Behind a health clinic in southern Harare, the capital city of Zimbabwe, there is a wooden bench known as a ‘friendship bench’. Every morning grandmothers, trained to deliver low-intensity cognitive therapy, take turns to sit on it and talk to anyone who sits down about issues that are troubling them. This low-cost, community-based psychotherapy has proved so effective that last year, New York adopted it, installing bright orange, plastic benches designed to stand out and catch the attention of passers-by.
In Chile, this type of talking therapy is delivered by nurses and social workers. In the UK, psychiatry graduates have been trained to deliver cognitive behavioural therapy in schools. Digital training programmes are being used to teach therapists internationally and online therapies are being developed with the aim of reaching people around the world.
With mental health problems predicted to be the main cause of global mortality and morbidity by 2030, innovative treatments like these are increasingly important.
The issue is gaining greater attention and traction in global health. Angela Merkel, for example, chose global mental health as a focus for Germany’s G20 leadership. The Secretary General of the UN made it a personal priority. And this week, the UK hosts the first Global Ministerial Summit for Mental Health.
But, as the Lancet Commission shows too many people are still left behind. Only one in five people receives appropriate treatment for depression in high-income countries – a figure which drops to about one in 30 in low and middle-income countries.
Many treatments for anxiety and depression are no more advanced than they were 30 years ago. We still don’t understand enough about why some treatments work for some people, but not for others. This is echoed in new research by the charity MQ, which found that 80 percent of GPs in the UK say finding a treatment that works for mental health patients is a process of trial and error.
More must be done to tackle gaps in knowledge, so that clinicians can tailor treatments to individual patients. We need to ensure that effective interventions for mental health are made available to all those who need them, and that we continue to improve existing treatments and create new ones.
Mental health research is fragmented, with researchers often working in silos, and conditions described and measured in different ways. Compare this to cancer, where it doesn’t matter whether you’re a cell biologist or a clinical oncologist – you’re working with a common purpose to cure cancer.
That same sense of common purpose is needed in mental health. Psychiatrists, neurologists and, public health specialists, neuroscientists, data scientists and cell biologists must share knowledge and collaborate. Solutions must be sought beyond the boundaries of traditional medicine, taking consideration of the multitude of societal and environmental factors impacting mental health – lived experiences of patients and their families, expertise of educators, employers, town planners, architects and governments all need to be part of the conversation.
It’s clear that a radical new approach is needed to drive this area forward, which is one of the reasons Wellcome has decided to renew our focus on mental health over the next decade.
Research, however, cannot effect change without appropriate mental health provision, support and infrastructure in country. Most governments currently allocate less than three percent of their health budget to mental health. In low-income countries this drops to less than one percent. This is not nearly enough. Mental health is not just a pressing public health problem, it’s a huge economic issue too. More investment is essential to develop and improve treatments, and to get these to the people who need them.
Mental Health affects everyone, directly or through experiences of relatives and close friends. There is no one left untouched.
Over 615 million people suffer from anxiety and depression worldwide. Mental health is one of the greatest challenges of our time. But there’s a genuine opportunity to innovate and transform all our mental health, in everything from basic research to prevention and frontline treatment.
In Zimbabwe, the friendship bench initiative has grown to hundreds of grandmothers, who together have helped thousands of people. By bringing together researchers, clinicians, patients and people from across the world to sit and share their experiences and expertise, we can improve all our mental health.