Dr. Rudolf Uher sometimes feels disheartened trying to help his adult patients. As a psychiatrist, first in London and now in Halifax, he sees the most serious cases of anxiety, depression or psychosis.
By the time patients arrive in his office, they have typically been living with their symptoms for years, and their problems are difficult to treat. Often, his patients who are parents will express a quiet worry. "I see myself in my daughter," they might say. Or "my son is just like me." Uher worries as well: Like a runner chasing a departed bus, isn't he trying, too often, to catch the problem too late?
Early intervention is the holy grail of mental illness – a goal the public system aspires to, but less often delivers. People struggling with mental disorders do better the earlier they get help, and yet, while the symptoms typically emerge at a young age, treatment often doesn't happen until much later.
Part of this is resources: Wait times are still too long even for patients in urgent need. But the science also still has puzzles to solve. Mental illness has a strong genetic component that burns through families – Uher's patients regularly report mothers, grandparents and uncles who were sick before them.
The likelihood of developing a mental-health problem is also influenced by the environment in which a child is raised. For the sons and daughters of Uher's patients, there's a one-in-three chance of developing a serious mental illness. But which child among three will that be? And if we could find them, how would we help them?
Uher, now a researcher at Dalhousie University, is trying to answer both those questions with a landmark study that this week has earned him the Royal-Mach-Gaensslen Prize for Mental Health Research, an annual $100,000 prize given to a promising Canadian mental-health researcher. Uher's team is closely following 300 children of different ages into adulthood, a cohort he hopes to increase to 500 over the next few years. Starting with the babies in the study, researchers are monitoring areas such as temperament, and how the infants react to new objects or situations. For the older children, they are inquiring about anxiety and depression, and hallucinations. Uher cites research in New Zealand that found that at the age of 11, about 15 per cent of all kids report "unusual experiences," such as hearing voices.
"You don't learn without asking," Uher says. "Children very quickly learn not to share because they get a weird reaction."
In the meantime, Uher has started an intervention that provides eight to 16 sessions of psychotherapy over three months to high-risk children between nine and 12 years old whose parents have a serious mental illness. (Another one for preschoolers is in the works.) Uher described a teenage girl, for example, who was afraid to cross the street but overcame that fear after the intervention. "We spent a lot of time on the road," Uher says.
The therapy – described to the participants as a "coaching course that will make them stronger" – also teaches skills the young patients can apply to other anxiety-inducing situations, hopefully preventing those symptoms from escalating into a clinical diagnosis.
"It is a very meaningful task," he says, and a tall order. "Having seen so many people so badly affected by mental illness, this is the opportunity to make a bigger difference."