Kate: Welcome everyone. And thank you for coming to the third and final panel event in this three-part discussion on the principles that will underpin Wellcome's work on mental health. So this event is on Envisioning Mental Health as Larger Than Healthcare. Please do follow and tweet using the hashtag for today, which is #WellcomeLEConversations. So just to introduce myself, my name is Kate Martin. My pronouns are she, her. I'm the lived experience lead for Wellcome's Mental Health Programme. And I'll provide an audio description for anyone who can't see the screen for any reason. I'm a white woman with short dark hair, and I'm wearing a white T-shirt and I'm sitting in a room and behind me, there is a painting on the wall. So for those of you who haven't engaged with Wellcome before, we are a global charitable foundation that uses science to solve the urgent health challenges facing everyone. And our vision for mental health is a world where no one is held back by mental health problems.
So before we get into the discussion, a few quick technical housekeeping things. So this event is being live streamed and is going to be recorded and shared after the session for anybody who can't make it. Just to reassure you, none of you listening and watching aren't on camera and your microphones are off, so we can't see or hear you. For anyone, for accessibility reasons, closed captioning is available if you want to use it. If you do want to enable this, please head to the settings on the bottom right-hand corner of your screen and switch the toggle on for closed captioning. If you lose the connection or drop off for any reason, just use the same link and you can come and rejoin us.
The session is for about an hour. We've got no breaks scheduled, but of course we can't see you. You can always pop off for a quick break if you need it and you'll get the recording afterwards. You can also submit questions in the Q and A function. We really welcome any questions as we go along. They'll be moderated and we'll try and get to as many of the questions towards the end of the panel discussion as possible. You can also upvote them so we can see which ones are the most popular questions. If we don't get through them all today, we will try and get answers back to as many of the questions after the event and in the post, and in email, as possible. As I mentioned, this is a three-part discussion on just one of the principles underpinning Wellcome's mental health work. The first two sessions on the 2nd and 7th of June. And we'll soon share the recordings for those so you can catch up.
Just to give a quick background. So these three principles really came from, I guess, a real recognition that... We know that mental health is an urgent global health challenge. And we've all got to cooperate if we're really going to find the best solutions and ways forward. We published a document called Expanding Our Visioning, Expanding Our Vision, apologies, in collaboration with our colleagues at UNICEF, the World Health Organisation, World Economic Forum, and the Office of the UN Secretary General to really think about what principles can we all work to, to really underpin our work on mental health. As well as this principle we're discussing today, the other two are putting lived experience at the heart of policy and practice and positioning local innovation as a focus for learning and funding.
I guess that the other thing to say about these principles are that we are all committed for these underpinning our work, but we are... Certainly, none of us position ourselves as experts here, these are aspirational. These are what we're working towards. And really these panel discussions, are the start of a learning journey of us learning in public and thinking, "What can we do to really ensure that these principles do underpin our work as we go forward." So really looking forward to starting the discussion, but continuing this over the months and years to come. So without further ado, I will start introducing my colleagues. So I will hand over to my colleagues and please do obviously introduce yourself. And also if you could tell me and tell us, when you hear envisioning mental health as larger than healthcare, what does that mean to you? And I will go over to Dion first, please.
Dion: All right. Thanks Kate. Can everyone hear me now? All right, thanks. Good day, everyone. My name is Dion. My pronouns are he and him. I am a lived experience advisor here at The Mental Health Priority Area at the Wellcome Trust. I'm currently based in Jakarta, Indonesia. And for the audio description, I am a Southeast Asian man with brown skin, long black hair tied in a bun and short facial hair, wearing glasses and a white shirt. In my background, you can see my white and grey wall room, lit with warm yellow lights. And for the question, envisioning mental health as larger than health.
I really think that mental health is something that exists in everything in our life. It is truly larger than everything because mental health exists in our social life, it exists in our physical health, and there are all of these aspects of mental health that can influence what you do, what you think and how you feel and so on. And I really feel that putting mental health as larger than healthcare is an important step in creating a better world for everyone. A better world, where we recognise that mental health is just as important even as healthcare or as other things in life. Thanks, Kate.
Kate: Brilliant. Thanks, Dion. And over to Cat next, please.
Cat: Hi everyone. I'm Cat Sebastian, and I'm the evidence lead for the Mental Health Priority Area at the Wellcome Trust, it's in London, UK. My pronouns are she and her. For the audio description, I'm a white women with Mediterranean heritage though I've got olive skin and dark brown, straight hair. I'm wearing an orange dress. And my background is my study which is quite a minimalist room with white walls and a wooden door and cupboard.
So the question, as evidence lead, envisioning mental health as larger than healthcare means following the evidence and providing the best evidence-based solutions for mental health. And the evidence suggests that actually mental health is larger than healthcare. The current healthcare-based solutions such as medication and therapy aren't the whole story for mental illnesses such as depression and anxiety.
So first of all, the majority of people with anxiety and depression, never enter the healthcare system. And for those who do, around 40% don't benefit, many also improve without healthcare intervention, but we actually know very little about the strategies that they're using or the effects that changing circumstances in their lives may be having on their mental health. And so over the past 18 months, I've been working on a programme called Active Ingredients which is trying to work out what are the core ingredients or components that work for treating or preventing adolescent anxiety and depression, specifically, focusing on what works for whom and why.
