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THE GLOBAL CRISIS OF DEPRESSION

The Low of the 21st Century?

Tuesday, November 25th 2014 ? Kings Place, London

S U m m ar y report

Sponsored by:

depression.

THE GLOBAL CRISIS OF DEPRESSION

SUmmary report

THE GLOBAL CRISIS A STRONG ECONOMIC AND SOCIAL CASE FOR PREVENTING, CONTROLLING AND MANAGING DEPRESSION OF DEPRESSION

The Low of the 21st Century?

Tuesday, November 25th 2014 ? Kings Place, London

Introduction

Depression is one of the biggest health challenges the world faces. More than 350 million people worldwide suffer from depression. One in five people will experience a period of depression in their lives, and it is the leading cause of disability worldwide. Aside from the personal cost to sufferers and their families, the impact on the economy is vast, with the cost in Europe alone amounting to 92 bn a year, much of which is down to lost productivity. Policy makers and employers are failing to grasp the scale and urgency of the problem. Meanwhile, mental illness continually loses out to physical conditions in the allocation of public health funds, and society still stigmatises those who suffer. The issue is complex and requires cooperation across government, academia, healthcare providers, the pharmaceutical industry, employers and patients. The Economist Events' conference, sponsored by H. Lundbeck, brought together key global opinion leaders from across these groups to give an insight into the global challenge of depression; the impact that depression has on society, workplaces and health; and how depression can and should be treated.

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THE GLOBAL CRISIS OF DEPRESSION

SUmmary report

A STRONG ECONOMIC AND SOCIAL CASE FOR PREVENTING, CONTROLLING AND MANAGING DEPRESSION

Kofi Annan, Former Secretary General, United Nations; Chairman, Kofi Annan Foundation

Depression must become a global priority because it not only affects health and well-being but also diminishes labour productivity and economic growth. Calling the challenge of depression a global crisis is no exaggeration at all.

Kofi Annan

The burden of depression

A lack of political resolve and a failure to acknowledge the scale of the problem of depression is undermining the fundamental human rights of hundreds of millions of people, said Kofi Annan, Former Secretary General of the United Nations, in opening the conference. Basic levels of care are being denied to those that need help ? in the rich world, accessing treatment for depression lags badly behind care for physical conditions. In poorer countries that lack proper functioning health systems such support can be non-existent, and these are countries that are often afflicted by poverty, conflict and natural disasters, so depression is more prevalent and severe.

It is predicted that depression will jump from fourth to second place in contributing to the overall global burden of disease. WHO member states have already approved the 2013-2020 mental health action plan, which calls for a 20% increase in treatment for mental health including depression by 2020. Mr Annan said that it is vital that these commitments are turned into concrete action on the ground all over the world. Mental health, and depression in particular, must also be placed within the Millennium Development Goals post-2015 agenda.

To tackle depression requires a multi-faceted approach. Mr Annan called on delegates to cast their nets wide when forging new alliances, and learn from initiatives created to fight infectious diseases where innovative partnerships across sectors and countries brought success.

We also need to find ways to widen the numbers of patients receiving treatment for depression and improve the education of general medical and health staff so it can be better diagnosed and treated, he said.

Depression, directly and indirectly, was estimated in 2010 to have a global cost of at least US$ 800 billion, a sum expected to more than double over the next 20 years.

Women are twice as likely to suffer from depression as men.

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THE GLOBAL CRISIS OF DEPRESSION

SUmmary report

A STRONG ECONOMIC AND SOCIAL CASE FOR PREVENTING, CONTROLLING AND MANAGING DEPRESSION

Norman Lamb MP, Minister of State for Care and Support, United Kingdom

There is a clear moral and economic case for improving care, helping people get the right support, making sure they can lead a normal life, free of stigma and discrimination."

Norman Lamb

Over 350 million people in the world are affected by depression, about the same size of the population of the United States.

In the UK, nearly half of Employment and Support Allowance claimants report a mental health problem as their primary reason for claiming benefits.

The political imperatives to address mental health and depression

The fact that mental health is far from achieving parity with physical conditions in the allocation of resources is a key challenge in addressing the crisis of depression.

Norman Lamb, Minister of State for Care and Support, Government of the United Kingdom, said that this imbalance between mental and physical health, has to change. Mental health always loses out. But it is not acceptable for people to live lives in misery, he said. In the UK, if you have suspected cancer you see a specialist within a fortnight, but if you have depression or an episode of psychosis you have no such right.

In its five-year vision on mental health, the government is setting waiting time standards for mental health services. From next year, people with depression will receive treatment in as little as six weeks and wait no longer than 18 weeks. A two-week standard to access treatment after a first episode of psychosis will also be introduced. However, these targets are still not good enough, some delegates later argued.

