Upfront

Mental illnesses such as depression, alcohol dependence, dementia and post-traumatic stress disorder make up 13 percent of the world's disease burden, according to the World Health Organization — more than cancer or heart disease. But mental health disorders don't get a commensurate share of the world's attention or resources.

"The investment in mental, neurological and substance abuse disorders does not match the burden of the disease," says Pamela Y. Collins, MD, MPH, director of the Office for Research on Disparities and Global Mental Health at the National Institute of Mental Health.

Collins and her colleagues are aiming to change that. She is one of the leaders of the Grand Challenges in Global Mental Health Initiative, which aims to identify the most pressing priorities for improving mental health care around the world. The project is led by NIMH and the Global Alliance for Chronic Disease, an alliance of research funding agencies from Australia, Canada, China, India, the United Kingdom and the United States that has worked together on previous "grand challenges" to combat other chronic diseases.

Collins and her colleagues gathered opinions from more than 400 researchers, clinicians and mental health advocates from more than 60 countries, then culled the results into a list of 40 "grand challenges." They published 25 of the challenges in an article in the journal Nature in July. The top five, ranked by feasibility, immediacy of impact and ability to improve health equity and reduce disease burden, are:

  • Integrate screening and core packages of services into routine primary health care.

  • Reduce the cost and improve the supply of effective medications.

  • Provide effective and affordable community-based care and rehabilitation.

  • Improve children's access to evidence-based care by trained health providers in low- and middle-income countries.

  • Strengthen the mental-health component in the training of all health care personnel.

The full list is online.

The project's leaders hope that governments, foundations and other funders will use the challenges as a blueprint to guide their research investments.

The issues are as relevant for rich countries as for poor ones, Collins says. Many people all over the world lack access to mental health services.

"There's a glaring [treatment] gap in the U.S. and Europe. It's worse in poorer countries, but, as a global community, we share some of the same issues," she says. "So we hope to see an increase in investment … in research that ultimately leads people to lives freer from mental disorders."

—L. Winerman