Five Questions with Global Mental Health Experts: A conversation with Professor Arthur Kleinman


Harvard T.H. Chan School of Public Health student, Davy Deng, interviews Dr. Arthur Kleinman, Professor of Medical Anthropology and Psychiatry, Harvard Medical School and Rabb Professor of Anthropology, Harvard University and Chair of the GlobalMentalHealth@Harvard Advisory Group.


Davy Deng:
You are known as one of the world’s leading experts on global mental health, particularly in East Asia. How did you first become interested in this topic?

Professor Kleinman:
I began my work in Taiwan in 1969, I was seconded there to the US Naval Medical Research Unit in Taipei because of the Vietnam War from the NIH. My responsibility was primarily to study infectious diseases and I was particularly interested in the stigma associated with Tuberculosis (TB) and leprosy. After spending a few years there, I realized that, as bad as the stigma of TB and leprosy was, comparatively, the level of mental health stigma was worse, so I became interested in this subject.

In 1978, after having done research on Taiwan’s healthcare system, I switched to mainland China where I began studying depression. I remember a conversation I had with the minister of health in China at the time. He adamantly told me that there are no such things as mental illnesses in China because it is a communist country, and that mental illnesses only existed in capitalist countries. I then became aware that there was a particular Chinese way of diagnosis for some of the depressive symptoms that people exhibited, called “neurasthenia” or literally in Chinese “nerve weakness”(神经衰弱). This was an obsolete medical term abandoned by the US at the time, but it was still widely used in China, so I decided to put my emphasis on introducing modern terms of diagnosis for mental illnesses to China and that began my decades of work on mental health in Chinese culture.

Davy Deng:
Since you began your work roughly 50 years ago, China has undergone a dramatic societal and economic transformation, how would you comment on the mental health care and mental health stigma in Chinese culture now?

Professor Kleinman:
There have been big changes in China’s mental health system. For example, mental health care has definitely become much more patient centric. In terms of mental health stigma, I would say it is still fairly high for chronic severe mental illnesses such as schizophrenia but not nearly as serious as it was in the past for depressive and anxiety disorders. This is particularly salient for generations that are under 40 years of age right now.

Another big change is the attitudes towards help-seeking behaviors. I’ve noticed that mental health problems in younger people exhibit more psychological distress and less somatic distress as seen in the older generations. This could be understood as the legitimation of a more affective idiom for youth, but surely it is also related to the fact that in the past a language of psychological distress and psychotherapies were seen as humiliating or simply western concepts that are not applicable to Chinese society. And now I would say there is a “therapy trend” (心理热) in China — people are very interested in counseling services and psychological treatments. Even for severe mental illnesses that require hospitalization, China’s mental hospitals are dramatically improved in quality from before. And health insurance for such care is increasingly available.

Lastly there is an emphasis on empowering the self and making changes in one’s life on one’s own, instead of relying on families, networks and institutions for decisions when it comes to mental health. This rise of individualism is not the same in my view as in the west because it is a more relational individualism.

Davy Deng:
China has traditionally been thought of as an example of a collectivistic society, do you think this brings challenges to eradicate mental health stigma?

Professor Kleinman:
I do not believe it is necessarily harder to eradicate stigma in Chinese culture. Chinese society is in fact both collectivistic and individualistic, and its society has undergone a turn toward individualism. If you look at Chinese society nowadays, you notice that the connections in Chinese culture are built around individuals and not families. What happens is that individuality is downplayed in cultural narratives and the interpersonal connections are emphasized. In contrast in the US, we emphasized the opposite and hyper-focus on individualism. And yet networks are very important in American society too. So in my opinion it would be a myth to call Chinese society only a collectivistic culture.

Davy Deng:
How would you comment on the mental health system in the US? What do you think is the main challenge here in the US?

Professor Kleinman:
The mental health system in the US definitely needs major reform. I am more optimistic about the mental health system in China than the one in the US. And I would argue that the mental health system in China is already equally good, if not better than that in the US. In my opinion, what’s happening is that in the US, we did a lot of research showing community-centered service can bring about positive outcomes for mental health patients by means of social re-integrations among other things. This led to deinstitutionalization. That in turn led politicians to argue for massive cuts in funding of mental health services, so that it is increasingly difficult to provide community mental health care in the US. Politicians did not use the money saved from de-institutionalization to build better mental health infrastructure for community services. The result is that lots of patients were discharged from mental health facilities but did not receive proper community services to help them recover, which contributed to a broken and chaotic system. That is what needs fixing.

Davy Deng:
What do you think of the progress we have made so far in global mental health?

Professor Kleinman:
Global mental health research has blossomed more than I expected with lots of excellent researchers, for example Vikram Patel, who are really moving the field forward. Just look at all the academic and media attention to mental health impact of the COVID-19 pandemic. If this were 20-30 years ago, there wouldn’t be a fraction of the attention to this issue. However, I think there is still a lot of work to be done. To begin with much more work needs to be done on improving the quality of care. Studies of community mental health workers are suggesting that this is an important way to move forward, especially in settings of poverty and marginality. But what we really require is amoral movement for mental illnesses such as the one that took place for HIV/AIDS in the late 1980s and early 1990s. Absent such a movement, ministers of finance are unlikely to greatly increase funding for mental health care to the level required that would greatly improve quality of services by increasing the numbers of mental health practitioners and the availability of mental health services in the community. And families will be left, as in the past, with the great burden of mental health problems and care, which they will have to continue to carry with inadequate resources. That is why I helped organize the World Bank’s project “Out of the Shadows” which addressed the financial needs of mental health care in societies.


Davy Deng obtained three bachelor’s degrees in psychology, chemistry and genetics from the University of California, Berkeley in 2019 and came to Harvard T.H Chan School of Public Health to pursue a S.M. in Biostatistics with an interdisciplinary concentration in population mental health. He is interested in topics related to humanitarian aids/human rights, political polarization, health equity and LGBTQ+ mental health. Additionally he has also been working on research with Dr. John Naslund in the Mental Health for All Lab at Harvard Medical School that investigates effective ways of designing digital peer support programs and the utilization of art therapy in re-socialization.

Professor Arthur Kleinman’s numerous publications have included works on social suffering, mental health, stigma, moral experience, and caregiving. Most recently, he co-edited a textbook on global health (Reimagining Global Health: An Introduction. 2013, UC Press), co-authored a book on moral life in China with his former students (Deep China. 2012, UC Press), and a book on humanitarianism in social sciences (A Passion for Society. 2016, UC Press). He is the author of What Really Matters: Living a Moral Life Amidst Uncertainty and Danger (OUP, 2006), Writing at the Margin: Discourse between Anthropology and Medicine (UC Press, 1995), and The Illness Narratives: Suffering. Healing and the Human Condition (Basic Books, 1988), amongst others. His new book is The Soul of Care: The Moral Education of a Husband and a Doctor (Penguin, 2019).

He is also the author of articles in The Lancet and New England Journal of Medicine on caregiving as moral experience; global mental health; values in health; reforming medical education via the medical humanities; the search for wisdom; and on culture, bereavement and psychiatry. He has co-authored articles on stigma and mental illness; on the appropriate uses of culture in clinical practice; and on medical anthropology. His current project is a collaborative study of social technologies for aging and eldercare in China. Kleinman is a member of the National Academy of Medicine and the American Academy of Arts and Sciences.

