GLOBAL MENTAL HEALTH

Mental Health Over the Life Course

Lecturer: Dr. Christopher Kemp

In this lecture, I’m going to talk about mental health over the human life course.

What changes in our brains as we age? The field of neuroscience talks about three phenomena:
plasticity, pruning, and senescence.

Plasticity is the brain’s ability to change and adapt as a result of experience. In early childhood,
the brain is highly plastic and prone to change. This is a critical period for healthy development
and highly predictive of good mental health later. Brain plasticity decreases from birth to
adolescence. Pruning is when the brain reduces and focuses its synaptic connections: this peaks
during adolescence. And finally, senescence is when the brain function starts to diminish.

This starts during adulthood and progresses through the end of life. Combined, these three
things, neuroplasticity, pruning/differential maturation, and senescence, give rise to the
biological substrate of the brain, which is responsible for mental health and mental disorder.

Based on the interaction of these three processes at different points in the life course, there are
critical environmental and social exposures that have important consequences for mental
health.

It's very interesting to note that if you calculate the prevalence of mental disorders, we see that
during the critical periods there is a high incidence and prevalence of mental disorders early in
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life as well as late in life. Brain functioning and the way brain matures has a lot to do with these
mental disorders and conditions. Environmental factors also play a very large role, particularly
early on.

Patel et al., 2018, Lancet Commission Report

For example, in early childhood, stress caused by adversity can lead to mental disorder later in
life in later life. MRI studies have shown that development of the brain’s grey matter changes
depending on family income and socioeconomic status during early childhood. Conversely,
interventions targeting parents and seeking to reduce adversity and early life stress can
improve subsequent mental health outcomes among children.

Most of the attention in our field gets placed on meeting the needs of adults with mental
disorders, leaving the needs of children significantly under-addressed. However, there's a really
high burden of mental illness among kids—about 10 to 20% of children worldwide will
experience a mental, neurological, or substance use disorder. (GBD 2017) Mental disorders are
the leading cause of disability among youth ages five to 24 years. (GBD 2017) And even more
importantly, most mental disorders in adults start to manifest during childhood and
adolescence.

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Unfortunately, there is a severe shortage of child mental health professionals. Let me give you a
comparison: there are more child psychiatrists in the entire state of California than in the whole
continent of Africa. So, there's a really big discrepancy between how many mental health
professionals are available in these countries compared to high-income countries.

There's also an inequity in service provision within and across countries, which means there’s a
large mental health treatment gap between individuals who need services and those who
receive them. This gap is substantially worse for children. Less than 1% of kids with mental
health needs receive care. (GBD 2017) That's a staggering statistic. That's like saying if one in
five kids has a mental illness, one in 625 kids is going to get care. Like the service gap, the
evidence gap for child mental health is huge as well. While 90% of children live in low- and
middle-income countries, only 10% of mental health trials in children come from those
countries. (GBD 2017) Consequently, there are low levels of detection of child mental health
disorders, resulting in a limited application of current diagnostic categories and a lack of
culturally appropriate and validated instruments.

In this lecture we introduced the life course perspective on mental health, discussed how the
brain develops over the human life, and described the gap in child mental health services
globally.

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