And just as an example, in our 2020 commission, of the 26 ingredients that we commissioned, while some ingredients were traditional healthcare-based solutions, such as medication, there were also many others that took a wider societal approach, so things like cash transfers, the role of green spaces and social relationships, or about what we think of as quite basic behaviours, such as sleep. So I think overall clearly there is an important role for healthcare to play in mental health, but there's also a role for wider societal change and awareness, community change and providing people with the agency to find a solution that works for them.
Kate: Brilliant. Thanks, Cat. And I'm sure we'll come back to much of that throughout the discussion. Over to Tash next, please.
Tash: Thanks, Kate. Hello everyone. My name is Tash. I use she and her pronouns and I'm based in Melbourne, Victoria, Australia. I'm one of the lived experience advisors for Wellcome Trust. I'm a white woman with long blonde hair, wearing a black floral top. Behind me, you can see some flowers, a lamp and some curtains.
When I hear envisioning mental health as larger than healthcare, there are a lot of things that spring to mind, and I definitely echo what's already been said. I think the one thing I would add is that at least in my experience, we don't blame individuals if they were to have a physical health problem. That's not always the case within mental health. And if we're looking at this as a really holistic approach beyond just what the healthcare system currently offers, we need to look at as communities, how we can bring each other together and really rise against the stigma that so many young people face in their experiences with mental health challenges and what as communities we can be doing, not only to stem mental health being an issue, but also to come together and really fight back against the stigma that's really been perpetuated in our societies. Thanks. Kate.
Kate: Brilliant. Thanks, Tash. And last, but certainly not least, Niharika.
Niharika: Thank you, Kate. Hi everyone. I am Niharika. I use the pronounce she and her. I live in India and I am a lived experience advisor with The Mental Health Priority Area. And I think I'm wearing a blue top and a white scarf today. And in the background, you can see a curtain and a mirror.
And when I come to the question and this principle specifically, I think I've always had too many thoughts about this specific principle, because first off, I believe that our minds don't live in isolation, they live in certain environments. They live in multiple environments that we go through every day. And that impacts, whether it's your family dynamics, whether it's your economic status, your financial stability, whether it's the way you interact with the world, whether it's the news cycle or social media, all of these things impact our mind and our mental health. And in fact, in India, I know that unemployment is something that's been related to a lot of mental health problems through different reports and studies.
We've also seen how Covid-19 impacted so many people and specifically with mental health concerns. And this is not just for people who have existing conditions, but also people who might face some mental health problems in the future. And so similarly, these are problems that are also solutions, which we need to think of beyond the clinical aspect. Like, if you see in low to middle-income countries, we also find that they are not even a decent expert to people with mental health problems ratio. We don't have enough therapists, we don't have enough psychiatrists.
Then how do we solve this problem? What are the solutions we look at? We need to look at a scope where we involve the community, we involve people with lived experiences. We go beyond the clinical aspect and we look at how community care and different people coming together can transform this thing. And I think that's why this principle is so important because it puts the onus on different stakeholders and not just the individuals like Tash mentioned. So yes. That's just one of the thoughts. Yeah.
Kate: Well, I love the first thing you said almost was, "I have too many thoughts." So let's hope we can get to as many of those thoughts as possible, Niharika. I know there's going to be a really rich conversation with everyone. And I thought actually what you were just saying about needing to bring everyone in and really trying to solve this together leads on, I suppose, to the first question really nicely, which is, so seeing mental health as larger than healthcare, what problem are we trying to shift with this principal? What problem are we trying to address? And I think I'll come to Tash first, if that's all right.
Tash: Thanks Kate. I think there's a lot of things that come to mind initially when you asked this question. And in the interests of time and allowing everyone to speak, I'll try to keep it relatively short, as difficult as that may be. It's so challenging to have a mental health issue and to access care, full stop. The gate-keeping that we experience in trying to access services, if that's what we attempt to do, or just simply getting community around us and planting holistic approaches to what it is that we need that suits us best is incredibly challenging. The investment that really hasn't happened previously within the mental health system continues to be lacking. And that's not necessarily something that we see across the board for other physical health issues.
If we envisioned mental health as much larger than health care, we acknowledge the impact that mental health has beyond an individual level. There is no individual that hasn't had a flow-on effect within their community when they've struggled. And vice versa, when another individual struggles, we feel that. As communities, we hold ourselves together and we come together as groups that care about each other. And when we see that play out across the world stage, the economic cost level and the personal human cost is beyond anything that we can ever imagine.
At least in Australia, we know that one of our biggest expenditures is in loss to GDP. So as we're trying to change that, the problem at its heart is that we don't understand what we actually need. It isn't as simple as medication or talking therapies as Catherine mentioned before. It's so much more complex than the work that Wellcome is currently doing relating to Active Ingredients. It's something we need to see across the board, across countries. It needs to be prioritised and I don't think we get to see that. I'll leave it at that, but I think that's one of our core problems so far.