The unmet needs for care for mental health problems have always been large; they have only increased during the current pandemic. Mental Health Care Leadership Champions will help narrow this gap by training and mentoring forward-thinking leaders. For more information visit: Mental Health Care Leadership Champions Program

EMPOWERING LEADERS FOR IMPROVED HEALTH OUTCOMES

The Certificate of Specialization comprises three programs, taught by faculty from the Harvard School of The Certificate of Specialization comprises three programs, taught by faculty from the Harvard School of Public Health, the GlobalMentalHealth@Harvard Initiative and an international pool of experts, embracing both empirical evidence and real-world lessons. Through this training and mentoring program, professionals from around the world will empower themselves to scale-up evidence-based and innovative programs to address the mental health needs of their communities with knowledge, skills, and peer support.

Those who complete both Foundations of Mental Health Care and Scaling Up Mental Health Care programs are invited to join a third program: a peer-learning collaborative to support and learn from one another as they embark on their journey of being champions for mental health.

Learn From the Experts

Foundations of Mental Health Care will be led by renowned faculty who have held both public health research and real-world leadership roles. Core instructors include Shekhar Saxena, former Director of the Department of Mental Health and Substance Abuse at the World Health Organization, Vikram Patel, co-leader of GlobalMentalHealth@Harvard, and Giuseppe Raviola, Director of Mental Health for Partners In Health (PIH), and the Director of the Program in Global Mental Health and Social Change (PGMHSC) at Harvard Medical School.  

To learn more and apply visit: Foundations of Mental Health Care | Executive and Continuing Professional Education | Harvard T.H. Chan School of Public Health

Written by: Ankita Shah, Program Coordinator, Sangath Bhopal Hub
Edited by: Juliana Restivo, Program Coordinator, Harvard Medical School

“Our experience today reinforced that ASHAs (Accredited Social Health Activists) have the potential to revolutionize mental healthcare. Their interpersonal skills were heart-warming and their strong ties to the community form the needed foundation to deliver accessible, patient-centered care. These lessons are relevant across India but also the rest of the world including North America”

Daisy Singla, Ph.D., C.Psych, Clinician Scientist, Center of Addiction and Mental Health, University of Toronto, Lunenfeld Tanenbaum Research Institute

Depression is the leading mental health cause of the global burden of disease[i] and estimated global costs of untreated depression are up to 16 trillion US dollars.[ii] Brief psychological treatments are among the most effective and cost-effective interventions in medicine[iii] and recommended as the first line of care[iv] to address this global burden. The major supply-side barrier of inadequate numbers and inequitable distribution of mental health specialists has been addressed by global mental health practitioners by task-sharing of these treatments to NSPs—including community health workers, lay therapists, peers, nurses, and teachers. There is now a robust evidence base demonstrating that NSP can effectively deliver brief psychological treatments for depression and other common mental health problems in a wide range of contexts.[v],[vi] Dr. Anant Bhan, Site PI for Sangath Bhopal Hub, shared why it is so important to engage with NSPs in this work, particularly in India, “ASHAs are the backbone of the community healthcare India, and by extension, our work. It is indeed an honour to be able to work with these community health change agents with such levels of dedication, commitment and hard work. We believe that the involvement of frontline health workers such as ASHAS is crucial for integrating mental health into primary health care provision.”

Despite the availability of NSPs-delivered, effective and cost-effective psychological treatments, the treatment gap for mental disorders remains a big challenge to be addressed. From the service-delivery perspective, clinical supervision of NSP-delivered psychological treatments positively impact the therapist in training, therapy quality and patient outcomes and thus it essential to ensure the quality of the treatment delivered. Previous approaches to clinical supervision have focused on mental health expert-led, applying ungeneralizable metrics to supervise delivery. This is particularly relevant in India as our country has limited, adequately trained specialists in psychological treatments who are available to provide expert supervision.

This study, funded by Grand Challenges Canada, and led by Principal Investigator of the study is Dr. Daisy R Singla, Clinician Scientist, University of Toronto, Sinai Health System, Lunenfeld Tanenbaum Research Institute, seeks to address the barriers by scaling up measurement-based peer supervision, and innovation the study investigators have designed, piloted and evaluated over the past decade, using the digital platforms for supporting NSP-delivered care in global health. This peer-supervision study is a component of the overall EMPOWER project. EMPOWER is a priority work-stream of the GMH@Harvard Initiative with the goal of increasing health system capacity for the prevention and care of mental health problems across the life course, globally. Using digital training, supervision, and quality assurance tools for specific evidence-based psychosocial interventions EMPOWER will train, and supervise, frontline health workers to deliver these interventions with assured quality. Learn more about EMPOWER’s mission and programs at EMPOWER.care. “The field of global mental health has reached an inflection point where we have sufficient evidence about ‘what works’ but do not understand ‘how to make it work’.” reflects Dr. Abhijit Nadkarni, Site PI for Sangath Goa Hub, “Studies such as the GCC EMPOWER peer-supervision project allow us to answer this critical question which will help the scaling up evidence based psychosocial interventions so that they are accessible to those who need them the most”

This supervision component of the EMPOWER project seeks to address the barriers posed by the orthodox approach to supervision, a key pedagogical and quality assurance tool in treatment delivery which is known to positively impact the therapist in training,[vii],[viii],[ix] therapy quality [x]  and patient outcomes.[xi],[xii] The Harvard Medical School Co-Investigators for the project are Professor Vikram Patel and Dr. John Naslund. The Investigators are collaborating with research teams at Dimagi and Sangath to adapt Dimagi’s well known CommCare digital platform for supporting NSP delivered care in global health.

In collaboration with projects based out of two Sangath hubs in Bhopal and Goa, the study will be conducted in primary care facilities in the Sehore district of Madhya Pradesh (14 facilities in rural settings), and the state of Goa (urban/peri-urban with 24 facilities). The NSPs will be trained to deliver a brief psychological treatment for depression called the Health Activity Program (HAP). In December 2021 the teams met in Hoshangabad district in Madhya Pradesh, India to test a beta version of Dimagi’s CommCare app for peer-supervision. There were 10 NSPs in total who attended the CommCare platform training consisting of five Accredited Social Health Activist (ASHA) supervisors and five ASHAs. “It was so inspiring, and humbling, to witness ASHAs, the formidable cadre of India’s public health workforce, demonstrate such commitment, motivation and comfort  in learning to engage with cutting-edge technologies to support their new roles as mental health care providers”. Professor Vikram Patel shared about his time meeting with the ASHAs during the pilot testing. The NSPs travelled from 9 to 60 kilometres to participate in the training. This set of NSPs has a diverse variety of qualifications, ranging from high school to post-graduate studies, with eight NSPs having completed either secondary or post-secondary education. The rest held a bachelor’s degree (BA). The NSPs ages ranged from 30 to 50 years old. This particular group of NSPs owned a smartphone and were well-versed in the procedure.

