Themes

ROAMER is structured around seven themes, representing all of the major disciplines in the field of mental health and well-being research in Europe.

Geographic, clinical, multi-disciplinary and life-course integration

European countries have high and highly variable rates of mental disorders, especially in urban and minority populations. This makes it difficult to get precise information on when and how to intervene. In addition poor access to prevention and to mental health care, elevated levels of chronicity, lack of treatment options, unreliable quality and high costs are difficulties that need to be addressed by and overall research strategy at the European level in order to integrate and promote mental health research. Lack of a coordinated approach to integrate and promote mental disorder and mental health research results in fragmented mental health-care delivery systems; skewed distribution of resources; a long and unpredictable route from basic discovery to potential therapeutic applications; a slow uptake of novel, effective and patient-centred ways of delivering mental health services; the absence of efficient promotion and preventive interventions.
In order to overcome the non-integrated state of mental health research in Europe, it is necessary to set up a methodology to acquire and organize the knowledge regarding current mental health research activities; to develop methodologies for life consultation, e-surveys and on analysis; and to integrate, harmonize, maintain and update the knowledge gathered.

Structuring of research capacity, infrastructures, capacity building and funding strategies in mental health research

Mental health research covers a wide range of disciplines from social science, psychology and cognitive sciences to genetics and biomarker research, imaging, basic neuroscience, animal models, translational research, clinical research, cohorts and epidemiology, and public health research. Insufficient and uncoordinated communication between disciplines often results in fragmented approach to mental health, with a risk of dilution of its components in broader disciplines. As a result, the development of integrated research centres and networks in mental health is lagging behind other disciplines. Although mental disorders generate a major burden for healthcare systems and society, the funding allocated to mental health research appears to remain in most countries at a very low level.
Evidence underlines that there is major need to analyze the funding mechanisms devoted to mental health and well-being research, not only regarding the total amount of funding available, but also the precise mechanisms for funding. By way of coordination actions, therefore, we need to extend our search beyond mental disorders in a narrow sense to the examination of mental health issues in somatic diseases as well as life-style and health risk behaviours.

Biomedical: Neurobiological, pharmacological and clinical research

Recent advances in neurobiological research allow us to indentify neurobiological mechanisms never investigated before. Genetic research has identified novel genes associated with major mental disorders and functional studies are elucidating neurobehavioural mechanisms underlying major psychopathology. Evidence suggests there is a common neurobiological basis for vulnerability as well as for the resistance to mental disorders. However, there is still a serious gap between our knowledge of basic mechanisms, processes and pathways on the one hand and treatment of medical disorders on the other hand.
To achieve progress in the area technical platforms are envisioned where novel gene variants and biological substrates linked to susceptibility for specific symptomatology can be investigated in depth. Thus, it is necessary to promote research to develop both bioinformatics and models to understand how stressful information is being processed.  A structured European approach to biomedical mental health research which combines the socio-cultural benefits of a broad European approach with state-of-the-art neurobiological, pharmacological and clinical research has the potential to considerably advance biomedical research on mental disorders.

Psychological research and treatments

Psychological treatments and interventions comprise a large group of methods and approaches to address the needs of patients and groups of patients with mental disorders or mental health problems, as well as their networks of support as it applies to prevention, treatment and rehabilitation. The effectiveness of strictly psychological treatments is well established of variants of cognitive behavioural therapy (CBT) in the area of many mental disorders. However, there is still a general lack of understanding about the basic mechanisms of behavior, the behavior change in the specific context of CBT, and a fundamental lack of knowledge about the situation of research on psychological treatments and interventions in Europe.
Therefore ROAMER coordination strategies for promotion and integration of research in the field of psychological research and treatments include developing a consensus about terminology and concepts; collecting existing data on psychological and psychosocial treatments in Europe; developing a map of existing research centres and programmes involved in psychotherapy research as well as more broadly psychological and psychosocial interventions; developing a methodology to identify gaps between science, evidence-based psychological methods and their application and delivery in routine care; and the integration of knowledge and insight gathered.

Social and economical aspects (including stigma and discrimination)

Nowadays it is clearly undisputed that the social and economic consequences of poor mental health across the life course can be profound. While methods have been developed to quantify these costs, so far little attempt has been made to estimate many other health, social and economic consequences of poor mental health. For instance, remarkably little research has been undertaken in Europe to quantify the economic impacts of co-morbid mental and physical problems. Major gaps also remain in our knowledge of the cost effectiveness of mental health promotion, prevention and rehabilitation interventions.
In order to move beyond the current state of the art it will be essential, initially to conduct rapid reviews on what is currently know about the broader social and economic costs of poor mental health in Europe. In addition, an inventory of which programmes against social exclusion, stigma and discrimination has been evaluated to determine appropriate indicators and establish outcomes. Further work is required in the domain of supported employment schemes that have been shown to be effective in helping people return to work and further research is also needed to disclose other options besides work that may be cost-effective and able to strengthen skills and confidence which have important roles in recovery. E-health and M-health are new approaches relevant to new forms of care provision, research infrastructure, public health research and dissemination.  Work needs to be produced with participation of relevant stakeholders to identify how information and communications technology can support the delivery of known interventions in clinical research settings. Work to be undertaken will also include the creation of new metrics to evaluate e- and m-health programmes; designing and testing end-to-end scalable solutions across EU member states; and the design and evaluation of web- and mobile-based dissemination of research results to EU citizens.

Public Health: Epidemiology, health services research, promotion, prevention

In spite of the importance of mental health for public welfare, mental health research in the public health research field is scattered and European-level coordination is missing. Data in existing national public health infrastructures, such as health registers, are rarely used for European-level studies. As a result of the lack of research coordination, Europe lacks even the most fundamental bricks for evidence-based mental health policy.
The coordination activities in this area centres on research needs in mental health epidemiology, mental health services research, prevention research in mental health, mental health promotion research and mental health policy analysis. ROAMER will provide a coordinated research action plan outlining the research needed to establish an evidence base for national mental health policies and an EU mental health strategy.  Particular focus will be on how public health research can address the situation of poor treatment and our general lack of knowledge on service provision and mental health promotion is organized in European countries. Additional research needs to be promoted and integrated to fill in the gaps in our knowledge about positive mental health in work life, the effect of mental disorders on vulnerable and disadvantaged groups. There is also need to promote research on the distribution of mental disorders across socio-economical groups.

Well-being

Well-being reflects individuals’ perception and evaluation of their own lives in terms of their affective states, psychological and social functioning. From a health perspective, concept and measure of well-being goes beyond the concept of health considered as the mere presence or absence of illness or disability; it also incorporates the impact of positive health and functioning which has typically received little attention in health sciences. From both a policy and a health perspective, well-being is an important outcome in and of itself. However, despite the fact that measures of well-being could provide an important source of information for comparative effectiveness analyses of behavioural and biomedical interventions, they are currently lacking from most intervention trials.
The field of well-being research lacks a consensus on important questions of measurement and cross-national comparability. It is needed to identify accurate means of measurement at both the individual and the population level; to identify barriers for incorporating well-being measures into intervention studies; to understand the mechanisms and pathways through which aspects of subjective well-being impact health outcomes, to identify modifiable factors in individuals or societies that might be potential targets for intervention.
The main goal of a coordinated and integrated research roadmap for well-being in Europe is to identify ways of increasing our understanding of how health status or other relevant life circumstances impact the various components of subjective well-being. This will include an exploration of the relationship between well-being and specific mental disorders, requiring an interdisciplinary approach.