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Grand Challenges in Global Mental Health

OVERVIEW

The Grand Challenges in Global Mental Health Initiative was led by the National Institute of Mental Health (NIMH) and the Global Alliance for Chronic Disease in partnership with the Wellcome Trust, the McLaughlin-Rotman Centre for Global Health, and the London School of Hygiene and Tropical Medicine.

The Grand Challenges Initiative provided a critical opportunity to bring mental, neurological and substance use (MNS) disorders to the forefront of global attention and scientific inquiry. The aim of the initiative was to identify research priorities that, if addressed within the next decade, could lead to substantial improvements in the lives of people living with neuropsychiatric illnesses.  A grand challenge was defined as a specific barrier that, if removed, would help to improve the lives of those affected by mental, neurological, or substance use disorders.

For the purposes of the Grand Challenges Initiative, the broad category called ‘mental health’ referred to factors (including disorders) influencing the health of the mind, brain, and nervous system. These conditions account for approximately 10% of the global burden of disease, as indicated by disability-adjusted life years (DALYs) reported by the World Health Organization [1] and the Global Burden of Disease 2010 study. [2] As a group, they are the leading causes of disability worldwide.[3] MNS disorders within the Initiative’s remit included depression, anxiety disorders, schizophrenia, bipolar disorder, alcohol and drug use disorders, mental disorders of childhood, migraines, dementias, epilepsy, etc. Conditions with a vascular or infectious etiology were excluded, as these were addressed in previous Grand Challenges initiatives.

The term ‘global’ encompasses mental health in any country of the world. A core focus in global mental health is to both reduce the overall burden of illness and to reduce -- and ultimately eliminate -- health inequities within and between countries. The term ‘global’ also refers to global influences on mental health -- for example, cross-national factors such as conflict, climate change or macroeconomic policies. The responsibility for improving global mental health transcends national borders, class, race, gender, ethnicity and culture; promoting global mental health requires collective action based on global partnerships.

BACKGROUND AND RATIONALE

Recognizing the importance of collective action for overcoming scientific hurdles, the global health community embraced the use of challenge initiatives for improving the lives of its global constituency. In 2003, the Grand Challenges in Global Health project promoted the discovery and development of new tools to fight infectious diseases that cause millions of deaths each year in developing countries. [1] In 2007, the Grand Challenges in Chronic Non-Communicable Diseases study addressed non-communicable disorders (excluding mental health) which have reached epidemic proportions in both the developed and developing worlds.[2] Both of these initiatives led to the commitment of significant new programs of funding from a community of private and federal organizations around the world.

In 2010, the Grand Challenges in Global Mental Health initiative was launched to focus our collective efforts on global mental health.

The 2010 Global Burden of Disease Study identified MNS/neuropsychiatric disorders as substantial sources of disease burden.[3],[4] As a group, mental and behavioral disorders are the leading causes of disability worldwide. In combination with neurological disorders, these disorders account for around 10 percent of the total global burden of disease.

Disease burden is not the only factor that renders neuropsychiatric disorders a high-priority topic. Across the world, the treatment gaps for these conditions are large; thus, many in need of care do not receive adequate or effective interventions. People living with neuropsychiatric disorders often face systematic discrimination in diverse domains of their lives. Despite the suffering and disability that neuropsychiatric disorders can cause, relatively few resources are allocated worldwide to fund the necessary research to effectively prevent and treat neuropsychiatric disorders.

In order to assist in targeting the limited resources for action, several priority-setting exercises have resulted in proposed research strategies in global mental health. A series of papers in The Lancet in 2007 reference identified gaps in the evidence base for depressive disorders, alcohol and substance-use disorders, child and adolescent mental disorders, and psychotic disorders, with a focus on closing the 

treatment gaps in developing countries. This group suggested a prioritization of research on implementation science, for example health policy and systems research, research on affordable delivery of cost-effective interventions, and epidemiological research on childhood disorders and substance use disorders.[1] In addition, WHO and the Global Forum for Health Research assessed priorities for research in low- and middle-income countries reporting that epidemiology, health systems, and social science research were top priorities. [2],[3]

The Grand Challenges in Global Mental Health Initiative built on these and other exercises to identify impediments to reducing the suffering associated with neuropsychiatric disorders. Identifying these challenges will help us determine the major scientific advances that are needed to make a significant impact on the lives of people living with neuropsychiatric disorders worldwide. The Initiative was unique in that its scope was global in perspective; it addressed a wide range of disorders that affect the nervous system; the consultation process involved a wide community of stakeholders; and, this initiative was explicitly linked to the support of a community of funders.

