Up to one in three has psychological problems

Not alone: up to a third of the people in Switzerland have mental problems Keystone

Psychological ailments are set to become the biggest challenge for the Swiss health service in the next decade.

This content was published on April 15, 2012 minutes

Inadequate or non-existent therapy will only aggravate the situation, as psychologist Alain Malafosse tells in an interview.

The specialist is not the first person to call for more coordinated research to produce better treatments. Jean-Nicolas Despland, director of the Institute for Psychotherapy at the university hospital of Canton Vaud, is also convinced that one in three Swiss people could suffer  psychological problems without further research.

Last week, the Swiss Health Observatory released a report stating that “it is possible that 17 per cent of the population could be suffering from psychological disorders”.

However, estimates can vary significantly. “A range of studies confirm that between 20 to 30 per cent of the population suffers from clinical psychological disorders,” according to Daniela Schuler of the Swiss Health Observatory, which coordinates the work of cantonal and federal health authorities.

Last September the European College of Neuropsychopharmacology published research on 30 countries, including Switzerland. On average some 38.2 per cent of people in Europe suffer from psychological disorders, the report states.

These figures are no exaggeration when compared to Swiss studies, according to Malafosse. Is it not worrying that 38 per cent of the population is affected?

Alain Malafosse: Of course it is. I can confirm the estimates of the European study. There are very profound studies, such as that of professor Martin Preisig of Lausanne University. It shows that between 30-35 per cent of the population suffers from mental disorders.

Severe pathologies like manic depression – a significant disability – affect five-to-six per cent of the population. This is a serious public health problem. Does Switzerland has enough resources to tackle this problem?

A.M.: When it comes to funding, Switzerland is among the countries making the largest investments in the preventive area.

But better education of primary care physicians is critical because at present, 90 per cent of those who suffer from depression and anxiety have never been to a specialist – or ever sought  treatment at all, for that matter.

One of the biggest problems is that doctors tend not to continue their training after they open their practices. Despite new research findings, the current therapies are still very general.

A.M.: In medicine, psychiatry has one of the largest shortcomings with regard to care and treatment strategies that are tailored to the individual patients. These are essential.

We lack the knowledge to develop better therapies. Take the study of cancer and heart and circulatory diseases, for example; in comparison, efforts are still insufficient in our research area – not just in Switzerland, but worldwide. Why is this?

A.M.: There are various and also sociological reasons; mental illness evokes fear, and the victim is often reluctant to see a doctor. Hopefully, society will become more accepting of such diseases, as has happened with cancer and epilepsy. This would surely be beneficial for the success of therapy.

Exactly the same difficulties exist among the health authorities. And within psychiatry there are also major differences between the various psychological, physiological and biological approaches. All of this contributes to the large research gap. You have announced an epigenetic discovery, which establishes a link between abuse in childhood and stress in adulthood. This could contribute to the development of better therapies for patients.

A.M.: Absolutely. Many psychiatric pathologies are diseases that are simultaneously triggered by biological and genetic factors and life itself, such as very early trauma – even in the womb.

This approach tries to understand how these factors alter the functioning of genes and will have an impact on all psychiatric disorders. Does this mean that epigenetic research will change our understanding of mental health if we can better understand the interaction of the genes that determine and change our behaviour?

A.M.: I hope so. Epigenetics enables researchers and specialists to understand mental illness differently. It is easier to accept that both biological and sociological factors trigger mental illness.

The understanding of epigenetic factors may contribute to the understanding of how all these factors interact. It may also change the way in which specialists evaluate and treat their patients. Based on their clinical and laboratory experience, what is the main concern of specialists?

A.M.: In Switzerland, we are dealing with more and more pathologies that are expressed in impulsiveness and violence. From a clinical and social point of view, this aspect in connection with mental illness has become very important.

In addition there is an even bigger problem: drugs. Addiction worsens mental problems such as delusions, anxiety, depression and personality disorders.

There are mental illnesses that are conducive to drug use, which in turn aggravates the disease. From a clinical and social perspective, this aspect of mental illness has become very important.

Mental illness in Switzerland

Some 40% of patients on invalidity benefits suffered from psychological disorders in 2010.

The figure rose to 43% for recently pensioned people, according to statistics.

Health insurers shelled out SFr1.5 billion ($1.63 billion) to treat mental illness in patients in 2010. This amounted to 9% of the total mandatory health insurance costs, according to Daniela Schuler of the Swiss Health Observatory.

European health officials have confirmed that mental health disorders represent the biggest challenge for health authorities on the continent.

It is estimated that from as soon as 2020, mental health disorders will be the primary cause of illness and disability in industrialised countries.

Up to 90% of patients in psychiatric institutions have consumed legal or illegal drugs.

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