Kate: Brilliant. Tash. Very succinctly pulled together a whole range, a real breadth of an answer there. And I guess what I was hearing you saying was about the problem we're trying to address. And listening to that, it also opened up in my head a whole load of possibilities about what we can then change if we do start to refocus this, but we'll come to the possibilities a bit later. I just wondered if anybody else wanted to come in. So what are your views and what problem are we really trying to solve by seeing mental health as larger than healthcare? Great. Niharika, over to you.
Niharika: Yeah. I think two things that come to my mind right now are either way or often, I think a lot of the people live in their own bubbles. We are all living in our different bubbles and we feel that, like a lot of people feel that mental health problems or people with mental health problems are in one bubble and then the rest of the people in the society are in different other bubbles. So how do we break that notion that it's not just three, four or five different bubbles, but a society together?
How the decisions that our policymakers take on different policies, whether they are related to cost, whether they're related to economic status, whether it's social justice, all of those things impact different people in different bubbles. So just thinking from that manner that we are here collaboratively and every decision that you take has, might have some kind of mental health impact on certain sections of society or certain people. And if you take that thought first and then think about a policy, or then think about a decision or a business decision, I think that would transform how we think about this principle.
And the second point is the stigma that we face when we talk about mental illnesses or mental health problems. People just tend to stay away from it. People tend to exclude people with lived experiences or people with mental health problems, which... And I think they are great. All of us here are great resources if people would want to utilise our expertise and use it in formation of different decisions, in formation of different collaborations. So yeah, I think reducing that stigma would also help.
Kate: Reducing the stigma, but as you say, also making best use of the expertise available to us. The more we can learn alongside what people are trying, whether that's individuals, communities, societies, to understand, really help us shift forwards our knowledge about what does work, what helps who and to really share that expertise and build the evidence base, a much richer evidence base, that we can use to understand how we can really address mental health challenges. Cat or Dion, I wondered if you had anything to add about the problems we're trying to address. Dion. Yes, over to you.
Dion: Yeah. Thanks, Kate. So the point that Niharika made really made sense, especially here in my country, the stigmatisation on mental health is very strong. So a problem that actually this principle can shift is where, here we tend to see mental health issues as something that is very abnormal. It's very strange. And sometimes even people see people with mental health problems as dangerous. That is even multiplied by how our government defines mental health issues.
In the research and the reviews made by our own ministry of health, they stated that the mental health issue that they acknowledge is only schizophrenia. Only psychosis and those kinds of issues are acknowledged as mental health issues or mental health problems. Then the people generalise that and stigmatise people with mental health issues as being simply, for lack of a better term, being crazy.
So that's something that this principle can really target and really shift. It's that how people perceive mental health is not only as this problem that is dangerous for everyone, it's debilitating and so on, but we really need to see mental health perspectives from a more holistic point of view. We need to see that there are a lot of aspects of mental health. Everyone has mental health. And maybe a lot of us have mental health problems and that's fine. And either from healthcare or through other various ways, we can manage our own mental health and find something better for us in the future.
Kate: Thanks, Dion. Cat, was there anything you'd like to comment on?
Cat: Yeah, just quickly. I agree with what's been said by everyone so far. I wanted to pick up in particular on this point of what does it mean when we think of mental health within the healthcare system? And I think originally, maybe 20, 30 years ago, thinking of it as a healthcare problem was meant to be de-stigmatising because it's like, "We have health physical health problems and we have mental health problems" "and you shouldn't feel any more stigma, the mental health centre" and the physical health". But in a way it's almost like the pendulum swung too far and instead people feel "It's a medical problem. and therefore there is stigma" "and what's more as a medical problem, I need to take personal" responsibility for it." Whereas actually a lot of the cause and influences on mental illness are broader than that and broader than anything that any one individual can control. And so I think that is a big challenge in trying to take the positives from that approach, but also saying, and then it's bigger than the individual.
Kate: Absolutely. I think one of the challenges that we picked up on when we commissioned some engagement with young people about understanding and some conversations that we've had as a team is it's just that lack of knowledge out there, what we can all use to help our own mental health when we're having challenges and just needing to really find ways of how do we evidence a much wider range of approaches that people can find what works for them.
And absolutely, this is not about knocking the really valuable helpful support we can get from healthcare systems, it's as we've all said, it's about what else is there? What other things can we do within it for ourselves, within our communities, within our societies that will help shift this? What other possibilities are there? So great this leads really nicely onto the next question, which is, so if we are trying to see then, if we're trying to make a shift to see mental health as larger than healthcare, this is more as a principle of thinking about how do we start to even address this and put this into action? What might some of the challenges be in achieving this principle? Dion, can I come to you first this time?
Dion: Right, Kate. As I said earlier, I think mental health exists in every aspect of our lives, whether we accept it or not. And if we look at it from a bio-psycho-social standpoint, it's clear that all of these aspects intersect with and influence each other. But sadly, so few of us have yet to recognise the importance of the psychological factor in this whole bio-psycho-social equation. And even for me saying mental health is a part of healthcare can already be considered as a privilege because here mental health isn't even part of the healthcare, let alone it being larger than the healthcare.
