Acting early is the key to the prevention of mental health problems, argues Vikram Patel from Harvard Medical School. This month, we publish an article based on his lecture delivered at the Royal Society of Medicine in which Patel persuades us that there is an opportunity to reimagine our approach.1
Three epidemiological observations underpin Patel’s optimism. First, childhood neglect and deprivation are strong risk factors for mental health problems. Second, most mental health problems encountered in adulthood have their origins in childhood. Third is a growing evidence base to support interventions targeting social environments and psychological capabilities of children.
Patel makes a clear case that the brain is a work in progress from early childhood to young adulthood, and particularly susceptible to environment. This theme is picked up by Adrian Heald et al. as they explore the impact of the vote to leave the European Union on the mental health of ethnic minorities. The harmful effects to mental health are clear, claim the authors, but the issue is ignored in political and media discourse.2 What’s also lacking is high-quality research to help understand and tackle the problem.
Ben Goldacre et al. provide interesting research to answer a separate question. Their national study of prescribing in English general practice finds that homeopathy prescribing is associated with poor performance on a range of prescribing quality measures.3 The explanation for this association is unclear although the authors postulate that it may reflect underlying practice features such as extent of respect for evidence-based practice or poorer stewardship of the prescribing budget.
Efforts to improve service in primary care include video consulting offered by private companies. With improvements in video-conferencing technology and mobile devices, virtual consulting will become more widely available. Benedict Hayhoe et al. see a future for the NHS working with private providers but argue for urgent research to explore concerns about safety and working practices.4 We finish with research, too, and a clear account of the vexed issue of placebos in trials of surgical interventions.5
References
- 1.Patel V. Acting early: the key to preventing mental health problems. J R Soc Med 2018; 111: 153–157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Heald A, Vida B, Farman S, Bhugra D. The LEAVE vote and racial abuse towards Black and Minority Ethnic communities across the UK: the impact on mental health. J R Soc Med 2018; 111: 158–161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Walker AJ, Croker R, Bacon S, Ernst E, Curtis HJ, Goldacre B. Is use of homeopathy associated with poor prescribing in English primary care? A cross-sectional study. J R Soc Med 2018; 111: 167–174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Peters L, Greenfield G, Majeed A, Hayhoe B. The impact of private online video consulting in primary care. J R Soc Med 2018; 111: 162–166. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Wartolowska KA, Beard DJ, Carr AJ. The use of placebos in controlled trials of surgical interventions: a brief history. J R Soc Med 2018; 111: 177–182. [DOI] [PMC free article] [PubMed] [Google Scholar]