METHODOLOGY

The methodology was an adaptation of the Delphi method used for the Grand Challenges in Chronic Non-communicable Diseases study. A Delphi Panel consisting of approximately 400 stakeholders was surveyed three times. Panel members were selected to provide a representation of the diverse clinical, policy, advocacy, user and research communities whose interests are covered within the Initiative’s scope of global mental health.

Specifically, the Initiative's adapted Delphi method consisted of the following major steps:

  1. The Scientific Advisory Board established the scope and question for the Initiative.
  2. The Scientific Advisory Board guided the selection of a broad and representative Delphi Panel.
  3. Round 1: Each member of the Delphi Panel submitted his or her suggestions in response to the Grand Challenges question.
  4. The NIMH Working Group qualitatively synthesized the Round 1 responses.
  5. Round 2: Each member of the Delphi Panel selected his or her top 40 challenges from the longer list of Grand Challenges identified in and synthesized following Round 1.
  6. The NIMH Working Group compiled a consolidated list of the top 40 Grand Challenges from Delphi Panelists’ selections.
  7. Round 3: Each member of the Delphi Panel rated the consolidated list of 40 Grand Challenges on four dimensions (Feasibility; Potential for disease burden reduction; Impact on equity in population; and Immediacy of impact).
  8. The NIMH Working Group analyzed the results and presented them in summary form to the Scientific Advisory Board for interpretation.
  9. The leadership teams published a manuscript in July 2011 describing the initiative and presenting the top 25 challenges.

RESULTS

The findings from the Grand Challenges in Global Mental Health initiative were published as a comment in the July 7, 2011 issue of Nature (PMC3173804 ).

Of the 594 individuals nominated to the Delphi panel, 422 agreed to participate.  They worked in 60 countries around the world, with the largest percentage (24%) working in Asia, followed by Africa and North America (both 20%), Central and South America (18%), Europe (16%), and Australia, and New Zealand (2%). 

The three rounds of the prioritization exercise yielded six grand challenge goals (Table 1) and 40 grand challenges (Table 2).  These identified priorities encompass a spectrum of research activities, ranging from basic, discovery science to implementation and policy research.  Four themes recurred throughout the data: 1) use a life-course approach to study MNS disorders; 2) use system-wide approaches to address suffering; 3) use evidence-based interventions for MNS disorders; and, 4) understand environmental influences on risk and resilience for MNS disorders.

Table 1. Grand Challenge Goals
Goal A Identify root causes, risk and protective factors
Goal B Advance prevention and implementation of early interventions
Goal C Improve treatments and expand access to care
Goal D Raise awareness of the global burden
Goal E Build human resource capacity
Goal F Transform health system and policy responses