I guess what I'm trying to say is this issue is something that has been seen from the sidelines by a lot of people, because a lot of people, especially those not involved in the mental health area or people not working directly in the mental health area, interacting with people with mental health difficulties often don't really understand the importance of mental health in the aspects of everyone's lives. And they often only see mental health as something in the reports. Like a lot of people move towards this, they try to address mental health as something important, as something as important as physical health.
But I see that it often falls short. It often falls that they're only considering it because it might reduce their earnings, it might reduce their overall success in the company. And seeing it from that standpoint, I really feel that we're not really humanising people with mental health issues. And so, especially in my context, in low- and middle-income countries, mental health is larger than healthcare is, I think, important to move forward to.
As Niharika said earlier, I think community engagement is very important where people like us don't really have that much access to healthcare and also mental health care from a clinical standpoint. So all of these different approaches, like maybe my colleagues will explain later about the active ingredients part, is all of these different approaches, considering mental health as something larger than only drinking your medicine on time and making sure you go to your psychiatrist appointment on time is really important and something that should be held in high regard by everyone, not only those in the mental health field, but also those stakeholders that also would, I don't like to say benefit, but everyone would especially benefit with better mental health conditions., especially those with the issues themselves. I guess that's my point of view.
Kate: Brilliant. Thanks, Dion. And actually, you just reminded me of a conversation we were having a few years ago with one of the young adults I used to work with. Who said that One of the biggest issues for her was that when she started to access formalised mental health services, all the other things that had been helpful along the way, everyone backed off. And it was a bit like, "Well, you're in formal services now. "And all these other things you've been doing." Whether that's things that gave her a sense of purpose or other important things in life seemed to stop as if it was a replacement. We should never... With this rich conversation we had as a group is that we need all of these things, that they're all an adjunct to each other. And that we've got to find the best package that will help us. It's not either, or, but there's all sorts of different possibilities that we can build around individuals, but starting to unpick that is a complex picture, particularly, trying to move that forward. Tash, I'll come to you next. What challenges do you see in us achieving this principle in practice?
Tash: Thanks, Kate. I think in a similar vein to whatever else has spoken about so far, is that at least within physical healthcare at the moment, we seem to have a relatively solid understanding of what best practice is, of what works, when it comes to mental health care, that's lacking. For example, I work a fair bit within the suicide aftercare space for young people, despite months of looking at the research, there is really limited consensus on what actually works. If you were to have a physical health element, that's not typically the case.
So if we're envisioning mental health as much larger than just healthcare, there needs to be that fundamental investment in understanding what mental healthcare looks like, what elements it is that are effective and how it is that those elements become effective. Is it communities working together? Is it finding that sense of purpose? What about it is important to individuals? Are there certain therapies that are most effective for individuals or for groups? How do we find what fits people best? It's not as simple as medication and therapy, or even finding a sense of purpose or employment or something that matters to you.
There are so many elements and we just don't understand yet what that is. We're relying on individuals to know that themselves, when a lot of the time, when you're already really struggling with mental health challenges, that's the last thing that you want to be able to do. The challenges are so broad but I think at the end of the day, it comes down to research and how that research partners with young people with lived experience, their families, their carers the people around them to truly understand what it is we're facing and how we move forward.
Kate: You've also reminded me there of, in some of the recent engagement where we've done talking about what's most important about new interventions, new approaches, about the active ingredients with young people in multiple countries, one of the strongest messages that came through was that all approaches should have a really strong evidence base. That just because something sits outside of the traditional ways we've seen health or health care and mental health support, doesn't mean it should be held to a lesser standard of evidence. That whether it's peer support, self-care, whatever, and exercise, nature, whatever it might be, the evidence is still important to give people a trusted range of approaches that they can use for them. So that we just always see the evidence as what works for who is the really strong independent principle. Cat and Niharika, I wondered if you anything to add on, what challenges you might see about achieving this principle.
Cat: Yeah. I completely agree with Tash about the lack of understanding of what works. And I think part of that is that we still have a relatively poor understanding of what mental illness actually is. I mean, it exists on a continuum and deciding where the cut off point is between people who need help and those who don't is in some ways an arbitrary decision. And mental health problems are highly heterogeneous in terms of what causes them and also how they present. So unlike in areas of physical health care, we don't have specific biomarkers, for example, that can help point the way to specific treatments, whether that's within the healthcare system or outside of the healthcare system.
So I think research to work on tailoring based on a mechanistic understanding of how different illnesses develop for different people is important. I think I also wanted to pick up on a point that Dion made about the economic burden that mental illness has for the whole of society and how... I sometimes find it surprising when I look at these global burdens of disease studies and see depression is up there in the top five causes of huge global burden of disease globally. And yet the amount of attention that's paid to mental health by governments and industry pales into insignificance compared with other practice, whether it's physical health or broader factors. So I think raising awareness of making that link between the actual ingredients of what works to help people and the direct economic effects could go a long way, but I think it's a challenge at the moment because I don't think those links are well understood.
Kate: Thanks, Cat. Niharika, anything to add?