Study team members who also attended the pilot testing and met with ASHA’s included:

  • Deepak Tugnawat, Director of projects in Sangath Bhopal
  • Nitish Dube, Associate Director, Dimagi
  • Ankita Shah, Project Coordinator, Sangath Bhopal
  • Azaz Khan, Project Intervention Coordinator, Sangath Bhopal
  • Deepali Vishwakarma, Project HAP supervisor, Sangath Bhopal
  • Phool Singh, Project HAP supervisor, Sangath Bhopal
  • Radhika Tak, Project HAP supervisor, Sangath Bhopal
  • Akshat Purohit, Project HAP supervisor, Sangath Bhopal

[i] Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10(11): e1001547.

[ii] Patel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development. The Lancet 2018; 392(10157): 1553-98.

[iii] Organization WH. Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological and substance use disorders, 2015: World Health Organization; 2015.

[iv] World Health Organization. Mental Health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG): Clinical Management of Mental, Neurological, and Substance Use Conditions in Humanitarian Emergencies. Geneva: WHO, 2015.

[v] Singla DR, Kohrt B, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low-and middle-income countries. Annual Review of Clinical Psychology 2017; 13(1).

[vi] Van Ginneken N, Tharyan P, Lewin S, et al. Non‐specialist health worker interventions for the care of mental, neurological and substance‐abuse disorders in low‐and middle‐income countries. The Cochrane Library 2013.

[vii] Saxon D, Firth N, Barkham M. The relationship between therapist effects and therapy delivery factors: Therapy modality, dosage, and non-completion. Administration and Policy in Mental Health and Mental Health Services Research 2016: 1-11.

[viii] Fairburn CG, Allen E, Bailey-Straebler S, O’Connor ME, Cooper Z. Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists. J Med Internet Res 2017; 19(6): e214.

[ix] Kühne F, Maas J, Wiesenthal S, Weck F. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC psychology 2019; 7(1): 54.

[x] Weck F, Jakob M, Neng JM, Höfling V, Grikscheit F, Bohus M. The effects of bug‐in‐the‐ eye supervision on therapeutic alliance and therapist competence in cognitive‐behavioural therapy: A randomized controlled trial. Clinical psychology & psychotherapy 2016; 23(5): 386-96.

[xi] Saxon D, Barkham M, Foster A, Parry G. The contribution of therapist effects to patient dropout and deterioration in the psychological therapies. Clinical psychology & psychotherapy 2017; 24(3): 575-88.

[xii] Singla DR, Hollon SD, Velleman R, et al. Temporal pathways of change in two randomized controlled trials for depression and harmful drinking in Goa, India. Psychological Medicine 2019: 1-9.

Written by: Udita Joshi, Research Coordinator, Sangath Bhopal Hub
Edited by: Juliana Restivo, Program Coordinator, Harvard Medical School

Project EMPOWER (India) completes pilot training of more than 40 community health workers in Gujarat, India to provide evidence-based psychological treatment

According to the latest survey by WHO, COVID-19 pandemic has disrupted critical mental health services in 93% of the countries worldwide. This has led to a prolonged exposure and upsurge in mental health conditions and exposed the deficiencies of India’s mental health care system which reaches less than 5% of the population and is under-resourced. This burden of mental health conditions is expected to rise as the socio-economic ramifications of the pandemic unfolds. 

EMPOWER is a priority work-stream of the GMH@Harvard Initiative with the goal of increasing health system capacity for the prevention and care of mental health problems across the life course, globally. Using digital training, supervision, and quality assurance tools for specific evidence-based psychosocial interventions EMPOWER will train frontline health workers to deliver these interventions with assured quality. Learn more about EMPOWER’s mission and programs at EMPOWER.care.

The relationship between mental health and COVID-19 has led to increasing demand but due to inadequate resource allocation, staggering gaps in the workforce capacity, service provision is suffering. Growing evidence from Low-and Middle-Income Countries (LMICs) demonstrates that frontline healthcare providers, with appropriate training and supervision, can effectively deliver brief psychological treatments for depression. However, scaling up this evidence is hampered by reliance on face to face methods for training, supervision, and quality assurance barriers. One of GlobalMentalHealth@Harvard’s effector arm implementing partners in India, Sangath, has sought to address these barriers efficiently and at scale, by using digital approaches to train and support by building on extensive formative work with the target participants, and developing learner-centered and focused content. ESSENCE is a National Institute of Mental Health funded U19 Scale Up Hubs research project which is one of the foundational research projects to inform the EMPOWER program. ESSENCE developed and evaluated digital approaches to train non-specialist providers (in India these are government accredited community health workers, also known as Accredited Social Health Activists) in Madhya Pradesh, India. 

The Sangath Bhopal Hub are the leading implementers for EMPOWER India. The Sangath Bhopal team has now recently expanded on the ESSENCE project with the recently concluded Project EMPOWER in Gujarat. The project led by Dr. Vikram Patel, Principal Investigator, Harvard Medical School and Dr. Anant Bhan, Principal Investigator, Sangath Bhopal Hub has successfully trained 43 community health workers in the Health Activity Program, an evidence-based psychological treatment for mental health issues like depression, anxiety and substance use or alcoholism. The pilot phase of the project was initiated in August 2020 and was implemented in the tribal district of Jhagadia in the Bharuch district of Gujarat. 

Participants and project partners during a project dissemination event at Gujarat Institute of Mental Health (GIMH), Ahmedabad.

The objective of the project was to engage the frontline health workers in digital training and build capacities for delivering mental health treatment at the grassroots. The frontline health workers were trained in providing evidence-based psychological treatment in rural communities that are underserved. 

The pilot phase was implemented with 29 Accredited Social Health Activists (ASHAs) and 14 Community Health Officers (CHOs) of Jhagadia block in selected primary healthcare settings of Gujarat (7 Primary Healthcare Centers and 2 Community Healthcare Centers). The training was delivered in the Gujarati language to all the participants with the help of an online learning management system (LMS) nested within the TeCHO platform which is used across the state by the health system as per the advice of local partners. The LMS contained educational content in various forms such as audio, video and PDF files. The audio and video content made it easy for the participants to learn and understand the training modules. The project team also conducted focused group discussions (FGDs) and competency assessment tests to understand the level of knowledge and awareness the frontline health workers acquired from the program. 

The results are encouraging and key findings will be shared soon. The Sangath Bhopal team took the opportunity to discuss the findings and appraise the work with State officials in Gujarat and discussed opportunities for future work.

The findings of the pilot were presented by Dr. Udita Joshi, Research Coordinator, Sangath Bhopal Hub and Aakrushi Brahmbhatt, Research Assistant, Sangath Bhopal Hub with the participants and project partners during a project dissemination event at Gujarat Institute of Mental Health (GIMH), Ahmedabad. The team also presented the success stories from the field and a project dissemination report.  Experiences were also shared by the participants of the digital training from Jhagadia during this presentation. 

The pilot was implemented by Sangath Bhopal Hub in collaboration with SEWA Rural, Harvard Medical School, and the National Health Mission, Government of Gujarat. The project was funded by the Tata Trusts via The Lakshmi Mittal and Family South Asia Institute Harvard University

For any further updates contact: Dr. Udita Joshi udita.joshi@sangath.in

Is care coordination the missing piece to combatting the mental health crisis? A top mental health expert joins the podcast dedicated to successful care coordination to review how intertwined these subjects are, or should, be.

