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World Mental Health Day: Q&A with Professor Rob Howard

The BRC spoke to Professor Rob Howard, Mental Health Theme Lead and Professor of Old Age Psychiatry at UCL, on World Mental Health Day about better treatments for people with dementia and psychosis.

1.            What impact do you hope your research has on people with mental health conditions?

I work in the dual fields of dementia and mental health disorders in older people such as depression, psychosis and anxiety; and I hope that the clinical trials and studies that we have conducted have provided better and more evidence-based treatments. For example, in the DOMINO trial, we showed that withdrawing a commonly-prescribed Alzheimer’s disease (AD) drug from people in the advanced stages of the disease doubles their risk of being placed in a nursing home within a year. As a result, clinicians now continue treatment into the late stages of AD. With my colleague Dr Suzanne Reeves, we showed with PET scanning that extremely small doses of antipsychotic are sufficient to block sufficient dopamine receptors in the brain to have an antipsychotic action without significant side effects in AD patients who have symptoms of psychosis.

2.            Are there specific scientific developments and/or technologies that have made your research possible?

Most mental health research that has led to improvements in treatments for our patients has been unashamedly low-tech. The PET study mentioned above is an unusual example. Developments in clinical trial design and the availability of good clinical trials units, excellent and friendly statisticians and the NIHR structures that support trial recruitment within the NHS have all been crucial to the success of my studies. 

3.            What do you think the next big breakthrough will be in our understanding of mental health?

We are long overdue on big breakthroughs in mental health. When I look at the advances in our understanding of fundamental neuroscience and the new treatments that have appeared in neurology over the last couple of decades, the potential for mental health is striking. Yet, the knowledge base that I was given when I qualified as a doctor in 1985 is (sadly) completely adequate to practice in 2017. We have had no new fundamental understanding of our patients’ disorders and all of our current drug treatments were essentially discovered in the 1940s and 1950s. Things have to change and I suspect that a single serendipitous finding - maybe a repurposed compound, will lead to the next jump ahead. UCL is just the most fantastic place to work if you want to be at a major junction of world-class neuroscience, mental health and translational research, together with great clinical partners at UCLH and Camden and Islington Foundation Trust, and is a highly likely place to see such breakthroughs. I’m excited by UCL’s plans for a new Institute of Mental Health to bring together all of our researchers at St Pancras Hospital.

4.            What made you chose a career in mental health research?

I think you have to share something of the feeling of being an outsider to choose a career in psychiatry. I love the stories of my patients’ lives and I don’t think that there is another medical specialty that gives the opportunity to travel alongside the people that you are caring for. The rewards are great and, despite our antique treatments, most of our patients get better.

5.            How can patients and the public help researchers discover more about mental health research?

Traditionally, mental health patients have been under-represented in research. It is still more difficult to recruit people with mental health diagnoses or dementia into clinical trials than it is for more medical conditions. Participants in clinical trials – even if they end up being randomised to placebo – almost always do better than patients who aren’t in trials, so there are good selfish reasons to get involved. The public can help by donating to mental health charities that support research. Sadly, people are generally much less generous to us than they are to the cancer or heart disease charities. Every family will be affected by a mental health disorder at some point and we need to give mental health research the priority it deserves to move things on.