Current evidence on depression – the view from Centre for Mental Health by Sean Duggan Around nine out of 10 people who die by suicide suffer from a mental health problem with depression being the most common co-existing difficulty affecting 60% of those who tragically take their own lives. Nearly one-fifth of adults in the UK experience anxiety or depression. Often these problems remain unrecognised and untreated – sometimes for many years. This is despite that fact that there are effective interventions that have been proven to make a difference to those suffering with depressive illnesses. The World Health Organisation has estimated that by 2030 more people will be affected by depression than by any other health problem. These findings reinforce the importance of treating depressive disorders as a health priority and of making available proven, cost-effective and accessible interventions to reduce their burden. Other evidence reinforces the critical importance of intervening early to improve the life chances of those facing or already suffering from mental illness. Early intervention not only improves the prospects and life chances of those with poor mental health, it reduces the burden on families as well as broader costs to the public purse. Yet the UK spends less than 4% of its national budget on mental healthcare with evidence pointing to a health system increasingly geared towards short term solutions (Lintern, 2012). So what should we do? We need to be more alert to the early signs of poor mental health. It is particularly important to identify poor mental health early and give children a good start in life in terms of their emotional wellbeing. Increasingly science is pointing to the damaging effects both of maternal depression and anxiety before and after the birth of a baby. This damage not only affects a mother’s wellbeing; poor maternal mental health also undermines the mental health of children. Only a small number of mothers suffering from poor peri natal mental health get identified; even fewer get the help that can make a difference. Simple screens used by midwives, health visitors and GPs could help identify risks and support better access to care. The Centre is currently working with partners to improve the availability of better quality peri natal care, to assess its cost effectiveness and to support improved GP practice. We also need to identify childhood and youth mental health problems as early as possible. The government acknowledges that half of people with lifetime mental health difficulties first experience symptoms by the age of 14 and one in ten children aged between 5 and 16 will have a diagnosable mental health problem. Most parents actively seek help for their children and yet only a quarter get the help they need. This is in spite of excellent evidence that effective interventions can both make a difference to children’s life chances and to the future burden on the public purse. Far too frequently, children’s needs are picked up by chance. Teachers don’t know the symptoms of mental health problems in children (often these present as behavioural problems) and, if they do, they remain unsure where to refer them. We need more systematic ways of picking up when children’s wellbeing moves outside healthy ranges and we need better and more accessible support with mental health and emotional wellbeing available in schools to help teachers, parents, children and young people to get prompt help when they encounter families or children distress. Furthermore, young people have often expressed significant concerns that help is not available in convenient and non-stigmatising settings, that it often feels irrelevant to their needs and that they often face a lengthy wait to access the help that they need. Young people should have a major role in shaping what prevents and helps them recover from mental health difficulties and this needs to be taken into account in the design of local support. Early identification for adults also requires whole-system sensitivity both to the signs of poor mental health and about what to do when early signs are spotted. This includes the need to build awareness and capacity in employers, faith leaders, police custody, courts and custodial settings, voluntary and statutory sector support services and many others providers working with groups at higher risk of developing poor mental health. It is not acceptable that people with mental health problems can expect to die 10 to 20 years earlier than those without a diagnosis (http://www.psych.ox.ac.uk/research/forensic-psychiatry). It is essential that we begin to take seriously the distressing and damaging impact that mental illness has on lives, on communities on families and on the public purse. Investment in mental health support must be increased at least to match investment in physical health and also to adequately reflect this increasing economic burden. Most importantly it should aim to reduce the significant distress and health inequalities faced by those facing or living with poor mental health. However, increased investment needs to go hand in hand with a more creatively designed and responsive system of support which provides non stigmatising help, builds capacity in communities and in workplaces, provides easy access to help where and when people need it and which draws together what we know works and what those with lived experience know promotes their progress and recovery.