List of 40 Grand Challenges in Global Mental Health 

  • Integrate core packages of mental health services into routine primary health care.
  • Reduce the cost and improve the supply of effective psychotropic drugs for mental, neurological and substance use disorders.
  • Train health professionals in low‐ and middle‐income countries to provide evidence‐based care for children with mental, neurologic, and substance use disorders.
  • Provide adequate community‐based care and rehabilitation for people with chronic mental illness.
  • Strengthen the mental health component in the training of all health care personnel to create an equitable distribution of mental health providers.
  • Incorporate a mental health component into international aid and development programs.
  • Develop treatments for mental disorders for use by non‐specialist health workers with minimal training.
  • Develop school‐based mental health promotion programs for children and adolescents.
  • Develop sustainable models to train and increase the number of culturally and ethnically diverse lay and specialist providers to deliver evidence‐based services for mental, neurological and substance use disorders.
  • Improve access to evidence‐based interventions (i.e. screening and treatment) for mental, neurological and substance use disorders in populations affected by conflict and displacement.
  • Develop an evidence‐based set of primary prevention interventions for a wide range of mental, neurological and substance use disorders.
  • Integrate mental, neurological and substance use disorders into the chronic disease agenda at all levels of government.
  • Reduce the duration of untreated illness by developing culturally‐sensitive early interventions for mental, neurological and substance use disorders across settings.
  • Create parity between mental and physical illness in investment in research, training, treatment, and prevention
  • Conduct screening for mental, neurological and substance use disorders during routine primary health care visits.
  • Develop locally appropriate strategies to eliminate childhood abuse and enhance child protection.
  • Develop culturally‐informed methods to eliminate the stigma, discrimination, and social exclusion of people with mental illness and their families across cultural settings.
  • Increase capacity in low‐ and middle‐income countries by creating regional centers for mental health research, education, training and practice that incorporate the views and needs of local people.
  • Develop mobile and IT technologies (e.g. telemedicine) to increase access to evidence‐based care for mental, neurological and substance use disorders.
  • Establish and implement minimum health care standards for mental, neurological, and substance use disorders around the world.
  • Develop national child and adolescent mental health policies.
  • Redesign health systems to integrate mental, neurological and substance use disorders with other chronic diseases.
  • Develop methods to improve parenting skills and promote secure attachment with caregivers in infancy and childhood.
  • Enact a National Mental Health Plan for each country.
  • Develop interventions to reduce the long‐term negative impact of low childhood socioeconomic status on cognitive ability and mental health.
  • Support community environments that promote physical and mental wellbeing across the life course.
  • Involve people living with or affected by mental, neurological and substance use disorders in policy and practice development.
  • Incorporate functional impairment and disability into assessment methods for mental, neurological and substance use disorders.
  • Enable family environments that promote physical and mental wellbeing across the life course.
  • Promote awareness among researchers about the importance of cultural adaptation of interventions and development of context-appropriate concepts, instrumentation, and manuals.
  • Establish cross‐national evidence on the cultural, socioeconomic, and services factors underlying disparities in the incidence, diagnosis, treatment, and outcomes of mental, neurological and substance use disorders.
  • Foster resilience and enhance protective factors for mental, neurological and substance use disorders across developmental and life course stage.
  • Identify modifiable social and biological risk factors across the life course.
  • Develop methods for predicting (pharmaceutical or psychosocial) treatment response and side effects.
  • Establish shared, standardized global data systems for collecting surveillance data on the prevalence, treatment patterns, and availability of human resources and services for mental, neurological and substance use disorders.
  • Understand the impact of poverty, violence, civil conflict, and migration on mental, neurological and substance use disorders.
  • Develop valid, reliable definitions, models, and measurement tools for the quantitative assessment of mental, neurological and substance use disorders at the individual and population levels for use across cultures and settings.
  • Understand adaptive, normative, and resilient responses to daily life stress.
  • Create a standardized diagnostic system based on symptom severity and brain functioning that is applicable across cultures.
  • Identify biomarkers for mental, neurological and substance use disorders.

Supplementary information , which includes (1) a more detailed description of the results for each Delphi round; (2) a supplementary discussion; (3) acknowledgements, author contributions and conflict-of-interest disclosures; (4) descriptive information about the Delphi panel; (5) Round 2 results (both complete and separated between overall and basic scientists' rankings); (6) and Round 3 results across ranking criteria is available with the online version of the manuscript.

At a briefing held for the UK press in London on July 6, 2011, Drs. Shitij Kapur, Barbara Sahakian and Graham Thornicroft, members of the Initiative's Scientific Advisory Board, spoke to journalists from The Daily Mail, The Telegraph, The Guardian, BMJ, The Times, and Research Forthnight about the Grand Challenges in Global Mental Health initiative.

The U.S. National Institute of Mental Health announced the publication of the Grand Challenges in Global Mental Health commentary in an online press release and in a Director’s Blog entry.

Results and Supplementary Information in Nature

The results of the Grand Challenges in Global Mental Health initiative appear in the July 7, 2011 issue of Nature (PMC3173804 ). Supplementary Information  is available.