Niharika: Yes. I think I agree with all the points, from a perspective of research and evidence that we can build. I think from a policy and advocacy point of view as well, when we go to people or stakeholders, everyone is too afraid to go into an uncharted territory. That, "We haven't tested this before. We haven't tried this before. Businesses would ask "What evidence do you have?" Stakeholders would say, I have 10 better things to focus on.
So we have to build a case for and get that buy-in from these stakeholders and the people to test some of these things out because some of the solutions also have huge scope, whether it's the intersection of mental health with pop culture, whether it's community care, whether it's data, which I think Wellcome Trust is also focusing on with the data bank. All of these are things that are the intersection of that.
And these are starting points. We are starting to get onto them right now. So getting that buy-in and encouraging people to look at these intersections, and especially with the focus on the low- and middle-income countries and the marginalised communities as well, which are often ignored in terms of the evidence in research or policy and advocacy, all the perspectives. So if you can at least get those buy-ins and focus them on these communities, I think these will be two of the biggest challenges that we can work on.
Kate: That's almost a seamless link to the next question, Niharika, which is, I guess, how exactly do we get people to work together to fulfill this principle? Because it's clear that we are all gonna have to... I guess, from the principle, particularly that we need to bring all sorts of different people, communities, governments, the industry, et cetera, to come together to solve. So you've touched on this already, but I'll just ask you to follow on, I suppose, and say anything else you'd like to say about how do we bring people together to tackle this, tackle this issue and to fulfill this principle?
Niharika: Yeah, I thank you for that question.
I think that was the next thing on my mind as well when I was talking about this. There are so many stakeholders, like you mentioned, from individuals to funders, professionals, local organisations, governments. And getting all of them together, I think we first need to start by sharing our own experiences, whether we as lived experience experts or whether we have organisations that have started to look at these things because I know Wellcome is doing such great work.
We know that there are a lot of community organisations in different countries that have started to look at these things. So once we start sharing these learnings openly through such webinars, through different reports, through talking more about it on different platforms, I think that opens people up to the conversation that opens people up to at least look at this particular principle.
And then you also need to build this case for how different things are interconnected when you're looking at policy, for example, and education policy for policymakers is looking at an education policy and they're not talking to people with lived experiences, how would they know what mental health effect it can have on students? If there is a mental health helpline which is talking to someone in distress, if they won't have connections to get them to maybe some domestic violence helpline, or if they don't have a connection with the social protection services, how would they solve that problem?
Again, we're focusing on just the Western side of things, how would the different other countries which already have low resources come into play? So these are the things that we need to talk about and these are the solutions we need to look at and build a case for cross-community and cross-cultural collaborations, which will help different kinds of people come together to solve this challenge.
Kate: Brilliant. Thanks, Niharika. I wondered who else would like to come in next to think, to share about what do you think... How do we bring people together to put this principle into practice? Tash.
Tash: Thanks, Kate. I think at the end of the day, we'd all love it to be quite as simple as saying, "This is important. So we're going to do it. In practice, I don't think that's quite the case yet. In Australia, we've had about two years' worth of really serious energy and effort put into a Royal commission that looked at what was wrong with the Victorian mental health system. And it hasn't fixed it yet and it won't.
At the core we need the buy-in. We need to look at really core systems, change models and figure out where it is in history we are right now. We need to prioritise learning from the decades of advocacy and lived experience that has come before us and how we utilise those experiences and those learnings as we move forward. All of these things need to be really well documented so that the generations that come after us as well, continue to learn and continue to thrive in this space. Working together is going to be so key to that.
And that means that we have to prioritise lived experience, but that doesn't mean that we discard the other expertise in this space. How we listen together, we learn together, come together is so crucial. We don't want anyone outside. We need to do this really together. And if we're not willing and ready to do that, we're going to face more and more challenges as we try to see really transformative systemic change. Okay. I guess putting it simply it's yes, coming together, but how we prioritise all voices and we don't exclude any.
Kate: Sure. And I really liked your point. Well, the whole point that both you and Niharika made, but I guess just to echo that this, all of these three principles, this one included, these are not new ideas that Wellcome suddenly invented, these are built on. I do say that they're the long advocacy from people across the mental health system, including people with lived experience, mental health practitioners, researchers, others who are really trying to think about how do we create that system change?
How do we really focus our thinking and our learning, drawing on the history of the knowledge that's come before us, to really think through what can we do to make a difference here? How do we really stop seeing mental health intervention just as a purely individual issue to seeing through how do we create interventions and change a community, at a system level? It's complicated. There are no quick fixes, but I think what's really exciting is that these conversations are continuing to happen on a bigger scale. And I think really, hope that they continue to happen and certainly we'll do our part for that. Cat, Dion, I wondered if you wanted to jump in next.
Cat: Yeah, I agree with everything that's been said. And just to bring a specific mental health science perspective, one of the challenges that we've been addressing in our work so far is that mental health is so broad. And we know that there's so many disciplines which could potentially be involved in what we call mental health science and not just psychiatry, psychology, neuroscience, but also economics, philosophy, neurobiology, the list is endless. And a lot of these specialties don't speak the same language as one another.
