Lewis Wolpert: 'Almost every family in the land will at some time be affected by mental ill health. It's shocking how little the public understands about it'

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The Independent Online

Considering how much everyone cares about their health it is surprising, even shocking, how little the public as a whole knows and understands about medicine and particularly mental health. What is even worse is that there are very few studies by the relevant authorities, from the Department of Health to the Royal Colleges, to find out what actually is understood. Their interest has been on attitudes, not understanding.

Science does go against common sense, but many of the misunderstandings are just due to ignorance and the influence of the media. A survey found that almost half of those asked thought that tomatoes do not have genes unless they have been genetically modified. And my own questioning of friends about the difference between viruses and bacteria found that they know that one does not take an antibiotic for an illness caused by a virus, but not a clue that a bacterium is alive, a cell, while a virus is dead and contains the code for replication when it infects a cell.

There is also evidence that patients have poor recall of what the doctor has told them and a very poor appreciation of the probability and risk - they often see 8.9 per 1,000 as a lower risk than 2.6 per 1,000. There is again a very poor realisation of the importance of randomised clinical trials. As the Nobel prize-winner Sir Peter Medawar pointed out, "If a person is poorly, receives treatment to make him better, then no power of reasoning known to medical science can convince him that it may not have been the treatment that restored him to health."

Mental health literacy by the public is of the greatest importance but sorely neglected. Almost every family in the land, as the Royal College of Psychiatrists points out, will at some time be affected by mental ill health. "Literacy" in this area means recognising the different forms of mental illness; the risk factors and the causes; the role of self help; and when and from whom to seek professional help. There is virtually no research about such literacy in the UK, and the general public does not apparently perceive psychiatrists as medical doctors, and what little reference they get in the press is usually negative. Of more than 330 health-related articles in the UK press, only 47 were about psychiatry and of these only 11 per cent were positive, and 64 per cent negative. Studies from Germany and Australia found that the public believes that mental health professionals can help with schizophrenia but not depression, but patients who have received professional help for depression have more confidence in the value of medication. The use of anti-depressants is opposed by various groups and individuals for reasons that are hard to understand; there are those who wish to persuade the public that they are both dangerous and lead to dependence, as promoted recently in two totally irresponsible Panorama programmes. Anti-depressants have helped many thousands and saved many lives as well. Such attitudes possibly reflect hostility to the pharmaceutical industry as well as a belief that it is psycho-social rather than biological factors that are the causes of mental illness. Natural remedies rather than medication are very often favoured. Even the Nuffield Council on Bioethics, in its report on the genetic basis of mental illness, argued that one could not really identify genetics as a key cause separate from environmental influences, and insisted that the patient be viewed as a whole. This totally ignores the overwhelming evidence for the major role of the effect of genes on mental illness.

Is it not shocking that there is no insistence in the national curriculum that children should be introduced to mental health literacy? It is mental illness that they are most likely to encounter; and in Northern Ireland the mental health group Aware Defeat Depression has an excellent programme to explain mood changes and depression to school children. And in some American private schools children can be asked questions such as: in 40 words give your opinion as to why suicide has tripled since your parents were your age; describe one possible theory that could explain anorexia; true or false - a person suffering from schizophrenia has multiple personalities.

I am thus delighted with the Newcastle Declaration last year, supported by many health organisations, which called for a significant improvement in the public understanding of psychosis (apparently the least stigmatising term), and that every 15-year-old should be equipped by mainstream education to understand and access help for psychosis.

Lewis Wolpert is Professor of Biology as Applied to Medicine at University College London

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