Questions? Please contact us at grandchallengesgmh@mail.nih.gov

PARTNERS AND LEADERSHIP

The Grand Challenges in Global Mental Health initiative was led by the U.S. National Institute of Mental Health (NIMH) and the Global Alliance for Chronic Disease, in partnership with the Wellcome Trust, the McLaughlin-Rotman Centre for Global Health, and the London School of Hygiene and Tropical Medicine.

Three discrete leadership bodies were responsible for the stewardship of the Grand Challenges in Global Mental Health Initiative: the Executive Committee, the Scientific Advisory Board, and the NIMH Working Group.

The Executive Committee provided broad oversight of the Grand Challenges initiative.  Its membership comprised leaders of key funding agencies and members of the board of directors of the Global Alliance for Chronic Disease.

All affiliations refer to participants’ roles at the start of the Grand Challenges priority-setting initiative.

Executive Committee

Co-Chairs

Abdallah S. Daar is Professor of Public Health Sciences and of Surgery at the University of Toronto. He is also Director of Ethics and Commercialization at the McLaughlin-Rotman Centre for Global Health at University Health Network and University of Toronto. Professor Daar was the lead investigator in the study to identify the Grand Challenges in Chronic Non-communicable Diseases and has participated in several other global studies applying the Delphi methodology. He is chair of the Global Alliance for Chronic Diseases and chair of the Advisory Board of the UN University International Institute of Global Health. Professor Daar is a Fellow of the Royal Society of Canada, the Academy of Sciences for the Developing World (TWAS), the Canadian Academy of Health Sciences, and the New York Academy of Sciences. He is a member of UNESCO's International Bioethics Committee and of the Ethics Committee of the Human Genome Organization. Professor Daar was awarded the UNSCO Avicenna Prize for Ethics of Science in 2005 and holds the official world record for performing the youngest cadaveric kidney transplant.

Thomas R. Insel, M.D., is Director of the U.S. National Institute of Mental Health (NIMH), the component of the National Institutes of Health charged with generating the knowledge needed to understand, treat, and prevent mental disorders. His tenure at NIMH has been distinguished by groundbreaking findings in the areas of practical clinical trials, autism research, and the role of genetics in mental illnesses. Prior to his appointment as NIMH Director in the Fall 2002, Dr. Insel was Professor of Psychiatry at Emory University. There, he was founding director of the Center for Behavioral Neuroscience, one of the largest science and technology centers funded by the National Science Foundation and, concurrently, director of an NIH-funded Center for Autism Research. From 1994 to 1999, he was Director of the Yerkes Regional Primate Research Center in Atlanta. While at Emory, Dr. Insel continued the line of research he had initiated at NIMH studying the neurobiology of complex social behaviors. He has published over 250 scientific articles and four books, including the Neurobiology of Parental Care (with Michael Numan) in 2003. Dr. Insel has served on numerous academic, scientific, and professional committees and boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and is a recipient of several awards including the Outstanding Service Award from the U.S. Public Health Service. Dr. Insel graduated from the combined B.A.-M.D. program at Boston University in 1974. He did his internship at Berkshire Medical Center, Pittsfield, Massachusetts, and his residency at the Langley Porter Neuropsychiatric Institute at the University of California, San Francisco.

Members

Warwick Anderson is the Chief Executive Officer (CEO) of the National Health and Medical Research Council (NHMRC), Australia's major governmental funding body for health and medical research. Previously, he was Head of School of Biomedical Sciences at Monash University and Deputy Director of the Baker Medical Research Institute, following research fellowships at the University of Sydney and Harvard Medical School. Professor Anderson obtained his PhD from the University of Adelaide, South Australia. His research has focused on renal mechanisms in the pathogenesis of hypertension, including the roles of renal vascular remodeling and the renin-angiotensin system. He has published over 170 peer review articles. For his contributions to medical research, Prof. Anderson was made a Member of the Order of Australia in 2005.