But one of the things that we're hoping to do is to try and break down those silos and get people to work together. We're thinking now about how can we incentivise through interdisciplinary research, through team science, through moving away from this one lone principal investigator model. So that's one side of things from the research point of view. I acknowledge from passion and hierarchy, that the problem is much broader than that, but those are some of the things that we're thinking of in terms of research.
And just to give an example, one of the things that came out of our Active Ingredients commission was how interrelated, very disparate ingredients seem to be. So for example, we had one team that was looking at neuro information and tackling that as a potential intervention for depression. And we had another team that was looking at social relationships, and it turns out that actually one way that you might be able to tackle high levels of inflammation is through social relationships. And so there's all sorts of these potentially counter-intuitive links that we're still learning about and that we need to bring people together across the disciplines to make the most of in terms of impacting intervention.
Kate: That really reminds me of one of the points, I think, Dion made is about seeing that we're not, and the problems we experience are not separate from the world we live in and all the things that we engage in and to see the person in their personal relationships in our communities and the societies we live in. So it's really fascinating to see all these interrelations across all those different levels and to really see how these things connect. Dion, would you like to add anything else about how do we get people to work together to make the shift?
Dion: Yes. Thanks, Kate. I would also like to add on Cat's point about research. I think if we are trying to convince all of these different people, all of these different... All of these different sides on how to approach mental health as an issue, we can really make a structural change, we can really make a transformative change by providing decent research basically.
Well, I think the research is one of the best tools that we have to convince these people who each have their own responsibilities and have their own things to gain. But through research, we can really convince them on what the facts really are, what works and what doesn't, how can we make things better, but not only by saying it, but we're giving them real data, we're giving them real facts. So I really think that through research. Whether you're a researcher, you're a research funder, or you're just somebody who wants to contribute more, I think that seeing psychology, seeing mental health as something that can be put on paper, not only be felt or not only be, that can be seen directly is something important.
And I think by seeing all of these real cold, hard facts, those people who previously thought that mental health isn't that big of an issue or there are only specific ways to address mental health can be persuaded to create all of these changes. Of course, it's going to be hard. We have gone all over this for a long time, but I'm sure if we keep persisting, in the end, it will all work out.
Kate: Let's hope so, Dion. But I think you're right. We need to, we need to understand more. I think is the fundamental issue that we're facing. And that's why for me personally, it's so exciting working on this programme and working with our colleagues across the field of mental health science, including our colleagues with lived experience and those people doing all sorts of other innovative work here is to really understand actually, how do we build a better evidence base?
How do we understand where our focus should be or what even the possibilities are for really making a difference on the interventions available around mental health? We just got a quick clarification question in the chat. So thanks to whoever asked that. Cat, if we just come back to you quickly, the first active ingredient you mentioned was it neuro intervention or was it neuro inflammation you mentioned? If you could just briefly describe what that was. Just to say to everyone, - with an email. we will make sure we include some links to our work on Active Ingredients and the evidence from that. So we'll include more. But Cat, if I could just ask you to describe a bit more about what that is.
Cat: Yes. Sorry, to use that technical term. It's basically neuro inflammation and it's the interaction between the nervous system and the immune system. And so we're learning that, it's very much not my area of expertise, but we're learning that there are important links between the two. So for example, if the immune system releases an inflammatory response, and then this does have an effect on how the brain functions. And particularly early in life, trauma can also lead to immune responses that lead to neuro inflammation, as well as things like viral infection. So there's evidence that in a subset of people with depression, there may be inflammatory factors that contributes to the symptoms.
Kate: Brilliant. Thanks so much. But also really interesting, you said earlier, to see actually how some of the more social interventions or relational interventions still have some effects on some of the more biological aspects around mental health. And this is what's so fascinating about driving this work forward.
So quickly then, I guess, onto the last question, before we try and get on some of the questions from people who were putting them in the Q and A chat. If I could just ask you briefly, I'll go around each of you, to say for you, how would the world look different or better? If we did manage to see mental health as larger than healthcare, how would the world be better or different in your perspective? Cat, I'll come back to you first, if that's all right.
Cat: I think a major aspect would be that mental health would be taken into account more than it currently is at a structural level. So for example, by governments or industry, when designing policy, for example, around poverty and inequality, designing an education system, as we learn more and more about how important early development and adolescence is in the etiology of mental health. Urban planning, the importance of green space, when thinking about the effects of things such as climate change and pollution.
So I think an understanding that mental health is intimately related with all of these. Well, it might also look different in terms of how mental health is viewed by the public. So it's great that awareness of mental health is increasing. And as I was talking about before that people are beginning to see that you should seek medical help for mental illness in the same way as a physical illness as one potential approach, but at the same time, this compartmentalises mental health. And so it would be great to see a broader understanding of what mental health is and what works in the public at large.
Kate: Brilliant. Thanks, Cat. Well, I'll look around for who goes next. Niharika, could I come you? What would the world look like to you, but how would it be different?
