I am just back from a 15 day listening tour, visiting scientists and clinicians in Melbourne, Sydney, Singapore, Shanghai, and Tokyo. I heard about some innovative experiments in both research and practice, some of which could inform what we do in the U.S.
Australia has put a priority on mental health with a large new investment in both services and research. The same nation that gave us lithium (rather than incarceration) as a treatment for mania in 1949, and antibiotics (rather than psychoanalysis) as a treatment for peptic ulcer disease in 1982, is now focused on youth mental health. Borrowing from other areas of medicine, they are trying to identify youth at risk and intervene before distress becomes disorder.
Their approach is not biomedical, not psychological, and not even obvious. Building on the pioneering work of Patrick McGorry, a psychiatrist named Australian of the Year in 2010, the government is establishing 90 community centers for youth, called headspace centers, for access to experts on everything from reproductive health to family conflicts to substance abuse.
The headspace center I visited was in a strip mall in a lower middle class area outside of Melbourne. The colors were bright, the décor was hip, and the location was embedded with legal services, tutoring, and employment advice. The messages were supportive (“Is it just me?”) and the staff was engaged not only in providing services but measuring outcomes. The government’s decision to scale up the headspace movement follows a national initiative on depression and anxiety called beyondblue (Australians seem to like lower case names) and more than a decade of research on the earliest stages of schizophrenia. The effort also coincides with new programs in mental health research. The recently opened Mental Health Research Institute in Melbourne is a state of the art neuroscience center where mental disorders are studied as brain disorders.
Next I visited Singapore, which has been the Dubai of science and technology, with a major building boom for new research buildings, new recruitment of talent, and even a new medical school. The government has committed 3.5% of its gross domestic product to science (the comparable figure in the U.S. is below 1%). This is nowhere more evident than at the Biopolis, a modern “city for science” where the theme is convergence of engineering and biomedical research. The newest building, one of more than 10 large facilities built in the past decade, is for neuroscience. Along with the adjacent Fusionopolis, which is a futuristic, all-inclusive universe for scientists and their families, Biopolis is an extraordinary experiment in scientific innovation. What happens when you build ideal facilities, recruit the world’s most innovative scientists (many from the U.S.), and provide nearly unlimited resources? Singapore’s Agency for Science, Technology and Research (A*STAR) hopes to answer that question with these ambitious experiments. Their awards of $1 million to each of 1,000 top science students says that they are going “all in” on science and technology as the investment for the future.
I was also impressed by Singapore’s commitment to training. I visited a new medical school, the Duke-NUS School of Medicine, where there are no lectures, every student completes one year of research, and the curriculum is built around problem solving. The 56 students in the class that just arrived are from 24 countries and include engineers as well as liberal arts majors. They were selected from over 1400 applicants, with the finalists required to participate in a joint problem solving exercise. Ranga Krishnan, the Dean of this new school and former chair of the Department of Psychiatry at Duke, speaks proudly of the excitement of building a medical school for the future, where research is part of education and education is influenced by the best research on learning.
China, of course, has been investing in science on a grand scale. I met with several senior investigators who came from China to the U.S. over the past three decades, established distinguished careers in academia or the NIH, then returned to China in the past decade to build laboratories with new facilities and abundant funding from the government. Add to this investment a cohort of thousands of eager students with some of the world’s best education in science and math. It’s no wonder that a recent report from the Royal Society predicted that China will overtake the U.S. in research productivity by 2013 . (see also Rising Above the Gathering Storm Revisited , NAS, 2010)
Where is the focus of China’s mental health research? This is hard to say, as mental health care is still split off from other medical care and mental health research is not yet a priority relative to research on heart disease and cancer. There are emerging efforts on the prodrome of schizophrenia and the genetics of mental illness as well as long-term projects on the epidemiology of suicide, but the highest priority appears to be in neuroscience. A major new area is primate neurobiology, from transgenic monkeys to defining circuits for cognition and behavior. And there is brilliant ongoing work, at the Institute of Neuroscience in Shanghai as well as other centers, on synaptic plasticity, neurodevelopment, and computational modeling of cortical function.
Finally, Japan. In Singapore and China, I kept hearing that this is the “Asian century.” Japan, which is still recovering from the March 11th earthquake and tsunami as well as a decade long recession, was a little less exuberant. But Japanese scientists are no less ambitious. I heard about exciting new biomarkers for depression, novel risk factors for schizophrenia, and an experiment to replace the label “schizophrenia” with a new, less-stigmatized Japanese term.
Logging so many miles, I had plenty of time to read and think about how the world is changing and what this means for mental health. I took along Thomas Friedman and Michael Mandelbaum’s new book, That Used To Be Us. The question they ask in this book, “What world are we living in?” is one for all of us to consider. For mental health research, we live in a world where innovation is global. The next best idea may be coming from a student in Singapore or a young scientist in Shanghai. Other countries are making unprecedented investments in science and science education. Rather than compete, we need to collaborate, learning from their experiments and partnering on their best ideas. I came back jet lagged but fired up about the possibilities for progress if we think and work globally.
Knowledge, Network and Nations: Global Scientific Collaboration in the 21st Century, Final Report . The Royal Society, March 2011.
Rising Above the Gathering Storm, Revisited: Rapidly Approaching Category 5 . National Academy of Sciences, National Academy of Engineering and Institute of Medicine of the National Academies. NAS press, 2010.
Friedman and Mandelbaum, That Used to Be US: How America Fell Behind in the World it Invented and How We Can Come Back. Farrar, Straus and Giroux, NY, NY, 2011.