2.1.1 Brain Development and Children

The conditions a mother experiences during pregnancy can have lasting effects on their child's developing brain, ultimately influencing their lifelong physical and mental health. Positive early experiences provide children with a foundation for building sturdy brain architecture, which supports a broad range of skills and learning capacities throughout the lifespan (National Scientific Council on the Developing Child 2020). Exposure to early adversities increases the risk of mental disorders (Heim, Entringer, and Buss 2019; Arango et al. 2021; Solmi et al. 2022; Dragioti et al. 2022). Apart from obvious psychiatric conditions that affect about 10% of pregnant women globally, other environmental challenges such as living in a low socioeconomic status environment, exposure to infection or malnutrition can impact foetal developmental trajectories. Overnutrition and obesity during pregnancy are becoming a serious public health concern. Several epidemiological studies suggest that children of obese mothers are more likely to exhibit behavioural problems or be diagnosed with a neurodevelopmental disorder, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs) or developmental delay. Indeed, it is becoming apparent that prenatal metabolic stress is comparable to psychological stress as a risk factor for mental disorders (Musillo, Berry, and Cirulli 2022). Although accumulating evidence supports a direct relationship between nutrition, stress susceptibility, mental health and mental function throughout the lifespan, the evidence is correlational, and there is a major gap in our understanding of how these effects come about. Novel breakthrough findings on the bidirectional relationships between nutrition and brain functioning are urgently needed to inform public health policy on diet. Improved mechanistic understanding of how nutrition affects mental health and cognition will guide the development of new nutritional interventions and evidence-based advice that will promote and maintain brain fitness throughout life. The promotion of dietary habits that lead to better mental health, and the identification and validation of critical individual nutritional components, will improve sustainability in our healthcare systems and reduce the economic costs associated with poor mental health and cognitive decline (Adan et al. 2019; Higgs et al. 2024 – ECNP Nutrition Network).

2.1.2 Transdiagnostic and Translational Approaches for Brain Disorders

Diagnostic classification for mental disorders such as the current use of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and ICD-11 (International Classification of Diseases, 11th Revision) is based on common signs and symptoms. Both DSM-5 and ICD-11 rely on categorical diagnoses, where disorders are classified as distinct entities based on specific criteria. However, this approach can be rigid and fails to capture the continuum of mental health symptoms. The variation in symptoms, behaviours and other observable traits (phenotypes) among individuals with the same diagnosis or across different diagnoses of mental disorders highlight the complexity and diversity of mental health conditions, which often do not fit neatly into categorical diagnoses (Fountain, Winter, and Bearman 2012; Thomas et al. 2019).

Transdiagnostic approaches in psychiatry and psychology involve identifying and targeting underlying mechanisms and processes that cut across multiple mental disorders. Rather than focusing on disorder-specific symptoms, these approaches aim to address core factors that contribute to various conditions. Translational approaches bridge the gap between basic neuroscience research and clinical application. The goal is to translate findings from the laboratory into effective treatments, diagnostics and preventative measures for brain disorders. Emphasizing transdiagnostic and dimensional models may better capture the complexity of mental health issues, ultimately leading to more effective and personalized care. Transdiagnostic overlap refers to the presence of common symptoms, risk factors such as genetic predisposition (cross-disorder group of the psychiatric genomics consortium, cell 2019) and environmental factors and underlying mechanisms across multiple mental disorders (Kas et al. 2007). This concept challenges the traditional categorical approach of diagnosing mental health conditions as distinct entities and instead suggests that many mental disorders share similar features. Addressing translational gap will optimize biological knowledge and drug discovery for mental disorders (Dolmetsch and Geschwind 2011).

Social dysfunction is a common feature across various mental disorders, including Alzheimer's disease, anxiety, ASDs, bipolar disorder, depression, personality disorder and schizophrenia (Porcelli et al. 2019). By employing a transdiagnostic and translational approach, researchers aim to identify common biological and psychological mechanisms underlying social dysfunction. This approach leverages quantitative biology to develop more effective treatments and interventions. In the context of social dysfunction, quantitative biology seeks to quantify behaviours, brain functions and genetic factors that contribute to social impairments and subsequently uses mathematical models, computational techniques and statistical methods to understand biological processes. For instance, social dysfunction relates to shifts within socioaffective brain systems among schizophrenia and Alzheimer's disease patients (Porcelli et al. 2019; Braak et al. 2024). The EU PRISM project aims to provide quantitative biological measures to facilitate the discovery and development of new treatments for social and cognitive deficits (Kas et al. 2019). Recent studies indicate that alterations in Default Mode Network (DMN) connectivity are associated with social dysfunction across various mental disorders. These findings suggest that the DMN plays a crucial role in social cognition and that disruptions in its connectivity can lead to difficulties in social interactions (Saris et al. 2022; Peleh et al. 2020; Ike et al. 2024; Ronde, van der Zee, and Kas 2024).