Niharika: I think it would be much more caring and collaborative world. It would be a space where mental health is taken as a universal human right in its most basic sense. It would be kind of a space where we'll put people at the heart of policy instead of the other way around just keep throwing policies at people. It would be a space where we'll discover so much more about the existing intersections that we know of. And we might as well discover new intersections through all the evidence that we gather.
And I think as someone who's lived with anxiety for over 10 years, who's experiencing immense grief at this particular moment, it would even make this space a little less lonely for me because often we're just sidelined or secluded or within our own community. So I think if the principal is put into action, it would be a little less lonely. And I think funders, if they would invest into this principle, they would see a lot more local solutions and local innovation, which is also a principle that we focus on. And it would also bring in the missing voices that we talked about. And it would not just hold a small set of people accountable, but the right stakeholders accountable for putting things into action. So yeah, a lot of scope if we just start doing the work on it.
Kate: Brilliant. Thanks, Niharika. Thanks for such a thoughtful answer. I think just to... I know I'm not asking myself this question, but I'm going to answer it anyway. Well, the first thing that jumps to mind for me, what would change is that the people, the world would be a lot more validating to the things that people find useful. I know there's a common, in my own experience, and certainly a common experience of many people is the things that you find work for yourself are not things that you've necessarily had access to the evidence on or that have necessarily been evidenced. And that often on perhaps seeing us as credible or perhaps that... People just don't have access to the knowledge about what works.
And to me, the world would be a much more validating, supportive place because there were so many other options at hand of what would work for who. Whether they're structural, societal, relational, individual, whatever it might be, they'll just be a whole host of other factors that we could trust and know about to support our own mental health or that of our friends, families, peers. As you say, would be a less isolating place where we're figuring out what those things are. Anyway, back onto you guys, other people are supposed to be answering the questions. Tash, can I come see you next? And then Dion.
Tash: Absolutely. Really briefly, I'd just say like everyone else, I'm tired of losing friends, family, colleagues to mental health issues. And I say that beyond just suicide. I think we've all known people that have lost parts of their identities to their experiences. If we get this right, that's something that will change. And I think for me, that stands above all else. Thanks, Kate.
Kate: Absolutely. Thanks, Tash. Couldn't agree more. And last but not least, Dion.
Dion: Right. So putting it simply, a world that is more peaceful and understanding and where everyone and I mean, everyone, those with mental health issues, those who are just fine, have this equal opportunity to grow and to experience the same things. And as everyone has already stated, I think that of course, by resolving this issue, by resolving the issue of mental health, I think everything and everyone would be in a far better place in the future.
Kate: Brilliant. Thanks so much for such amazing, brief, but amazing answers. And the riches of the things that we covered. So that's the end of the questions that we have, but I know there has been a few brilliant questions put in the chat. I think a lot of you have touched on this question, but I'll ask it anyway. So thanks to Chloe for asking this question. So I'll just read it out to you guys and if anybody wants to add anything else, let me know. "So we know that many mental health problems are impacted by or caused by environment" and social issues, "but we constantly talk about individual solutions. How do we push for the" structural changes we need "to tackling poverty, poor and secure housing, working, poor working" arrangements, et cetera?" So I know some of you have touched on that, but I wanted to make sure we had the opportunity to... We know there's complex causes and factors, but often we still do fall back on individual solutions. What can we do about that? Anything else? Who would like to jump in on?
Cat: I mean, I think it's the million dollar question and really difficult to track evidence into action. I just say that now is such, in many ways, an awful time with what's happening with the pandemic, but it's also a time when awareness of mental health is rising as a result. And also where there's great societal change in a short period of time. And I'm wondering if there's ways to capitalise on this by raising awareness of mental health.
For example, we already see effects of changes in working arrangements through force working from home, and that may have accelerated some of the changes that might've otherwise taken decades. And are there other ways that we can harness that? For example, people have been talking more about policies such as universal basic income as a result of some of the furlough schemes. So I think now is a great time to be seizing that opportunity, as mental health researchers.
Kate: Brilliant. Thanks, Cat. I'd like to just open it up to any of the colleagues, any other thoughts you'd like to add?
Niharika: I think just adding that mental health to everything a different kind of stakeholder does, whether it's a business decision or a policy decision, just having that mental sense there, that what mental health impact can this have if this particular thing is implemented? Will add a lot of caution, will add a lot of responsibility to people who are bringing out those policies.
And I think all of us, like I know that there's a lot of focus on individual actions, but then as collaboratively as a group, we need to constantly push for these things because it is a fight that we are on, it is a challenge that we are tackling. So we need to make people accountable for these things and have more of these conversations.
Kate: Great. Thanks Niharika. And I just want to squeeze in one more question if I can. So thanks, to Rebecca, for this one. "What innovations, if any, have we seen in the mental health space" that we think tackle this topic? So I know we can send some stuff around some of the evidence, reviews recorded from the Active Ingredients. But I just wondered if anyone had any other examples to share of any innovative practice you've seen related to this area.
Tash: Happy to jump in, Kate. I think something I've seen that was incredible was the Friendship Bench model out of Zimbabwe. And that was really a community-led approach to tackling mental health issues, but also a real lack of resources. So it trained actually grandmothers in the community as lay mental health professionals that would sit on a bench in that community where people could approach them and have those conversations. And it was actually based on problem solving, brief interventions And it saw incredible success.