ACMA Podcast Page: acmaweb.org/podcast

Podcast Platform Links:

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The United States has devoted more resources, attention and industry professionals to positively impact mental health in America, including suicide and substance abuse mortality rates. Despite this increased attention, mental health metrics in the US have increased in the last 20 years, especially with youth and minorities. What’s broken and why is it broken? While the pandemic has had a noticeable impact, research shows that mental health in the US was declining before COVID-19 due to various factors, including dialogue about its implications.

Dr. Vikram Patel, MBBS, Ph.D. and Harvard professor, joins the Care Transitions Today podcast to discuss reimagining mental health care. Joined by host and longtime healthcare leader Deb McElroy, hear Dr. Patel explain the mental health care implications of the pandemic, review innovative approaches to enhance access to quality care and examine how these approaches can be scaled to reduce mental health disparities. To listen to this episode, visit acmaweb.org/podcast or search “Care Transitions Today” on any podcast platform.

Dr. Patel is the Pershing Square Professor of Global Health and Wellcome Trust Principal Research Fellow at the Harvard Medical School. Over the past two decades, he has focused on reducing the treatment gap for mental disorders in low resource countries. He is also a Fellow of the UK’s Academy of Medical Sciences and has served on WHO expert and Government of India committees. Dr. Patel is the co-founder of Sangath, a local NGO dedicated to mental health and wellbeing. He has led efforts to set up the Movement for Global Mental Health, a network that supports mental health care as a fundamental human right.

About Care Transitions Today

Care Transitions Today is a biweekly podcast created by the American Case Management Association (ACMA), currently in its second season. The podcast is hosted by Deb McElroy and is dedicated to discussing topics related to all things case management and transitions of care with experts from across the country. Deb brings her extensive experience in the public health sector to embrace frank conversations and share experiences, wisdom and expertise to help health care professionals respond and adapt to today’s health care environment.

About the American Case Management Association  

The American Case Management Association (ACMA) is a professional membership organization for nurses, social workers, physician leaders and other health care professionals in case management and transitions of care practice. Founded in 1999, ACMA is comprised of more than 8,000 members nationwide, making it the largest non-profit professional membership association for case management and transition of care (TOC) professionals. ACMA provides resources, solutions and support to over 40,000 educational subscribers. For more information, visit http://www.acmaweb.org.

Write up written by Jon Vickers
American Case Management Association
jvickers@acmaweb.org

LITTLE ROCK, ARK
July 28, 2021

The below is originally posted in full on HMS News & Research – read it here

A $10 million Lone Star Prize was awarded to Meadows Mental Health Policy Institute for its competition entry, the “Lone Star Depression Challenge.”

In collaboration with the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School, the Center for Depression Research and Clinical Care at UT Southwestern Medical Center, and The Path Forward for Mental Health and Substance Use, the Meadows Institute aims to increase the rate of recovery from depression in Texas from less than 10 percent today to more than 50 percent through early detection and treatment in primary care.

The Lone Star Prize, awarded by Lyda Hill Philanthropies and managed by Lever for Change, is a Texas-based competition that was launched in early 2020 to find and fund bold solutions focused on building healthier, stronger communities.

Vikram Patel, the HMS Pershing Square Professor of Global Health, will lead the HMS portion of the collaboration. He will use the EMPOWER initiative to deploy a suite of digital tools to train, supervise, and support community health workers in delivering brief, psychological treatments that have proven effective for treating depression in primary care and community settings around the world. 

“We’re at the start of a journey to build the world’s community-based mental health force, which is essential for addressing the vast unmet need for high quality mental health care,” Patel said. “Our initiative uses both established and novel digital tools to leverage decades of clinical and implementation research, giving community health workers the power to implement evidence-based treatments for patients with depression.”

Throughout his career, Patel has led pioneering studies that quantified the health, social, and economic costs of mental illness in low-resource contexts globally. He has developed and tested models of care delivery that leverage available low-cost resources, such as community health workers, to deliver the high quality mental health care described in his book, Where There Is No Psychiatrist. This work is embodied in his long-standing collaboration with the Indian nongovernmental community health organization Sangath.  

“The Lone Star Depression Challenge is a fantastic opportunity to build a project at scale in one of the largest states in the U.S.,” Patel said. “Ultimately, we hope our approach will greatly expand the footprint of the existing mental health care system into the community, in particular reaching those who have historically had limited access to mental health care, and show the potential of this innovation to help millions of other people around the nation and around the world.”

Paul Farmer, chair of the HMS Department of Global Health and Social Medicine, offered heartfelt congratulations for Patel and to the other collaborators in the Lone Star Depression Challenge, noting that the prize rightly acknowledges the importance of addressing mental health as a matter of highest importance.

“Every careful study of the afflictions that burden communities, regardless of how they’re bounded, shows that mental illness is at the top of list, while resources to address it remain the lowest of our priorities,” Farmer said. “From India to the United States, Vikram has sought to correct this mismatch, not only by calling it out but by developing effective, safe, inexpensive, and novel community- and family-based interventions to address this imbalance. The world has reason to join us in celebrating this prize.”

In Texas today, an average of eight to ten years passes before depression is diagnosed after symptoms emerge. Because of this, fewer than 1 in 15 of the 1.5 million Texans suffering from depression each year receive sufficient care to recover.

The Meadows Institute says that once fully realized, the Lone Star Depression Challenge will free Texans affected by depression by scaling clinical solutions in health systems, empowering marginalized communities to achieve equitable outcomes, and harnessing purchaser-driven market forces to accelerate adoption of these changes. The Lone Star Prize will enable the collaborators to combine and scale up three innovative programs.

These programs include:

EMPOWER, a suite of digital solutions enabling community-based frontline providers to learn, master, and deliver brief psychological treatments, therefore extending their reach to marginalized communities with limited access to quality care. EMPOWER builds on two decades of research demonstrating that frontline providers can be trained to deliver brief psychological treatments for depression.

Patel will direct the implementation of EMPOWER for the Lone Star Depression Challenge along with project co-lead John Naslund, instructor in global health and social medicine at HMS.

Naslund noted that there are many gaps in mental health coverage across the large, diverse population of Texas, accentuated by deep disparities in coverage between urban and rural communities, racial and ethnic groups, and social and economic strata. 

“One of our main goals is to close those gaps, particularly around equity,” Naslund said. Because specialist mental health care is scarce in many communities with high rates of depression, it’s especially important to expand the reach of mental health services to primary care and to strengthen the community health system, he said.

Over the course of the five-year term of the Lone Star Depression Challenge, EMPOWER will train hundreds of community health workers and reach many thousands of Texans in need. Community health workers will learn to recognize depression and to use an evidence-based treatment called behavioral activation, which seeks to break the vicious cycle of social withdrawal and retreat that characterizes depression and replace it with a virtuous cycle of engagement and recovery, Naslund and Patel said. The initiative will also train frontline workers to recognize when patients require specialized care, for example in acute crisis situations, and support a referral system, they added.

