I. Pelc – BCNBP 2005

Prof. I. PelcBelgium Scientific Counterpart to WHO Mental Health Europe

The Challenge of a Competitive Belgium Research in Mental Health

Belgian College of Neuropsychopharmacology and Biological Psychiatry - BrusselsDecember 8th 2005

WHO European Ministerial Conference on Mental Health

1. Promote mental well-being for all2. Demonstrate the centrality of mental health3. Tackle stigma and discrimination4. Promote activities sensitive to vulnerable life stages5. Prevent mental health problems and suicide6. Ensure access to good primary care for mental health problems7. Offer effective care in community-based services for people

with severe mental health problems8. Establish partnerships across sectors9. Create a sufficient and competent workforce10. Establish good mental health information11. Provide fair and adequate funding12. Evaluate effectiveness and generate new evidence

Helsinki, January 2005

Mental Health : Facing the Challenges, building solutions

Action Plan

I. Pelc – BCNBP 2005

I. Pelc – BCNBP 2005

THE EUROPEAN GOVERNMENTS SHOULD :

• Support national research strategy at a coordinated and national level

• Bridge the knowledge gap between research and practice

• Insure that research program include long-term evaluation

• Invest in training in mental health research

I. Pelc – BCNBP 2005

I. Pelc – BCNBP 2005

Diagnosis (DSM IV) 12-month estimate (%) 12 month estimate (million)

Alcohol dependence 2.4 7.2

Illicit substance dependence 0.7 2.0

Psychotic disorders 1.2 3.7

Major depression 6.1 18.4

Bipolar disorder 0.8 2.4

Panic disorder 1.8 5.3

Agoraphobia 1.3 4.0

Social phobia 2.2 6.7

Generalised Anxiety Disorder (GAD) 2.0 5.9

Specific phobias 6.1 18.5

Obsessive-compulsive Disorder (OCD) 0.9 2.7

Somatoform disorders 6.3 18.9

Eating disorders 0.4 1.2

Any mental disorder 27.4 82.7Source : Hans-Ulrich Wittchen, Frank Jacobi (2005). Size and burden of mental disorders in Europe : a critical review and appraisal of 27 studies. European Neuropsychopharmacology, Volume 15, Number 4, pp. 357-376. 12-months values rounded by Commission.Percentage values based on Commission’s own calculations.

I. Pelc – BCNBP 2005

ECNP TASK FORCE (2005)Estimated number of subjects in the general EU population

(age 18-65) affected by mental disorders within past 12 months

ECNP TASK FORCE (2005)

With little variation of country,

only 26 % of all mental disorders receive

any or even fewer adequate treatment

I. Pelc – BCNBP 2005

Mental Health Problems in EuropeSize and Burden

Economic Costs ECNP Task Force

• Total health economic costs/year =300 Billions Euros

• Most important part is related to indirect costs : 132 Billions Euros

• Drug Treatment Costs : 4 % of total costs

I. Pelc – BCNBP 2005

Total Expenditure on Health as a % of GDP (Europe 2002)

Austria 7.7Belgium 9.1Denmark 8.8Finland 7.3France 9.7Germany 10.9Greece 9.5Iceland 9.9Ireland 7.3Italy 8.5Luxembourg 6.2Netherlands 9.1Norway 9.1Portugal 9.3Spain 7.6Sweden 9.2United Kingdom 7.7Source : OECD 2004

I. Pelc – BCNBP 2005

Estimates of mental health expenditure as a proportion of total expenditure on health

Austria N/ABelgium 6Denmark 8Finland N/AFrance 5Germany 10Greece N/AIceland 6.3Ireland 6.8Italy 5Luxembourg 13.4Netherlands 8Norway N/APortugal 5Spain 4.6 – 5.3Sweden 11United Kingdom 12

Source : WHO Atlas on Mental Health 2001

% of health budget

I. Pelc – BCNBP 2005

But…

Contributions of mental health problems to overall burden of ill health in Europe is estimated to be 20 % of Disability Adjusted Life Years (DALYs) (WHO 2004)

I. Pelc – BCNBP 2005

million EUR %Policy 5.2 3 %

Research 2.7 1 %

Prevention 8.2 4 %

Treatment (assistance) 71.7 38 %

Law enforcement 98.0 54 %

Source : De Ruyver, B. – Pelc, I. – Casselman, J. et al Drugbeleid in cijfers. Gent, Academia Press, 2004.

