PAmela Collins’ journey into global mental health began on a bus in Haiti in 1987.
Working for the first time in a majority-black country, the young medical student sometimes took public transportation and enjoyed blending in with the majority. “What really struck me that summer was how important social context is to health,” he says. collinsMD, MPH, Bloomberg Centennial Professor and Chairman mental health. “Our daily experiences, how we move through the world as part of a majority or a minority, all have an impact on our well-being and certainly our mental health. ”
She left Haiti with a determination to pursue global mental health and went on to lead research on HIV and mental health, stigma and discrimination, and urban youth mental health.
Collins, who took over as chair in July 2023, shares his insights in this Q&A on issues such as access to mental health care, prevention of mental disorders, and priorities for the department.
Why aren’t more people getting the mental health care they need?
Access is an issue everywhere. This is a story where the problems are global and the challenges are truly global. Although there are huge differences in resources between countries, the challenges are strikingly similar. Once recognized as having a depression, anxiety, or substance use disorder, only a minority receive minimally adequate care. That’s what we really have to fix.
Additionally, in many parts of the world, the history of mental health services has been tainted by negative experiences of colonialism and its aftermath. The services that have evolved are often not ones that people generally feel comfortable accessing, compounded by the fact that they are severely underfunded. I think that in most parts of the world, including this country, many people feel a great deal of resistance to professional mental health services. And that’s understandable, given the history of discrimination and poor quality care, as well as human rights violations and abuse of these services.
So even if access were available worldwide, would people still be anxious about receiving treatment?
Most people would not want to receive poor quality or overly restrictive mental health services if they knew they were receiving them. In the United States, overly restrictive care often means jail or prison, right? The majority of people in prisons and jails are living with a mental health condition. For example, the National Alliance on Mental Illness notes that Chicago’s Cook County Jail is one of the largest mental health care providers in the country. A path to prison can also be linked to a lack of services in the community. The goal is to create and provide quality community-based care that meets most needs.
“When people are identified as having depression, anxiety, or substance use disorders, only a minority of people receive the minimum amount of appropriate care. This is something we really need to address.”
How are you working to improve global mental health?
This is a complex issue. This is because there are biological, social and environmental factors that increase vulnerability to poor mental health. We can start by feeling a need. How can we prevent mental illnesses and reduce risk? And when they occur, how do we provide care and reduce disability? These are important questions for global mental health.
What can the United States learn from other countries about mental health care?
No country in the world has enough mental health care providers for its population. One of the exciting things about the last 15 years or so is that we’ve had the opportunity to see how people innovate in places around the world with very different levels of resources and very different types of health systems. That’s what I got. When I was leading an international mental health initiative, [the National Institute of Mental Health], some of our early work focused on whether non-specialist professionals can provide evidence-based and culturally consonant mental health care in a variety of settings. For example, if you are a woman suffering from perinatal depression, community health workers and their allies can be equipped to provide mental health services.
What can we do now to prevent mental disorders?
In 2022, researchers will conduct a rigorous global meta-analysis to identify important risk factors for mental disorders that, if addressed, could reduce population-level mental illness. They found that childhood adversity topped the list. Reducing childhood adversity, a wide range of problems from war crimes to neglect and child abuse, could reduce the global incidence of schizophrenia spectrum disorders. Approximately 38% increase. This is just one example, but it means we should seriously think about the causes of childhood adversity. Approximately 50% Many mental disorders begin in teenage years. We need to intervene sooner. One of the responsibilities of public health is to determine what can be done at the population level to keep children and young people safe and reduce their exposure to adverse events that can affect both their physical and mental health. It’s about continuing to ask questions.
your recent Nature analysis Our focus is on creating cities that are mental health friendly. why?
As humans, we overcome adversity, but the scars still remain. The paper takes an ambitious look at what cities can do to prevent scarring. What resources do people in cities need to develop strength and support development? , we want to ensure that the trajectory of young people is not hindered. These require complex actions, but simpler steps can be taken. We can create a judgment-free space for young people to be their authentic selves.
What are the main priorities for the department?
Our priority is to respond to the current public mental health crisis and anticipate population-level mental health needs over the next decade. I recently met with a group of young people from the West Coast, and they said, How can you get help before it becomes a crisis? ” Part of our work helps respond to these crises by designing interventions, testing them, and studying their implementation. But how can we avoid the crisis? This brings us back to the theme of prevention, which continues to be a priority for our department.