The Cloudbreak Initiative, which will scale detection and treatment in primary care centered on two proven approaches: measurement-based care, the routine use of repeated, validated measures to track symptoms and functional outcomes in clinical settings, and the collaborative care model, an integrated approach to the treatment of depression that involves care managers and consultant psychiatrists engaging directly within primary care settings. Together, these approaches have been proven in multiple studies to help at least 40 percent of people treated in primary care achieve full symptom relief and another 25 percent to recover substantially.

The Path Forward, an existing partnership between leading North Texas health purchasers and their national counterparts, harnesses the power of public and private health leaders to reform payment approaches to incentivize health systems to accelerate adoption of effective depression care provided to employees and their dependents.

The Lone Star Depression Challenge deploys proven approaches to overcome the systemic barriers preventing Texans with depression from accessing care sooner and more effectively.

Cloudbreak is redesigning primary care for depression to function just like primary care does today for heart disease and cancer, EMPOWER is making access to evidence-based care more equitable by building a community-based mental health workforce which can link people in the least resourced communities to care sooner, and The Path Forward is harnessing market forces to speed implementation of both approaches.

The Meadows Institute, which will oversee the Lone Star Depression Challenge, was founded in 2014 to help Texas legislators, state officials, members of the judiciary, and local leaders identify equitable systemic solutions to mental health needs and has become Texas’s most trusted source for data-driven mental health policy. The Meadows Institute has begun to make a significant impact in multiple areas, helping Texas leaders shift the focus of new investments toward early intervention, address the mental health crisis in jails and emergency rooms, expand the mental health workforce, and improve access to care for veterans and their families.

“The Lone Star Prize will make possible the first-of-its kind, wide-scale expansion of three proven initiatives to improve the lives of Texans living with depression,” said Andy Keller, president and CEO of Meadows Mental Health Policy Institute. “On behalf of the Meadows Institute and our partners in this project, we are immensely grateful to Lyda Hill, Lyda Hill Philanthropies, and Lever for Change for the opportunity and encouragement to dream big and share these bold solutions across our great state.”

EMPOWER is one of five workstreams in GlobalMentalHealth@Harvard, a University-wide interdisciplinary initiative based at HMS that Patel launched in 2018 to work toward a world where mental health is valued and realized by all through a combination of transformative education, research, innovation, and engagement.

“I am excited to bring evidence-based interventions emerging from global contexts to the U.S. Our rollout in Texas builds on critically important formative work to adapt these interventions for the U.S. and to test the use of digital technologies for training frontline workers,” Patel said, noting that crucial support for the development of EMPOWER’s work on the Lone Star Depression Challenge came from Mala Gaonkar and the Surgo Foundation, Natasha Müller, the National Institute of Mental Health, the Wellcome Trust, and the American Psychological Association.

View the full Lone Star Prize announcement from Lyda Hill Philanthropies and Lever for Change here.

Portions of this story are adapted from a Meadows Institute news release.

An Interview with Dr. Helmi Zakariah, CEO of AIME

When COVID-19 reached Dr. Helmi Zakariah’s home country of Malaysia in January 2020, he was consulting in Brazil as CEO of Artificial Intelligence in Medical Epidemiology (AIME).  A trained physician, public health professional, and digital health entrepreneur, Dr. Zakariah found himself in high demand as the Malaysian government began to mount it’s COVID-19 response. He was asked to return home to his state of Selangor to lead the Digital Epidemiology portfolio for the Selangor State Task Force for COVID-19, and upon arrival immediately began to address the many challenges COVID-19 presented.

Like much of the rest of the world, the Malaysian economy struggled, and local businesses were forced to shut their doors as COVID-19 spread rapidly and governments prepared to respond. What became instantly evident was the urgent need for businesses to reopen and operate safely. In his new position, and with a vast array of skills in digital epidemiology, Dr. Zakariah set out to develop a system that would do just that. The solution: a QR-based contact tracing tool aptly named ‘Selangkah’ or ‘Step in Safely.’

Selangkah presented a seamless method for contact tracing for local businesses, who were able to obtain their own unique QR code and place it at the building entrance for customers to scan. Once scanned by a customer, the only required input field was a phone number, allowing for increased anonymity.

So how does it work? The platform relies on a machine-learning algorithm to sift through all positive COVID-19 cases and identify what is deemed a ‘close contact’. Those individuals are then notified of their exposure and are recommended to be tested. As Dr. Zakariah notes, “with contact tracing, it’s not only about how big your uptake is but how efficiently you sift through all of your data.” 

Despite early resistance from members of the Malaysian government, largely due to skepticism of whether businesses would use the platform, Selangkah was piloted with enormous success. In Dr. Zakariah’s home state of Selangor, the most populous state in the country home to 10 million people, a staggering 7.3 million utilized the system, with over 88.7 million total uses to date. When asked why he thought there was such a successful adoption of the platform, Dr. Zakariah explained that there is precedent for this type of information logging in Malaysia. “If you are visiting a friend in a condominium before you step in, you give your name and contact information for security reasons at the guard house. We just created a digital guestbook that was centralized. That makes it easy to be understood by the community.” All the data is shared with consent and individuals are not continuously tracked.

Upon successful pilot implementation, increased collaboration with the Malaysian government has allowed for the expansion of Selangkah. Not only has the tool been scaled and replicated nationally, but it has been adapted to collect additional safety data. For example, it now has survey capability; when the QR code is scanned a survey appears inquiring about other COVID-19 precautions taking place at that business. Data on mask-wearing, sanitation processes, and more are also now collected. “The idea is not for enforcement, but rather to measure public compliance,” said Dr. Zakariah. Additionally, Dr. Zakariah shares that the decision to scale the tool and utilize it for the purpose of resource allocation is indicative of a larger mindset shift within the government: “We have seen a lot less resistance from the government to new digital health solutions. They are seeing that some things work if you just give it a try.”

Dr. Zakariah ultimately attributes the success of Selangkah to three distinct, yet connected factors – data, cost, and community. “You can’t do this without data” Dr. Zakariah exclaimed, referring to mounting a strategic COVID-19 response. Good quality data that is truly representative of the challenge at hand is essential to allocate resources and take appropriate precautions to stop the spread of disease. Cost was another important element that led to the ubiquitous use of the QR system. “The cost for a shop owner is extremely cheap. It is one piece of paper. All you have to do is go to a website, register, and print a code,” shared Dr. Zakariah.

But perhaps the most important element to the platform’s success was the community-driven approach. “In the early stages there was less intervention by the government, it was really a crowd-sourced, community-driven solution that was later adopted by the government,” Dr. Zakariah said. Empathy and reassurance were essential tools that Dr. Zakariah equipped himself with to achieve local business buy-in, once that was acquired, everything else followed. “When you come up with a solution that is ‘people-centric’ you need to actually go to the ground level, the recipe for success is community first.”

To learn more about Selangkah, visit their Twitter @SELangkah_cvd19

Over the next few weeks, GMH@Harvard will be featuring a five-part series on the largest mental health genetics study in Africa and the project’s corresponding training initiatives. The study and training efforts are a collaboration between scientists in Ethiopia, Kenya, South Africa, Uganda, and Boston at the Harvard T.H. Chan School of Public Health and the Broad Institute. The series explores issues of equity, ethics, building the next generation of psychiatric geneticists, and what it takes to recruit more than 35,000 people.


