I. Pelc – BCNBP 2005 Prof. I. Pelc Belgium Scientific Counterpart to WHO Mental Health Europe The Challenge of a Competitive Belgium Research in Mental Health Belgian College of Neuropsychopharmacology and Biological Psychiatry - Brussels December 8th 2005

WHO European Ministerial Conference on Mental Health 1.Promote mental well-being for all 2.Demonstrate the centrality of mental health 3.Tackle stigma and discrimination 4.Promote activities sensitive to vulnerable life stages 5.Prevent mental health problems and suicide 6.Ensure access to good primary care for mental health problems 7.Offer effective care in community-based services for people with severe mental health problems 8.Establish partnerships across sectors 9.Create a sufficient and competent workforce 10.Establish good mental health information 11.Provide fair and adequate funding 12.Evaluate effectiveness and generate new evidence Helsinki, January 2005 Mental Health : Facing the Challenges, building solutions Action Plan 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

Diagnosis (DSM IV)12-month estimate (%)12 month estimate (million) Alcohol dependence Illicit substance dependence Psychotic disorders Major depression Bipolar disorder Panic disorder Agoraphobia Social phobia Generalised Anxiety Disorder (GAD) Specific phobias Obsessive-compulsive Disorder (OCD) Somatoform disorders Eating disorders Any mental disorder Source : 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 months values rounded by Commission. Percentage values based on Commissions 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 Europe Size 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 7.7 Belgium 9.1 Denmark 8.8 Finland 7.3 France 9.7 Germany10.9 Greece 9.5 Iceland 9.9 Ireland 7.3 Italy 8.5 Luxembourg 6.2 Netherlands 9.1 Norway 9.1 Portugal 9.3 Spain 7.6 Sweden 9.2 United Kingdom 7.7 Source : OECD 2004 I. Pelc – BCNBP 2005

Estimates of mental health expenditure as a proportion of total expenditure on health Austria N/A Belgium 6 Denmark 8 Finland N/A France 5 Germany10 Greece N/A Iceland 6.3 Ireland 6.8 Italy 5 Luxembourg13.4 Netherlands 8 Norway N/A Portugal 5 Spain 4.6 – 5.3 Sweden11 United Kingdom12 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% Policy5.23 % Research2.71 % Prevention8.24 % Treatment (assistance) % Law enforcement % Source : De Ruyver, B. – Pelc, I. – Casselman, J. et al Drugbeleid in cijfers. Gent, Academia Press, Belgian expenditures on drug addiction in 2002 in million EUR I. Pelc – BCNBP 2005

Research and Development investment by sectors Belgium 2003 I. Pelc – BCNBP 2005

RankJournal# of high impact papers 1Nature301 2Neuron292 3Science270 4Journal of Neurosciences163 5Proc. Natl. Acad. Sci. USA141 6Trends in Neuroscience125 7Ann. Rev. Neuroscience68 8Annals of Neurology60 9Archives General Psychiatry56 10Neurology43 11Journal of Neurochemistry37 12Amer. Journal of Psychiatry30 13Neuroscience29 14Psychological Bulletin26 15Psychological Review24 16J. Computational Neurosci.23 17Brain21 18Progress in Neurobiology20 Source : ISIs High-Impact Papers, I. Pelc – BCNBP 2005 Journals Publishing High Impact Research in Neuroscience,

BRAIN DECADE ( ) 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 – BELGIUM Higher Council of Health Working Group ( ) : Mental Health Research and Developments, Inventory, Critical Analysis, Recommandations, Impact on Public Health I. Pelc – BCNBP 2005

Evidence Based Medecine What 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 Practice Elements for clinical decision Clinical Experience Research data Patients (and therapists ?) 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 Patients 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 treatments targets Psychotic Disorders (1) From 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 clinical Improvement of Positive Symptoms Negative Symptoms Cognitive Performance Reduction of EPS Efficacy and effectiveness Study Protocols, RCT, Real Life Conditions, Compliance, Tolerability, Safety, Quality of Life, Access to Treatment, Continuity of Care, Care Costs, Patients and Therapists Judgment, Prospective Evaluation I. Pelc – BCNBP 2005 Adaptation of a personal communication from Prof. D. Lecompte

Evolution of treatments targets Psychotic Disorders (2) Stabilisation, Remission, Recovery Stabilisation : less external impact of positive symptoms Remission :mild detected levels of positive and other symptoms for at least 3 months Recovery : absence of any positive symptoms and mild other symptoms for at least 1 year (40 % of patients if followed up during 15 years !!!) Adaptation of a personal communication from Prof. D. Lecompte I. Pelc – BCNBP 2005