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The annual cost of mental health conditions in the UK is estimated to be almost £118 billion, more than public sector expenditure on education this year. Public attitudes to mental health have transformed, as increasing numbers reject the stigma historically attached to conditions such as anxiety and depression. A 2021 survey of more than 6,000 people found that, compared to five years ago, 83 per cent think it is more socially acceptable to discuss mental health.

One of the implications of this shift in social norms is that our health and social infrastructure is creaking under the pressure of increased demand. Simply allowing this degree of need to go unmet is not an economically sound strategy - the annual cost of mental health conditions in the UK is estimated to be almost £118 billion, more than public sector expenditure on education in 2021/2022.

Covid-19 has only exacerbated the depth of the problem. A study in the Lancet medical journal estimated that globally there were around 53 million more cases of depression in the wake of the pandemic, a 28 per cent increase. Workforce issues are also impacting the availability of mental health services, with calls for more psychiatrists to be trained so that long waiting times can be tackled. Given the resource-intensive nature of many therapies, what mix of treatments is likely to represent the most cost-effective strategy given other pressures on health and social care budgets?

It has been noted that the flurry of R&D activity in the 1950s and 1980s (which led to the development of antidepressants and antipsychotics) has not been followed by similarly significant breakthroughs in pharmaceutical treatments in recent decades. Yet, at the fringes, we are starting to see new, sometimes controversial interventions being developed as alternatives or complements to existing treatments, such as the use of hallucinogens to treat depression or virtual reality to tackle conditions such as post-traumatic stress disorder. Earlier this year, startup Clerkenwell Health opened Europe’s first commercial facility for psychedelic drug trials in London, with the goal of making the UK a global leader in the field.

If attitudes to mental health have evolved significantly over recent decades, an even more rapid shift has taken place in our awareness of the impacts of loneliness at the societal and individual level. In response, Prime Minister Theresa May launched a loneliness strategy in 2018, and the UK even created a ‘Minister for Loneliness’ to spearhead change.

While the exact relationship between loneliness and health is still somewhat unclear, it is estimated to be as harmful over the long-term as smoking 15 cigarettes a day. The underlying drivers of loneliness are also poorly understood, varying significantly between individuals. But long-term trends around the use of digital technologies, remote working and an ageing population point to the need for a sustained policy focus on how best to support strong social connections. In common with mental health, identifying the best evidenced, most affordable and scalable interventions to achieve this will prove a complex task.

Our contributors believe it is time to open our minds to new approaches. Imran Khan sees a pressing need to dislodge political inertia around the potential of psychedelics, whilst Professor Daniel Freeman argues that virtual reality treatments should feature more prominently in the therapeutic toolkit over time. To counter the rising tide of loneliness, Alex Smith calls for renewed investment in our social fabric, funded by a levy on automated retail transactions.

All in the mind was published as part of Minister for the Future, bold new thinking on the long-term issues policymakers can't afford to ignore, in partnership with Prospect. Illustrations by Ian Morris.

Psychedelics: Expanding the therapeutic toolkit

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