Introducing NeuroGAP-Psychosis
Get a glimpse of the study that aims to chip away at what we know about the genetics of schizophrenia and bipolar disorder. Click here to watch video.

Capacity Building & Training: Dr. Asha Omari
Hear Dr. Felicita Omari speak about ensuring sustainability in global research and the joint efforts of NeuroGAP-Psychosis and GINGER. Click here to watch video.


Addressing Stigma, Advancing Diversity, and Overcoming Inequity 
NeuroGAP-Psychosis scientists explain the taboo around mental illness in Kenya and Uganda and why genetic diversity is so important to the study of mental health disorders. Click here to watch video

Capacity Building & Training: Dr. Allan Kalungi
Hear Dr. Allan Kalungi, former GINGER Research Fellow and recent Brain and Behavior Research Foundation Young Investigator grant recipient, speak about the GINGER program’s impact. Click here to watch video


NeuroGAP-Psychosis: Reaching out to participants 
Study staff from Uganda and Kenya share what it takes to recruit more than 35,000 people and what their goals are in the end for NeuroGAP-Psychosis. Click here to watch video.

Capacity Building & Training: Dr. Jackline Mmochi
Hear Kenyan psychiatrist, Dr. Jackline Mmochi, discuss beliefs surrounding mental illness in Kenya and the importance of integrating genetics research in fighting stigma. Click here to watch video.


NeuroGAP-Psychosis: Presenting Early Findings
The Moi University team in Kenya discovers interesting ethnolinguistic findings from the first genetic and demographic data they collected. Click here to watch video.

Capacity Building & Training: Mowlem Pierre
NeuroGAP-Psychosis is helping people like lab technician, Mowlem Pierre, access the data and training he needs to complete a master’s degree and further his research career. Click here to watch video.


NeuroGAP-Psychosis: Hopes for the Future  

Investigators share the outcomes they hope to see from the study: reducing stigma around mental health disorders, new treatments for several mental illness, and increasing research infrastructure at their institutions. Click here to watch the video.

Bioethics: Autonomy, Equity, and Cultural Considerations
Three bioethicists from Kenya and Uganda talk about how they address ethics in genetics and mental health genetics, scientific fields still new to many parts of Africa. Click here to watch the video.


Written by GMH@Harvard Ambassador Board Members: Sarah Coleman, Amruta Houde, Bill Kriebel, Anna Bartuska

This year’s World Mental Health Day theme, Move for Mental Health: Let’s Invest, is timelier than ever. Mental health concerns and needs are growing and expected to substantially increase moving forward. Yet, mental health services have been consistently underfunded. During the COVID-19 pandemic, mental health services have been disrupted or halted in 93% of countries worldwide. As the treatment gap continues to widen, significant investment is needed to  increase access to care for the most vulnerable worldwide. In the first two articles of this 3-part series, we discussed what it means to invest in mental health broadly (part 1)  and how to invest in your own mental health (part 2). But, the question remains, how can we financially invest in mental health? This article emphasizes why the #TimetoInvest is now and offers an introduction to two types of funding mechanisms.

“World Mental Health Day is an opportunity for the world to come together and begin redressing the historic neglect of mental health. We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”

-Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization
Watch WHO’s Big Event for Mental Health Here

The Problem: Why Now? 
The greatest cause of disability globally is poor mental health, compounded by poverty, conflict, climate change, systemic racism, economic instability, and most recently, the COVID-19 pandemic. This unprecedented global pandemic has significantly affected many people’s mental health and restricted access to care for those with existing mental health conditions. The mental health impacts of COVID-19 include everything from increased anxiety and fear about the spread of the virus, loss of social networks, stressful experiences of healthcare workers on the frontlines, and a higher risk of substance use. Despite these significant impacts, mental health has not been at the forefront of global health funding. In LMICs, less than 1% of national health budgets are spent on mental health and only 0.4% of health development assistance is spent on mental health, despite the fact that for every US $1 invested in scaled-up treatment for common mental disorders there is a return of US $5 in improved health and productivity according to the WHO. Even more, a recent analysis by the World Health Organization estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to US $16 trillion over the next 20 years. Such an estimate marks mental health out as a highly significant concern not only for public health but also for economic development and societal welfare (WHO/WEF).

The Solution: Discrete and integrated funding streams 

Though mental health funding streams have expanded in the last decade, more investment is urgently needed. Investing in mental health also offers opportunities for return on investment for individuals, families, and communities as individuals can return to meaningful work. We propose a call to action for the global mental health community to invest in expanding two types of funding for global mental health: discrete mental health funding streams and integrated funding streams. To illustrate these two funding streams, we draw upon and cite examples from various leaders in the field of global health, including Partners In Health. Partners In Health (PIH) is a non-profit, global health organization that fights social injustice by bringing the benefits of modern medical science to the most vulnerable communities around the world.

Discrete mental health funding streams provide the opportunity to pilot new models and treatments. Current funding is often predominantly research-focused, which is essential in growing our understanding of mental health conditions and strengthening the toolkit of effective, evidence-based strategies and treatments. Discrete funding can also support implementation of evidence-based practices into routine care delivery. For example, Grand Challenges Canada (GCC) helped support the establishment of a community-based mental health program in Haiti with Partners In Health/Zanmi Lasante which is now a model for national scale and continues to support global mental health projects worldwide today. Private organizations or foundations (such as corporations, pharmaceutical companies, etc.); and individual donors, many of whom often have lived or personal experience and understand the impact of mental health conditions, can also be key partners. 

The second type of funding stream is mental health funding integrated with other health conditions as a wedge issue. Given the high comorbidities with mental health and physical conditions, integrated funding streams have the potential to not only improve mental health outcomes but have an impact more broadly, for example, to improve adherence to tuberculosis treatment or to provide psychosocial support to people with cancer. Alternatively, grants to promote HIV treatment can include mental health components around social support or counseling. COVID-19 offers yet another opportunity to incorporate mental health as a wedge issue into funding for health systems strengthening or emergency response initiatives. There are numerous examples of integrated models of mental health care, proving its impact for both the delivery of quality mental health care and as an advocacy tool. Partners In Health sites across the globe have taken this approach in integrating mental care into primary care in Haiti, Rwanda, and Mexico; with care for multi-drug resistant tuberculosis patients in Lesotho and Kazakhstan; with homeless care programs in Liberia and Sierra Leone; with care for non-communicable diseases in Malawi; and with maternal health care systems in Peru. The link between physical health and mental health is clear, and research indicates that integration of services improves patient experience and efficiency of health systems. 

Both types of funding streams are needed to address the immense burden of disease globally. However, with any mental health funding, buy-in from service users is needed from onset to ensure that mental health programs reflect the priorities and needs of beneficiaries. Involving individuals with lived experience in developing and driving funding priorities is also essential for ensuring the appropriateness and impact of funded initiatives. 

How can you invest in mental health? 

World Mental Health Day was on October 10th, but the movement continues. In the spirit of this year’s theme “Move for Mental Health: Let’s Invest” here are a few ways that you can support your own, your community’s, and global mental health: 

  • Invest in the strengthening of mental health care delivery to the most vulnerable by donating to organizations that are actively addressing these important needs like: 
  • View recordings of virtual events celebrating World Mental Health Day such as “The Big Event for Mental Health” organized by the World Health Organization. 

