We’re very pleased to be working with Scientists Without Borders (SWB) again after the successful Maternal Health and Nutrition Challenge that was awarded in early 2011. For this new Challenge, Increasing Global Diagnosis and Treatment of Unipolar Depression and Anxiety, SWB is partnering with Johnson & Johnson and its Janssen Pharmaceuticals division generate novel ideas to increase effective utilization of existing mental health services for the diagnosis, treatment, and care of unipolar depression and anxiety disorders among patients residing in low-resource settings. We recently spoke with Meredith Perry, Program Manager at Scientists Without Borders and Chenelle Bonavito, Program Associate at Scientists Without Borders about this important Challenge.
Hello Meredith and Chenelle – thank you for joining us. Could you start off by explaining to us the genesis of this Challenge?
Johnson & Johnson has been a long time partner of Scientists without Borders, and working together, we identified that a challenge seeking to increase the awareness and utilization of services to diagnose and treat unipolar depression and anxiety closely aligned with the company’s Healthy Minds Initiative, launched in 2011 by the Janssen Pharmaceutical Companies. Our challenge corresponds with the Healthy Minds Initiative’s goals to accelerate progress in the fight against brain disorders, educate people about them, and reduce the associated stigma.
What are the primary impacts of a lack of investment in mental health care, both to the people who suffer from mental health disorders and to society at large?
20-30% of LMICs do not have mental health policies, programs, and/or legislation. A lack of investment means approximately 76-85% of mental disorders in LMICS, as compared to 35-50% of such cases in developed countries, go undiagnosed or untreated. In LMICs a lack of investment translates into a lack of education and knowledge of the resources that are available. In low-resource areas mental health services, if they exist, are underutilized by the patients who need them. The reasons for the underutilization of existing services available for the treatment of depression and anxiety are complex and interrelated and can include factors such as: Depression and associated symptoms are not regarded as legitimate health conditions, as appropriate for medical intervention, or as an acceptable expression of distress; even when diagnosed, some patients may forgo or discontinue treatment because they feel “cured,” simply be receiving a diagnosis, dislike the side effects of medicines, or because talk therapies are outside their cultural norms; social structural barriers to care, including poverty, gender-based inequalities, and other social marginalization, undermine access.
Are there substantial differences between mental health services and investment in developed vs. developing countries, and if so, to what do you attribute the differences?
Although mental health services are not a priority across the globe (the vast majority of countries allocate less than 2% of their budgets to mental health care), there is a large disparity in the diagnosis and treatment of mental health disorders in developed and developing countries. For example, although often under-resourced, most developing countries have a mental health policy, while as we mentioned, 20-30% of LMICs do not have in place mental health policies, programs, and/or legislation. Also, although stigma and cost continue to prevent some individuals in developed countries from seeking and/or adhering to treatment, there is widespread acceptance in the value of discussing emotions and a large class of mental health and managed care professionals able to expertly provide integrated services including talk and cognitive behavioral therapies, group therapies, in and out patient care, and pharmaceutical interventions. LMICs often have only one mental health professional for tens of thousands to millions of people (while developed countries have a much higher ratio of caregivers to patients) and many people in LMICs do not avail themselves of the limited number of mental health professionals available because of cultural perceptions that depression is not an acceptable expression of distress nor legitimate health condition.
What are the primary barriers, beyond resource constraints, to diagnosing and treating mental disorders in developing countries?
Aside from resource constrains, the two main barriers that come to mind are: Stigma associated with the diagnosis and disclosure of mental illness which can result in discrimination, rejection and social exclusion; and the reality that mental health has not been made a sufficiently high priority on the global health agenda. Therefore, there is a lack of appreciation for the potential for economic return on investment in mental health
Why did you choose to crowdsource this Challenge rather than rely on alternate forms of ideation such as academic research?
We believe that good ideas come from everywhere—across the mental health, public health, medical, industry, communications, video game and mobile app design, research, hobbyist, AND academic communities. Academic research is just one source of potential solutions to this challenge.
In your mind, what are some of the attributes that you’d like to see in a winning solution? Or conversely, what don’t you want to see?
We’re looking for solutions that propose an integrated and equitable approach to improving awareness and use of existing mental health diagnosis and treatment services, which is to say that solutions can and should include a mix of technological, social, cultural, scientific and health care delivery innovations in mental health. The solution should incentivize use among the end user (whether that user is a mental health patient, a relative, community member, or a health care provider) and measure the use and impact of the innovation.
We don’t want to see solutions that work exclusively in one context or region, or propose a huge injection of cash or infrastructure—rather, we’d like sustainable, culturally-sensitive solutions that have the potential to be deployed across geographies so that patients and their support networks learn how to better use existing mental health infrastructure.
How do you envision applying the innovative ideas and solutions captured as a result of this Challenge?
Working together with Johnson and Johnson, we’ll assess if the winning solutions are feasible and sustainable, and pending their interest, explore the development of a pilot.
That said, Scientists Without Borders is committed to the principles of open science. The winning solutions will be posted on our website so they might be tested, piloted, or remixed by others working in the field of mental health.
Thank you for your time Meredith and Chenelle. Do you have any final advice or guidance for our Solvers as they tackle this Challenge?
As we attempt to increase awareness and use of existing mental health services, our team of judges welcomes creative and unconventional ideas from not only the mental and public health sectors, but also advertising, communications, and marketing; political organizing; mHealth and other mobile applications; social networking and gaming; psychology and teaching; and other existing models of outreach. From our earlier challenges, we have found that the strongest ideas draw from a variety of influences and disciplines.