The economic costs of depression weigh heavily - the estimated cost of mental health to the UK economy is between ?70 and ?100 billion each year, arising from sickness absence, benefit provision and loss of productivity ?almost the entire funding for the NHS. Delegates heard how the Improving Access to Psychological Therapies (IAPT) programme has treated over 2.6m people, with over 1.5 m completing their treatment, and over one million reaching recovery. Over 90,000 people have moved off sick pay and benefits.

Businesses should also want happy and healthy employees, Mr Lamb said. It is "enlightened self-interest". Schemes such as the Mindful Employer initiative has seen 1,200 employers sign up to a voluntary charter, and the likes of Barclays, with nearly 140,000 employees, has agreed to support mental health at work as part of the Time to Change scheme.

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THE GLOBAL CRISIS OF DEPRESSION

SUmmary report

FIGHTING DEPRESSION ? THE CASE FOR PREVENTION AND HEALTH PROMOTION IN DEPRESSION

We need to create a healthcare system that treats a broken mind and a broken leg on an equal basis

Nick H?kkerup

David Kinder, Deputy Director, Workforce, Pay and Pensions, Public Spending Group, HM Treasury

I was lucky in that I got support from work when I had to take time off for depression. I'm now chair of the mental wellbeing network, and the treasury has signed up to the Time to Change campaign. It has had huge success and support from the top down, which sends a very important signal.

David Kinder

We face a global challenge, and mental illness has severe consequences for the individual and for society, Nick H?kkerup, Minister of Health, Government of Denmark, told delegates. It is a costly burden and it is crucial we deal with this problem effectively, he added.

Mr H?kkerup said that while everyone carries the responsibility for their own health, it is the role of the state and of society to better understand mental illness and try to provide the possibility of a better life for those suffering.

However, healthcare systems are a barrier. While Denmark is proud of its free and equal access healthcare system, when it comes to mental illness equality is an illusion, he said. He added that Denmark has invested massively in capacity and increased the training of personnel but it plans to do more, including improving the right to a fast diagnosis and making specialised treatment available close to where a patient lives.

Finding the key to beating depression

A supportive workplace is absolutely vital in helping those with mental health issues, David Kinder, Deputy Director, Workforce, Pay and Pensions, Public Spending Group, HM Treasury, told delegates.

He described his own battle with depression and how the reaction of his line manager was hugely important. Initially, he feared that his diagnosis might spell the end of his career but his manager came back with the model response and said: "We value you, we support you, we want you to come back ? but take your time." He returned to work gradually but some months later had a relapse. Again, his work supported him, and he came back in a phased way.

That was in 2009, and his last major episode. Mr Kinder told delegates that meditation, diet, and exercise have all helped him to build resilience, but just as important is how he manages his work environment so that he can delegate and get feedback from line managers, good or bad, so that he doesn't automatically fear the worst.

Mr Kinder is now Chair of the Treasury's Mental Wellbeing Network, aiming to help those in similar situations.

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THE GLOBAL CRISIS OF DEPRESSION

SUmmary report

FIGHTING DEPRESSION ? THE CASE FOR PREVENTION AND HEALTH PROMOTION IN DEPRESSION

Hans-Ulrich Wittchen, Chairman and Director, Institute of Clinical Psychology and Psychotherapy; Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Dresden Technical University

Industry and investors must be encouraged to engage in depression and mental health research as the core health challenge of the future."

Hans-Ulrich Wittchen

Carrying the weight: the burden of depression

Hans-Ulrich Wittchen, Chairman and Director, Institute of Clinical Psychology and Psychotherapy; Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Dresden Technical University, looked at the burden of the disease. Burden is a complex concept with different connotations, and covers the burden to the patient, caregiver, the health system, society and economy. He stresses, though, that the world should be used with caution ? it is not the sufferer that is a burden.

Mental disorders are the most impairing and disabling of all disease groups and current estimates already exceed WHO 2030 projections, he pointed out. We are failing to address the burden, in spite of the fact that diagnostic tools exist, and drug and psychological treatments are available. Only 30-52% of sufferers have contact with any health professional, only 8-16% have contact with a mental health specialist, and only about 10% receive minimally adequate treatment. Treatment is typically provided too late with a mean delay after onset of three years, predominantly when severe complications arise such as comorbid escalations, chronicity, or a suicide attempt.

While the absolute numbers of cases increase, there is no evidence that depression rates have increased over the past two decades. However, the situation will get worse because of the ageing population, he said.

Every year 38.2% of the EU population suffer at least for some time from a mental disorder as defined by the diagnostic criteria of DSM-IV

In 2010, 148 million workdays were lost every month due to depression.

In terms of the cost burden of depression, indirect costs account for over 63%. Much less is down to direct treatment costs (psychotherapy about 1%, medication 3.5%).

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