Featured Topic: Introduction to Global Mental Health at UW
The last decade was one of considerable change and development for the global mental health field. In 2007, The Lancet medical journal featured a series of articles related to global mental health, marking a “call to action” that is widely considered to be a catalyst for the growth in visibility and legitimacy of mental health as an important focus of global health work.1 In 2008, the World Health Organization (WHO) published the Mental Health Gap Action Program (mhGAP), a guide for managing mental, neurological and substance use disorders that accounted for the greatest burden of disease. Around this time, international aid organizations and research organizations responded to the need to “scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes”.2 The 2011 publication of the Grand Challenges in Global Mental Health helped set the agenda for funding and action for the subsequent decade. Over the years that followed, numerous universities established centers of global mental health, the promotion of mental health and wellbeing were included in the United Nations’ Sustainable Development Goals, and knowledge of the global burden of mental disorders became more widespread. The joint World Bank-World Health Organization 2016 meeting, “Out of the Shadows,” re-affirmed the role of mental health in the global development agenda. The importance of mental health was also catching the attention of other stakeholders and became increasingly more visible on the agenda of the World Economic Forum. In 2018, the Lancet Commission on Global Mental Health and Sustainable Development outlined a blueprint for action in global mental health, expanding the vision from closing the treatment gap to addressing the mental wellbeing of whole populations and improving preventative approaches.3 The WHO’s Mental Health Action Plan 2013-2020 expires this year, leaving room for much discussion about the shifting priorities in global mental health work45. After such a meteoric rise to prominence, the field of global mental health is entering the new decade as a public health, political, and human rights priority.6
We as leaders, educators, students, or supporters of the field of global mental health have work to do. Here at the University of Washington, a Global Mental Health Program bridges the Departments of Global Health and Psychiatry & Behavioral Sciences under the leadership of Dr. Pamela Collins. While we are working to increase research, coursework, and engagement opportunities on campus in Seattle, we feel it is important to find a way to regularly engage with the larger global mental health community. This newsletter is the inaugural issue of what we hope can be a monthly publication, highlighting research, projects, policy developments, and events locally, and globally. Each issue will include ways to engage with us and fellow readers. Please don’t hesitate to contact us with issues, work, or events in the field of global mental health that you’d like to see included in future editions.
- Patel V, Prince M. Global Mental Health: A new global health field comes of age. JAMA. 2010 May 19. 303(19): 1976-1977.
- World Health Organization. mhGAP Mental Health Gap Action Programme. Geneva: World Health Organization; 2008. 37 p.
- Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. The Lancet. 2018 Oct 9. 392(10157):1553-1598
- World Economic Forum. Mental Health [Internet]. Geneva: World Economic Forum; 2020. [updated 30 Jan 2020; cited 31 Jan 2020]. Available from: https://www.weforum.org/agenda/archive/mental-health/
- World Health Organization. Mental health action plan 2013-2020. Geneva: World Health Organization; 2013. 48 p.
- Horton R. Offline: A perilous birthday party for mental health. The Lancet. 2019 Nov 9. 394(10210): 1696.
Spotlight: Pamela Collins, MD MPH
Q: What are the goals of the GMH program at the University of Washington?
With the start of 2020, my colleagues and I are beginning to implement our strategic plan for UW Global Mental Health. Our overarching goal is to help reduce the suffering related to mental health problems in low resource settings around the world. To do this, we develop, test, and build capacity to deliver contextually-appropriate and sustainable models for mental health interventions with local and global partners.
Our three strategic directions are to 1) understand mental health intervention gaps and opportunities in the places where we work, 2) build workforce capacity to deliver mental health services, and 3) elevate mental health on the global and local agenda.
We can’t do this alone, of course. We particularly value building and deepening our network of collaborations with partners here at UW, in Seattle and King County, and around the globe.
Q: What projects are you most excited about within the program?
I’m excited about all of our work. Our faculty and staff are involved in a broad range of projects, many of which focus on extending access to mental health care by integrating various mental health interventions into schools, community-based primary care clinics, maternal and child health settings, HIV care settings, etc.
Over the past month, several of us have been very actively involved in supporting the World Health Organization (WHO) as it launches its Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. Our current role is to work closely with the first 6 countries selected for the Special Initiative (Bangladesh, Jordan, Paraguay, Philippines, Ukraine, and Zimbabwe) to conduct situational analyses of their mental health systems.
This has been a wonderful collaborative learning experience. We presented the preliminary synthesis of information in Geneva a few weeks ago, and we had the opportunity to hear each country team’s emerging priorities for the initiative. We are now in the process of working with our country partners to finalize these snapshots of mental health services in their health care systems and communities.
Q: What advice would you have for someone looking to get more involved with global mental health?
I would say this is a great time for getting connected. One option for connecting is to choose a global mental health conference to attend annually. Another is to stay abreast of what’s happening by joining global networks that advocate for mental health. The Movement for Global Mental Health is one such network. Similarly, the Mental Health Innovation Network is a Web site that indexes and displays a variety of mental health interventions from around the world. They also host webinars from time to time. You can register at the site and receive notices of upcoming events.
If you want to plug into global mental health activities locally, stay tuned to this newsletter and to our UWGMH Web site. Our program faculty and staff can also help you connect to their projects. As you explore the landscape—both locally and globally—look for mentors or advisors who can help guide you.
Q: What do you believe is the most pressing issue we face within the field of mental health?
A: That’s a question we could struggle with in every issue of this newsletter. We have several interconnected issues, so it’s difficult to single out just one. So, let’s start with one piece of the problem. In many settings (and I would argue that this is true here, also), although rigorous research has shown that certain kinds of mental health interventions are effective, the financing required to sustain these interventions and make them available throughout the population is insufficient. As you may know, globally, countries spend, on average, around $2 per person per year on mental health care.
But scaling up treatment or preventive services requires more than funding. Real world implementation of services is complex, and this is one of the areas where we as a program hope to go deep—in studying the best methods for implementation (e.g. through implementation science), and by working with our implementation partners to apply their best practices, as well as to identify barriers in the process.
Other pressing issues relate to the very real needs of specific populations. We have a special interest in the mental health needs of children and adolescents. Childhood and adolescence can be periods of great vulnerability to the development of mental health conditions, but also a powerful time for intervening to preempt mental health problems and to reduce the potential disability associated with those conditions that may be developing. Similarly, managing the mental health care needs of women as they prepare for motherhood and beyond provides an opportunity to save lives and to influence the mental health and wellbeing of women, as well as their families.
Social stigma and associated discrimination related to mental and substance use disorders continue to influence health and mental health outcomes for many people around the world. Among our emerging priorities are to address the needs of people particularly affected by these social stressors, particularly people with severe mental disorders and people with substance use disorders.