Share a photo or video of how you are “Moving for Mental Health” on social media and tag #MoveForMentalHealth and @GMHatHarvard.

An Interview with Ann Aerts, Head of the Novartis Foundation

As COVID-19 sweeps across the globe and inundates health systems, governments face ongoing pressure to respond swiftly to stop the spread of the virus. While this public health crisis revealed the fragility of many health systems and highlighted weaknesses in governance structures, COVID-19 also shed light on the transformative power of digital health tools. In fact, new opportunities emerged for governments to reshape investment in their digital health infrastructure.

So why has this specific health crisis been a wakeup call for governments on the power of digital? According to Ann Aerts, Head of the Novartis Foundation, it is because this is the first epidemic response that is fully data driven. “COVID has catapulted us into a digital world,” she explains, “and has also brought digital health to the forefront of health and care delivery; even the most skeptical have been convinced that the benefits of virtual care largely outweigh the risks of having in person consultations during the pandemic.” Now more than ever, Ann is seeing a shift in mindset within governments, recognizing the power of rapid access to digital data and its potential to inform better decision-making, health planning, and more appropriate allocation of resources.

While this shift in mindset is critical, for many governments, there remains a gap between acknowledging the power of digital solutions and tapping into their potential to improve health outcomes. COVID-19 made this painstakingly clear – as many governments still rely on paper-based systems for data collection, and a lack of digital literacy remains commonplace – it is extremely challenging for some to meet the digital demands of this crisis.

That is where the Novartis Foundation comes in. As an organization that spent the last decade supporting the adoption and implementation of digital tools, they have been thinking critically about the core components that truly enable a government to increase their health systems readiness to adopt digital and AI-driven solutions. In a recent report developed by the Broadband Commission Working Group on Digital and AI in Health; the Novartis Foundation, Microsoft and other partners provided a roadmap for governments to do just that. According to Ann, it ultimately boils down to having a strong Informational Communication Technology (ICT) national framework, intersectoral collaboration, and visionary leadership. “Health is really a political choice”, says Ann, “it is an opportunity to make digital and AI an essential part of every health system, just as essential as hospital beds are.”

The report highlights learnings from countries around the world, showcases their innovative AI-driven solutions, and guides governments on where to invest resources to transform their health systems and reap the benefits of digital and AI. It goes on to highlight how technological innovation skyrocketed during the pandemic, and spotlights new tools hitting the market. The scope of innovations is expansive – from AI-enabled symptom checker chatbots to systems that leverage real-time big data to produce COVID-19 risk maps – and the reach is far, impacting health and care delivery, and outcomes at all corners of the world.

The Novartis Foundation believes this report is one way to better equip governments with the steps they should take to allow their digital health systems to deliver health and care in the digital era. Transforming these systems will allow for better reaction, not only to respond to the COVID-19 pandemic, but for future outbreak response preparedness. Ultimately, Ann notes, “this COVID crisis highlights the critical role health authorities play to make the right policy and investment choices.”

Low- and middle-income countries (LMICs), given their dual disease burdens, the significant shortage of skilled health professionals and rapid urbanization, likely have the most to gain from AI in health. They also have much to lose; if their governments fail to take the necessary steps to strengthen their data strategies and digital infrastructure, and improve the digital skills of their people, they risk missing key opportunities to tap into impactful digital solutions. 

As the Novartis Foundation continues to promote and share the report findings, they are committed to finding other ways to highlight the role of digital in the COVID-19 pandemic. In partnership with the Harvard Global Health Institute, they hosted an 8-part webinar series that brought together experts from low resource settings to share how they leveraged digital in the fight against COVID-19, and the hurdles faced along the way. Ultimately, the message is simple: “countries need to invest in data and the use of data if they want to improve their populations’ health,” says Ann.

Written by GMH@Harvard Ambassador Board Members: Bill Kriebel, Sarah Coleman, Anna Bartuska, and Amruta Houde
All artwork by Bill Kriebel

October, World Mental Health Month, begins at the end of this week! Saturday October 10th is World Mental Health Day and the theme this year is Move For Mental Health: Let’s Invest. The World Health Organization, for the first time ever will be hosting a global online advocacy and fundraising event on Mental Health.

We have aligned our three-part series to coincide with this important theme.In our first article of the series we discussed with Elisha London, Founder and CEO of United for Global Mental Health, about what it means to invest in mental health and how we can take action to improve global mental health. In this article, we share ways that you can invest in your own mental health, especially through mindfulness and expressive arts.  Our third article of the series will be released after World Mental Health Day and explore financial investment in global mental health.

It’s time to invest in your own mental health

Let’s get real.  COVID 19 is stressful and impacts how we feel, what we say to ourselves, and what we do.  Our lead author went through a lot of stress leading 13 teams in nine countries and turned to mindfulness and expressive arts to stay mentally healthy.  Now he shares these experiences as a Certified Peer Specialist and through this article seeks to share these strategies with others. In this article, we offer ways and resources to help you stay emotionally and mentally healthy during these challenging times. The following list of strategies is not mean to be comprehensive, but instead help you begin to invest in your own mental health. You may wish to start with these articles to set the stage. 

Links: Harvard COVID Mental Health, PIH tips, Invest in yourself

Invest in relaxing

Pretend like we are meeting in a big living room with a nice warm fireplace

Rest

Talk

Be comfortable and mindful

Meditate: Rest with your body and breath

Why? You are investing in reducing stress, staying calm, and improving your immune system

Links: relax, meditate, yoga, mobile apps, ADAA apps, stress apps, anxiety apps, app efficacy

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Invest in gratitude every day

Find greatness in being at home

Appreciate everything

Living is a miracle!

Savor your cuisine, it nurtures you

Why? You are investing in staying positive no matter what

Links: Giving thanks, gratitude science, gratitude journals, gratitude praise

Invest in being deeply aware of what is

If you can go outside, let nature speak to you

If you are spiritual, take time to cultivate spirituality

Now is the only time you actually live

Why? Investing in connecting with your inner and outer world will raise awareness of how you really are.

Links: Self awareness matters, self awareness benefits

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Invest in your body and your health

Walk, Exercise, Yoga, Run, Hike, Swim, Breath

Eat well, regularly and diversely

Consistently maintain your hygiene

Why?  Investing in your body is essential as science shows exercise can reduce symptoms of anxiety and depression

Link: Invest in your health

Invest in creating and expressing yourself

Dance, Sing, Play music

Photograph, Look

Draw, Paint, Watercolor

Why? Investing in playful heart energy and being present to boost your health and stay happy

Links: Artistic passion, Healing art

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Invest in challenging and strengthening your mind

Take classes, read, play games, etc

The importance is to keep your mind strong

Why? Investing in a strong mind keeps you young, active and healthy

Links: Stay young, brain exercises

Invest in building community!

This may be tricky with COVID.  Definitions of community can change to fit the times.