Belgian expenditures on drug addiction

in 2002 in million EUR

I. Pelc – BCNBP 2005

Research and Developmentinvestment by sectors

Belgium 2003

public7% industries

71%

universities22%

I. Pelc – BCNBP 2005

Rank Journal # of high impact papers

1 Nature 301

2 Neuron 292

3 Science 270

4 Journal of Neurosciences 163

5 Proc. Natl. Acad. Sci. USA 141

6 Trends in Neuroscience 125

7 Ann. Rev. Neuroscience 68

8 Annals of Neurology 60

9 Archives General Psychiatry 56

10 Neurology 43

11 Journal of Neurochemistry 37

12 Amer. Journal of Psychiatry 30

13 Neuroscience 29

14 Psychological Bulletin 26

15 Psychological Review 24

16 J. Computational Neurosci. 23

17 Brain 21

18 Progress in Neurobiology 20

Source : ISI’s High-Impact Papers, 1989-1998

I. Pelc – BCNBP 2005

Journals Publishing High Impact Research in Neuroscience, 1989-98

BRAIN DECADE (1990-2000) Neurobiology of Emotions (2004)

Brazilian Society of Neuroscience and Behaviour

• What are the most critical issues/questions in the neurobiology of emotion ?

• What do we know for certain about brain processes involved in emotion and what is controversial ?

• What kinds of research are needed to resolve these controversial issues ?

• What is the relationship between learning, memory and emotions ?

I. Pelc – BCNBP 2005

MINISTRY OF HEALTH – BELGIUMHigher Council of Health

Working Group (2005 - ) :

Mental Health Research and Developments, Inventory, Critical Analysis, Recommandations, Impact on Public Health

I. Pelc – BCNBP 2005

Evidence Based MedecineWhat is EBM ?

Sackett (2000) : The conscientious explicite and judicious use of the current based-evidence in making decisions about the care of individual patients

I. Pelc – BCNBP 2005

Adapted from G. Pieters Higher Council of Health Belgium.

Evidence Based PracticeElements for clinical decision

Clinical Experience

Research data

Patient’s(and therapist’s ?) preference

I. Pelc – BCNBP 2005

Adapted from G. Pieters Higher Council of Health Belgium.

Evidence Based Practice

Clinical Problem

Formulation of a specific question

Looking for evidences

Critical evaluation of the evidences

« Adapted Evidence »

Relevant for a specific patient

Patient’s choice

« Values »

Evaluation of the results

I. Pelc – BCNBP 2005

Adapted from G. Pieters Higher Council of Health Belgium.

Value Based Medecine (Fulford)

• Evidence Based Medicine : to consider the complexity of relevant research data

• Value Based Medecine : to consider the complexity of relevant values and/or individual choices

Adapted from G. Pieters Higher Council of Health Belgium.

I. Pelc – BCNBP 2005

Evolution of treatment’s targets Psychotic Disorders (1)

1930 - 2005From Shock Therapy to : Conventional antipsychotics

Dopaminergic receptors Broaders receptors sites D2 partial agonist (and atypical neuroleptics) Identification of specific receptor Identification of specific signal transduction

Preclinical and clinicalImprovement of Positive Symptoms

Negative Symptoms Cognitive Performance

Reduction of EPS

Efficacy and effectivenessStudy Protocols, RCT, Real Life Conditions, Compliance,

Tolerability,Safety, Quality of Life, Access to Treatment, Continuity of Care, Care Costs, Patient’s and Therapist’s Judgment, Prospective

Evaluation

I. Pelc – BCNBP 2005Adaptation of a personal communication from Prof. D. Lecompte

Evolution of treatment’s targets Psychotic Disorders (2)

1930 - 2005

Stabilisation, Remission, Recovery

Stabilisation : less external impact ofpositive symptoms

Remission : mild detected levels ofpositive and other symptomsfor at least 3 months

Recovery : absence of any positivesymptoms and mild othersymptoms for at least 1 year (40 % of patients if followed upduring 15 years !!!)

Adaptation of a personal communication from Prof. D. LecompteI. Pelc – BCNBP 2005