2.2.1 Insights From a Caregiver Perspective

Prioritizing brain health in youth involves a holistic approach that includes promoting a healthy lifestyle, providing emotional and educational support, fostering strong relationships and encouraging balanced media use and healthy risk-taking. Caregivers play a crucial role in creating environments that nurture brain development and mental well-being. The caregiver perspective highlights the tremendous and too often hidden value of caregiving. Informal carers play a vital role in supporting people living with mental health conditions, yet comparatively, little is known about the economic value of caring.

To address this, a recent study conducted by the European Federation of Associations of Families of People with Mental Illness (EUFAMI) in collaboration with the Care Policy and Evaluation Centre at the Department of Health Policy, London School of Economics and Political Science (McDaid and Park 2022), undertook an online survey of 712 adult informal carers supporting adults with mental health conditions between August 2019 and April 2020. This survey aimed to better understand the impacts of caregiving on carer quality of life, levels of loneliness, finances and employment and to estimate the economic value of time spent caring. The study clearly shows that without the input of these (mainly close family) carers, some of support would need to be provided instead by health and social care systems. The study found that adverse impacts on quality of life, loneliness and personal finances were greatest among carers living with care recipients. On average, informal caregivers provide 43.42 h of care per week, with those living with the care recipient reporting a significantly higher mean of 65.41 h per week compared to 25.71 h per week for noncohabiting caregivers. The economic implications of informal caregiving are substantial, with mean weekly costs per carer ranging from €660 to €2223, depending on living arrangements, and annual costs ranging between €34,960 and €125,412. Also, approximately 43% of caregivers have reduced their working hours by an average of 20 h per week, 82% have curtailed leisure activities by 12 h and 33% have decreased the time allocated to education by 10 h per week. Furthermore, the psychological burden is also significant, with 27% of caregivers reporting a diagnosis of depression and/or anxiety and 40% experiencing feelings of loneliness and a diminished quality of life. Despite these substantial challenges, only 23% of caregivers have been asked if they require any assistance or support.

Although the significance of supporting caregivers and recognizing the value of their contributions is well acknowledged, further efforts are needed to bring this issue to the attention of policymakers.

2.2.2 Personal Testimony—Meaningful Engagement of Young People Living With Mental Health Conditions

Anastasia Benzahi was diagnosed with schizoaffective disorder 3 years ago when she was 23. Art is her unique way of exhorting her feelings and emotions when she feels overwhelmed. She uses art as her own therapy to feel better daily. Two of her paintings are featured in this article (Figures 1 and 2).

Anastasia Benzahi was also a speaker at the EBC meeting at 2024 FENS Forum.

2.3.1 Impact of Adverse Childhood Experiences on Child and Adolescent Mental Development: Current Research and Future Directions

Early live experiences shape our brains. Adverse Childhood Experiences (ACEs) have a negative impact on the developing brain. For example, the Prefrontal Cortex, Amygdala, Hippocampus, can be affected in volume or structure (Lotfinia et al. 2023). Studies have consistently shown that ACEs result in increased risks of physical and mental health problems (Chang et al. 2019; Felitti et al. 1998; Hughes et al. 2017). There is a correlation between the number of ACEs and the rate of increased risk of both mental and physical health problems (Chang et al. 2019; Felitti et al. 1998; Hughes et al. 2017). Luckily, parents can counterbalance by providing sensitive and responsive parenting and creating a safe environment for a child. Unfortunately, studies show that the parents of children with a high number of ACEs, on average, are more victims of early childhood trauma (Buisman et al. 2021; Cooke et al. 2021; Ma et al. 2022). Early childhood trauma often has a negative effect on parental skills. These negative effects can be caused by nature (epigenetic changes) or by nurture. The review in the Lancet Public Health showed that the annual costs from the effect of ACEs on the health outcomes measured were US$581 billion in Europe (Bellis et al. 2019). Therefore, it is in the interest of both the individual and society that prevention and trauma treatment should be a top priority. Trauma-focused treatment of children and their caregivers could break the enduring cycle of transgenerational trauma (Narayan, Lieberman, and Masten 2021). Further research is needed to investigate the impact of trauma-focused psychotherapy and pharmacotherapy on brain structures and activity, and on epigenetic changes.

