wearables I think for me, from the pharma perspective, this is probably the number one priority area. Definitely for people with mental health conditions and being able to monitor not only intake of medicines, but also general wellbeing. It's actually about helping activate patient groups to participate in their own health and wellbeing.”

Affective computing – the beginning of the end of mental health bullying?

One of the most intriguing opportunities postulated by the routine inclusion of wearable sensors and implantable biosensors into the management of mental health in the future is the potential to understand, engineer or alter the emotions of people with mood disorders. This has the additional application to alter the approach to cognitive dissonance or accompanying affective disorders in people with chronic disease. Rosalind Picard is a Professor and Director of Affective Computing Research at the Massachusetts Institute of Technology; she describes ‘affective computing’ as computing that relates to, arises from or deliberately influences emotions. Professor Picard believes that “objective tools of engineering should be brought to the challenge of understanding emotions in people.” Heralded as the ‘end of seizures and depression’, these affective engineering tools may offer new ways to diagnose and monitor cluster B mood disorders (antisocial personality disorders, narcissistic personality disorders, borderline personality disorders) and provide new management tools for these and the cluster C disorders. This would be a revolution in psychiatric disease.

As someone with the quotidian symptoms of living with a mental health condition and having also battled daily bullying or stigma about my ill-health, the potential value of wearable technology for real-time cognitive health monitoring is an exciting prospect. A famous politician who bravely disclosed that his ‘black dog’ depression was severely disabling left us with the words ‘this is the end of the beginning.’ I hope that we can put an end to the bullying and discrimination of people with mental illness and this is the beginning of better relationships using technology between pharma, physicians and patients.