It's something that's been rolled out quite broadly across the US, the UK, Australia even and doesn't require extensive resources, but also takes a really culturally safe and community-led response to mental health that can be rolled out, it can be utilised and it can be used for priority populations and studied and shown to be effective, finding a little bit of a holy grail. Lots to learn there.
Kate: Brilliant. Thanks, Tash. Anybody else would like to come in with an example? Great, Cat.
Cat: So Tash reminded me of a charity that I think is doing important work, StrongMinds. They've been bringing interpersonal psychotherapy to particularly women with depression in Sub-Saharan Africa. And they've had very high success rates working, specifically, thinking about our Active Ingredients framework, working specifically on social relationships within communities and working with the specific community factors maybe at play. Yeah. So I think they're doing great work.
And I think, I can't remember the name of the charity, but they were doing surfing intervention in South Africa for children who would otherwise not have access to that and building community spirit and empowering young people through sport. So I think there's lots of fantastic innovations that don't necessarily need a lot of resources and don't need to occur within a healthcare setting.
Kate: Great. Thanks, Cat. Now, Niharika, were you going to come in then?
Niharika: Yes. I think one, one example, they're both from the same organisation in India, it's called Centre for Mental Health Law and Policy. And I think they've been doing some amazing work in involving community care through their projects, a similar model to what Tash also mentioned that how we can teach people on how to have a basic layer of community care to people experiencing mental health problems.
And the second really important thing because I believe that the way we talk about mental health also is a huge indicator of how it's treated by others. So they have been evaluating these reports that news outlets do on whether it's suicide or, mainly suicide, but how they report that because the language is really problematic in most of the cases with most organisations. So they've been evaluating those reports, pointing those things out, or giving the best practices which I feel is a great indicator in how we can also point out some things that are wrong and advocate for the right changes in the basic language also, or the different stakeholders like these organisation, how they tackle mental health.
Kate: Thanks, Niharika. And Dion, any final words from you before we start to wrap up?
Dion: Yeah. Maybe this is not an innovative programme per se, but I really think that this shift, this effort moving forward to focus on lived experience more in the research side of things is really an innovative way to see mental health.
Because as someone being on both sides of the coin as a researcher, trying to apply for these grants and as part of the board that selects people for these grants, I really think that these new and current approaches on bringing lived experience, bringing participation of the community and all of these parts into the research really, makes every part of the research worth way more rather than those only focusing on going from theory to practice. So I really think that by more integrating lived experience, both in the preparation stage, the research itself, and also in the dissemination phase is really the way to go for approaching this mental health issue.
Kate: I mean, perfect note to end on there, Dion. And just as a reminder for people, if they missed some of the earlier, the two earlier panel discussions, we'll make those available, same with the first one which was really thinking about how we bring lived experience into the heart of research policy practice. And there's some really rich discussion on that panel.
So thinking about how we see that experience as just another form of knowledge or expertise we need to bring in to the mental health space, alongside, not a replace of, all sorts of other forms of knowledge and expertise that we've got. I guess, the widest field of vision, the widest lens on an issue possible to really make sure that we're grappling with these, the problems, but also solutions in the best and richest way possible. We've gone one minute over. I'm afraid, but I think it was worth it.
Thank you so much to Niharika, Cat, Tash, and Dion, for all your contributions and thoughts. It's great to work with you all, but really appreciate your time and your... I know we could have spent the same time again talking about this topic. But as we said at the beginning, this is just the start of our conversations on these three principles. We are really committed to trying to learn in public, alongside our colleagues and across the field of mental health science to really start thinking through, how do we grapple with these complex, challenging, but really important principles to really move forward our knowledge around mental health and what works for who. And so thank you, to you all for joining me. Thank you. And also to everyone else who's joined us and listened in. Thank you to those who've submitted questions.
Sorry to those, I know I've just seen some of the questions come in towards the end of that discussion. I know we didn't get to all of them, but I will... We'll do our best to respond to those as a panel and send that round with the follow-up email that will go out. And please do. I know that my colleagues just put a link to a feedback survey in the chat, please do give us your honest feedback. These are the starting point of these discussions and panel discussions.
We hope there'll be a whole series more as our work progresses on these principles and other issues and challenges that we are trying to think about as part of our mental health programme, really keen to have as many conversations in public as we can. We want to make sure we're having the right conversations. So please do give us your feedback and help us improve on how we do this. So thank you all. Really appreciate you joining us. And we will be in touch with a follow-up email shortly. So thank you and goodbye from all of us.
- Chair: Kate Martin, Lived Experience and Public Engagement Lead, Mental Health, Wellcome
- Catherine Sebastian, Research and Evidence Lead, Mental Health, Wellcome
- Dion Agnuza, Lived Experience Advisor, Mental Health, Wellcome
- Natasha Swingler, Lived Experience Advisor, Mental Health, Wellcome
- Niharika Maggo, Lived Experience Advisor, Mental Health, Wellcome