Associate Professor Mara Violato

“One doesn’t necessarily need to be a medical professional to contribute usefully to mental health research”

Associate Professor Mara Violato

Health Economist

There’s no doubt, I think, that my Italian, family-oriented, Catholic upbringing has to a significant degree shaped my personal values and the choices I’ve made so far in life. During my years at high school and university, I did voluntary work in the local parish where I grew up (Padua, in the Veneto), working a good deal with children and adolescents as a leader of educational and community-based activities. My goal was to help them develop their skills as well as their spiritual life. I’ve always loved working with children: they’re so full of energy, creativity and potential – and I’ve always managed to relate well to them (except when they were being naughty – which I’m afraid to say was fairly often – and ran after me, during summer camps, brandishing all sorts of slimy animals: like little frogs and lizards, which I dreaded!). This voluntary work in the parish made me very aware that even in a pretty middle-class suburb in the relatively affluent North-East of Italy, not every child had equal opportunities in their early years. Here, low socio-economic status seemed to play a significant but relatively unacknowledged role. Some of these children and adolescents also manifested behavioural and conduct problems (including the bullying that went on among – done both by and to – teens), but addressing those issues was well beyond the scope of the voluntary work I was then involved in. Nevertheless, it was in those early years that I felt something nascent started to take shape: of wanting to do some good in the way of achieving, in however small and individual a way, a measure of social or societal justice; and that desire or want is something that’s never left me.

At university (Ca’ Foscari, in beautiful Venice: I was very fortunate!), I chose to study Economics, because – being a quantitative social science – that subject brought together my love of numbers (I adored maths and was, I think, quite good at it) and my affection for other people. After graduating, a scholarship allowed me to move to the UK and obtain first an MSc and then a PhD in Economics. Before then I had hardly travelled abroad, so I was over the moon at the opportunity not only to be able to continue my studies but to do so in the UK: nation-state of so many famous economists! But when it came to food and drink I was somewhat naïve. I wasn’t aware that in the UK it was then so difficult to get hold of a decent cappuccino or espresso, which at first was quite off-putting (bear in mind that the yearning for good coffee runs deep in an Italian). And my additional request for a brioche in the canteen queue was met with blank-faced incomprehension. Britain was then still some way off from fulfilling its foodie revolution, and my assumptions that I could live as I had done in Italy were soon dashed. But there were compensations. During my doctoral studies, I had the opportunity to teach undergraduate and MSc students, and loved it; and in fact my first job, after my post-graduate work, was as Teaching Fellow in Economics at the University of Dundee, in rainy Scotland. Despite Dundee’s reputation as “the sunniest city in Scotland”, getting used to those overcast skies for most of the year was another challenge, so in the end I escaped to “sunnier” England!

I took up a new position at the Health Economics Research Centre (HERC) at the University of Oxford, where after many years I am still working. My first research undertaken at HERC centred on investigating the socioeconomic determinants of poor child health in the UK using econometric (i.e. statistics applied to economics) methods and data from a large UK birth cohort study, the Millennium Cohort Study. What intrigued me most of all was research in which I looked at the negative impact of low family income on child mental health, and the exploration of the mechanisms underlying this relationship. My initial Italian voluntary work experiences came in handy here as I looked for fresh insights in my research findings.

Serendipitously, and quite by chance, I then found myself working with Cathy Creswell – and from that moment on, the economics of child mental health became one of my favourite strands of research. The good news is that one doesn’t necessarily need to be a medical professional to contribute usefully to mental health research. As a health economist, I conduct economic evaluations alongside several randomised control trials of treatments for child anxiety led by Cathy. For new clinical treatments to be approved for rollout in the NHS, it’s necessary to prove that they are not only clinically effective, but also good value for money. So this is where medicine meets economics, and this synergy is in effect the coalface where clinicians work alongside (rather than in opposition to!) health economists to identify not only clinical but also cost-effective treatments that can be afforded within the often limited NHS budget in order to improve the health of the general population.

I find this work extremely interesting and valuable, because it makes a real contribution in improving the mental health of children and young people. And I enjoy moreover the multidisciplinary nature of this research, in which clinicians, statisticians, health economists, qualitative researchers, members of the public and patients, all come together collaboratively to try to find solutions to improve the mental wellbeing of the young population

As a health economist, I contribute also evidence-based analyses of the long term negative consequences and costs to the individual, their family, the NHS and wider society of untreated mental health problems in childhood. I can do this by analysing large birth cohort study databases linked to educational and administrative healthcare data using econometric methods. I can therefore quantify the impact that poor mental health in childhood may have on educational achievement, patterns of later employment and use of healthcare resources in adulthood. It is always helpful – even essential – to make the economic case to persuade policy makers to invest resources in key health care and educational sectors. So, I think of my current research as a natural extension of my early desire to do some good, however modest it may be, in society at large.

Being a researcher can be exciting and rewarding – endlessly challenging, in fact – but can also at times be frustrating, with disappointments aplenty. For what it’s worth, my advice to those at the start of their careers might be: be persistent and patient, follow your interests, passion for what you believe in and instinct for what’s worthwhile and – this above all – never give up!

I would really like to see more emerging economists engaging with the fascinating, multidisciplinary and impactful area of mental health research in youngsters. I’ve never looked back, and neither I believe – should they choose to travel this road – will they!

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