Call family and friends, Zoom

Make sure your friends and family have the social support they need, especially if they are in quarantine or part of a vulnerable population

Check in on people you care about who are on the front lines such as clinicians, teachers, public health workers, etc

Join the global movement of COVID-19 response such as at Partners In Health and share success stories to lift each other up

Why? Investing in community keeps you connected with others which can become essential

Links: Socializing benefits, mental health communities, group mental health, PIH Covid response

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Invest in your wellness recovery action plan

Who are the people that you will call in a mental health emergency?

Who will take you to the hospital?

Which doctors, medications, and allergies do the emergency room staff need to know

Which medical information do you need to have on hand?

Why? Investing in emergency preparation while you are mentally strong, is essential if you may need help

Link: WRAP plan

Invest in keeping your bills paid and finances well managed

Simplify and keep a consistent process

Save money now in case you need money for healthcare emergencies or lost work

Why? Investing in your finances now will greatly reduce mental health concerns when sick

The following provides a good workbook for finances and the above topics 

Link: 8 Dimensions of Wellness

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What if all of this is too much?  Invest in getting help!

You may have a treatable mental health concern

Speak with a therapist or doctor

You could look up your concerns on the web, but this has dangers if you have a true concern

Why? Investing in one-on-one communication with a professional can isolate a specific concern that needs your attention

Links: Therapists, Crisis lines

What if you know you have an illness?  Invest in making connections!

Ok, this is not for everyone and is harder with Covid

Still, make the effort

Join a recovery community

Why? Investing in connecting with other people can be essential to healing, or at least beneficial

Links: Metro Boston RLC, McLean Hospital Waverly Place

What if your illness is much more serious?  Invest more!

If you have a serious condition and have tried many alternatives, you may need more

There are many residential programs throughout the US

Why? Investing in a residential program can help you treat your health holistically

Link: Residential treatment programs

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Invest in learning about mental health concerns

Why? Investing in learning about mental health can help you and others take the best actions

Links: NIH, NAMI, SAMHSA, CDC, WHO, MIND UK

Healthy and ready to help others?

Invest in the greater good of the world

We are in a time of multiple crises- public health, racial, economic, police brutality: all affecting our mental health and compounded by potential COVID-19 mental health related challenges

Why? This improves everyone’s mental health collectively, while helping ourselves

Links: Volunteering, Investment needed, racial tensions, COVID concerns

Don’t forget to invest in yourself and in your communities on World Mental Health Day, Saturday October 10!

Are you ready to #MoveForMentalHealth? Visit United for Global Mental Health and join the virtual #WMHD activities!  Stay tuned for our third and final article Investing in Mental Health later this month!

____________

Authors:

Anna D. Bartuska, Program Coordinator, Community Psychiatry PRIDE, Massachusetts General Hospital 

Sarah Coleman, Cross-Site Mental Health Officer, Partners In Health

Amruta Houde, Mental Health Program Associate, Partners in Health

William Kriebel, Master’s of Liberal Arts Student at the Harvard Extension School, studying Management. Certified Peer Specialist, Boston Medical Center

An Interview with Sathy Rajasekharan, Jacaranda Health

When the first COVID-19 cases began to spring up in Kenya, the government quickly responded with an array of infection prevention measures. While travel restrictions and curfews would help reduce the spread of the disease, there was a several-week gap that left pregnant women and new mothers confused on how to navigate care, while the Kenyan government created guidelines on how to safely provide care to those with ongoing needs.

At the same time, providers looked for ways to circumvent the healthcare service disruptions that were making it difficult to communicate with patients and deliver essential services. Fearing that maternal care would become jeopardized, it was clear a solution was needed quickly.

For Jacaranda Health, a non-profit organization that uses digital tools to improve maternal and child health outcomes, it was clear they were well positioned to overcome some of these challenges. Sathy Rajasekharan, Jacaranda’s Executive Director (Africa), explained that prior to COVID-19, the organization was already using a contactless approach to connect new and expectant mothers to care at public hospitals at the right time and place.

One of Jacaranda’s flagship products, the PROMPTS digital health platform, uses an AI-based triage tool to prioritize urgent health-related messages from mothers. These messages are then filtered to clinically trained help desk agents, who identify and refer high-risk mothers for care. Better yet, the platform is integrated into some health systems, enabling the help desk to link women to the care they need, while also alerting the clinics to the incoming patient. 

As these novel needs arose, Jacaranda’s help desk agents were able to adapt and provide mothers with timely responses to their questions. This approach meant that, within hours, mothers obtained a response, and when necessary, high-risk mothers were identified and immediately referred to receive emergency care. Sathy noted that while chatbots are a valuable information-sharing tool, they often serve as a step toward human interaction, rather than replacing it. “A COVID chatbot is a way to get them information quickly, but every mother has a unique question and so we have help desk agents ready to follow-up and provide that unique guidance,” he explained.

In the midst of the COVID-19 pandemic, tools like PROMPTS are more critical than ever. As cases started to spread and healthcare services were still adapting to guidelines and precautions, the over 200,000 users could quickly turn to the platform to get answers to their pressing questions. Sathy explained that as the virus spread, they started to see a new set of questions that were COVID-19 specific, such as  ‘how am I supposed to access services at night?’ and ‘can I deliver at home?’.

For emergency cases, the help desk agents will often call the mother directly and assist them in finding the closest facility to attend. They will also follow-up with the mother in order to verify whether she attended her appointment. In recent months, on average 95% of women who were referred to seek urgent care by PROMPTS did seek care at a facility.

On the provider side, Jacaranda’s Emergency Obstetric and Newborn Care (EmONC) mentorship program, which trains nurses in obstetric care skills, has since transitioned online. The Jacaranda team recognizes that despite the pandemic, the need for training on essential life-saving maternal health skills remains. Virtual platforms have enabled them to continue their work safely, reaching over 120 in-facility EmONC mentors across 70 government hospitals. Sathy recognizes that while there are limits to who the online training can reach, “people are really getting behind these digital solutions, recognizing the need for them, and seeing the potential role they can play in the current situation.”

As COVID-19 continues to disrupt ongoing healthcare provision, it is clear that digital solutions can play an instrumental role in bridging the gap. Now, Sathy says, he is seeing a shift in the acceptance of digital solutions – “there has been a widespread recognition that teleconsultation, telemedicine, telesupport – is incredibly helpful at this time – and so we are seeing an acceleration in people’s responsiveness to test these solutions.” A change in attitude could mean that in the future, barriers to the uptake and engagement with digital solutions could decrease. 

The acceptance of digital health tools has already begun to translate to an increase in demand. This has meant new opportunities for Jacaranda; including a partnership with local start-up M-Shule, a mobile-learning system, to create an e-learning platform for our EmONC mentors; and Health-E-Net, a telemedicine provider, to help to accelerate referrals for high-risk mothers.

While challenges remain in integrating digital health tools into existing workflows, Jacaranda’s success has in large part been due to the unique position they were in when the pandemic hit. Sathy shares, “I think what’s important is that we had the infrastructure present; it was very maternal and newborn health specific, but we adapted that data and data sourcing to be able to respond to more holistic challenges that we were seeing, with the end goal of maintaining essential services for mothers and babies.”

To learn more about Jacaranda Health, follow them on Twitter @Jacarandakenya and LinkedIn