This is a significant change in a field that, in recent decades, has looked at neurological and psychiatric illnesses exclusively from a biomedical point of view. The spectrum that covers mental illnesses has caused a substantial increase in the number of deaths and disability in the world. This is what led the researchers, authors of article published in NEJM Catalyst, to propose a multidimensional and multidisciplinary approach to replace the current one. The brain is an organ of enormous complexity: it controls our thoughts, memories, emotions, motor skills and personality. A healthy brain is the key to living longer and with purpose, which is why it is so urgent to innovate in this area. In the US alone, mental health issues impact 100 million Americans and cost 800 billion dollars a year.
The concept of the biopsychosocial model, which analyzes not only the weight of biological, but also psychological and social issues in the development of a disease, was created in 1977 by psychiatrist George Engel. However, its use did not have the reach it should have. Factors such as access to the health system, relationships, resilience and prejudices or stigmas, among others, were not considered relevant to brain health. It is worth adding that the term exposome was coined in 2005 to designate the totality of situations to which human beings are exposed during their trajectory, from conception to death. It is based on three domains, starting with the internal, which is unique to the individual: age, physiology, genome. The other two are general external conditions (socioeconomic and sociodemographic) and specific external conditions such as diet, occupation, lifestyle. They are complementary concepts.
A change of this magnitude will require a public policy of care that protects the citizen from the womb to the end of life. Building “protective factors” would include campaigns for a healthier lifestyle, support to stop risky behaviors, development of adaptive and overcoming skills, primary care for early problem mapping. Promoting patient functionality is a way to reduce stigma and improve people’s emotional well-being and independence. This is not a utopia. In Finland, in 2009, the first study based on biopsychosocial intervention was carried out – which included exercise, diet, social activity, monitoring of cardiac risks and cognitive training – with positive results. Other initiatives, such as the Barcelona Brain Healthin Spain, and the APPLE-Tree, in the United Kingdom, are ongoing. May they bear fruit!