2.3.2 The Value of Treatment, the Case of Autism

The results of the European Brain Council Value of Treatment study on autism care pathway in Europe stress the importance of early intervention (Mendez, Canitano, et al. 2023; Mendez, Oakley, et al. 2023). The UK National Institute of Health and Care Excellence (NICE) evidence-based guidance on recognition, referral and diagnostic assessment of autism in under 19 (NICE 2021) states that referral to autism diagnostic services should occur if worries regarding development or behaviour are raised by carers and that if the screening visit finds that symptoms indicate autism, a diagnostic assessment should start within 3 months. The earlier the intervention for autistic children, the better the prognosis. In addition, some early interventions are demonstrated to be cost-effective (Tinelli et al. 2023). The study results show major treatment gaps such as long waits from the time carers raised their first concerns about a child's development and/or behaviour until screening and confirmed diagnosis, delayed or no access to intervention once a diagnosis was confirmed, limited information about autism and how to access early detection services and deficient support for families throughout the journey. It is essential that early screening is provided to children by psychiatrists with the key role of primary care providers and paediatricians so that treatment can start early and improve the efficiency of the treatment received by this population. Despite autism's known societal and personal impact, Europe-wide consensus and support for early detection, diagnosis and intervention for ASD are lacking. The findings call for policy harmonization in Europe to shorten long wait times for diagnosis and personalized support and, therefore, improve autistic people and their families' journey experience and quality of life.

2.3.3 Rethinking the Management of Brain Disorders—The Case of Schizophrenia

Psychotic disorders, particularly schizophrenia, are severe mental illnesses associated with high rates of disability and functional impairment, causing significant individual burden and incurring high societal costs. Typical onset of schizophrenia is in late adolescence or early adulthood, and the complex management requires often life-long pharmacological and nonpharmacological treatment. Early symptom recognition and timely intervention can improve the course of illness and result in better outcome and prognosis; effective management leads to a functional recovery. However, recent reports have identified significant gaps in access to timely assessment and evidence-based treatment, with inadequate care pathways. Moreover, health services in many countries are currently facing an unprecedented demand for mental healthcare for young people. In the face of such demand, it can be challenging for health services to deliver high-quality mental healthcare, which, according to World Health Organization, should be timely, effective and evidence-based, safe and person-centred. There is a need to improve prevention and care of young individuals with first episode psychosis, to secure transition between various types of care tailored according to individual needs. In order to understand gaps and challenges, there is an in-depth patient care pathway analysis required to aid the development of specific strategies for advances in schizophrenia care. There is also a need for increased specificity of the components of integrated care included in youth mental health interventions, in order to consider the potential impact in different European countries' health settings and systems. Referring to a previous study (Mohr et al. 2018) and based on the data from mental health experts, users and their families, the EBC in collaboration with a Board of experts developed a survey that will review the state of care for people with schizophrenia in nine European countries. The results will help to guide the policy makers and mental health providers how to effectively help young people with psychosis.

2.3.4 Age Transitioning and Prevention

Age transitioning from adolescence to adulthood can be a stressful process, because this period reflects a lot of changes, including developmental (e.g., biological, psychological and social) changes, legal changes (e.g., becoming a legal adult at 18, doctor cannot communicate with a parents without the patient's consent, the patients themself have to ask for appointment and before the parents could arrange it) and lifestyle changes (e.g., more independence, move away from home but financially, they are often dependent on their parents). A big part of mental disorders starts before age 18, for example, all neurodevelopmental disorders, several anxiety, mood and eating disorders. Young people with mental disorders are particularly vulnerable during the transition period. Furthermore, mental disorders can emerge during their transition into adulthood. It is very important not to lose young people with mental disorders from the healthcare system during the transition period, whereas there can be severe consequences of untreated mental disorders including impaired academic and occupational functioning, social withdrawal, substance abuse and increased risk of suicide. Therefore, transition in the healthcare system needs to be a targeted, planned transfer that starts long before it happens and that takes into account developmental and disorder-specific needs. Ideally, it should take place at a time when the disorder is stable and the transferring and receiving health care teams should meet with the patient and family together.