Muhammad A. Dhansay, MBChB, DCH, MMed (Paed), FCPaed is Acting President and Vice-President for Research of the South African Medical Research Council, which is mandated to conduct and promote health research nationally. He is a paediatrician and child health specialist, as well as having extensive experience in nutrition in general and paediatric nutrition and micronutrients in particular. Global Health Research is a particular interest. As Acting President chairs the MRC Executive Management Committee and has been involved in the current strategic restructuring of the MRC. As Vice-President: Research (since July 2007), he heads the Research Directorate and has oversight of 45 MRC research units (internal and external), is an ex-officio member of the MRC Ethics Committee, and chairs the MRC's Grants Committee and Research Unit Review Panels. He has been with the MRC since 1986, initially as Specialist Scientist (Medical) and then as Director of the MRC's Nutritional Intervention Research Unit.

Story Landis, Ph.D. has been Director of the National Institute for Neurological Disorders and Stroke (NINDS) since 2003. As NINDS Director, Dr. Landis oversees an annual budget of $1.6 billion supporting neuroscience research by investigators in institutions across the country and in the intramural program. Dr. Landis received her undergraduate degree from Wellesley College in 1967 and her Ph.D. (1973) from Harvard University. After postdoctoral work at Harvard University, she served on the faculty of the Department of Neurobiology there. In 1985, she joined the faculty of Case Western Reserve University School of Medicine, creating the Department of Neurosciences. Dr. Landis joined the NINDS in 1995 as Scientific Director and worked to re-engineer the Institute's intramural research programs. She has garnered many honors, is an elected fellow of the Academy of Arts and Sciences, the American Association for the Advancement of Science and the Institute of Medicine.

Depei Liu is Vice President of the Chinese Academy of Engineering and President of the Chinese Academy of Medical Sciences and Peking Union Medical College. He obtained his PhD in molecular biology in 1986 at PUMC, and did postdoctoral training at UCSF from 1987 to 1990. He has made important contributions to regulation of gene expression and molecular mechanism of cardiovascular disease. Dr. Liu served as President of both the Chinese Society of Biomedical Engineering and of the Beijing Society of Biochemistry and Molecular Biology. He is also a member of the Institute of Medicine, and fellow with the Third World Academy of Sciences. Dr. Liu's awards include: Award for Special Contributions, State Council of China; Award of Science and Technology Advancement, Ministry of Health; and Top Award of Chinese Medical Sciences & Technology.

Anthony Mbewu is the Executive Director of the Global Forum for Health Research and Honorary Professor in Cardiology and Internal Medicine at the University of Cape Town; and a Foreign Associate of the Institute of Medicine. Prof Mbewu trained in medicine at Oxford and London Universities; and trained as a Specialist in Cardiology at the University of Manchester; whilst also working on his research doctorate. He has been a Consultant Cardiologist at the University of Cape Town; and Executive Director for Research at the MRC; and President of the MRC. He has served on the Boards of the Medical Research Council; the South African Medical Association; and the Academy of Science of South Africa; and Medicine's Control Council. He chaired the Ministerial National Task Team that wrote the the plan for South Africa's antiretroviral programme which has enrolled over million people onto treatment. He is Co-Chair of the Inter Academy Medical Panel; and Vice Chairperson of the Board of the Global TB Alliance. He was a member of the Director General of WHO's External Reference Group for a Research Strategy for WHO.

Anthony G. Phillips is a world-renowned expert in brain function and behavior. He is the Scientific Director of the Canadian Institutes of Health Research - Institute of Neurosciences, Mental Health and Addiction (CIHR-INMHA), the Founding Director of the UBC Institute of Mental Health, Professor in the Department of Psychiatry and Senior Investigator with the University of British Columbia/Vancouver Coastal Health Brain Research Centre. He is a former Head of the Department of Psychology at the University of British Columbia. Dr. Phillips earned his BA, MA and PhD in Psychology from the University of Western Ontario. His research focuses on the neurobiology of motivation, drug addiction and mental illness, with a specific emphasis on clinical implications. He has published over 300 peer-reviewed papers, and is a Fellow of the Royal Society of Canada. Distinguished awards include: NSERC Steacie Fellowship; UBC Senior Killam Prize; Donald Hebb Award - CPA; CINP Award for Innovation in Nueorpsychopharmacology; CCNP Heinz Lehman Award 2009.

John Savill, BA, MBChB, PhD, FRCP, FRCPE, FASN, FMedSci, FRSE is chief executive and deputy chair of the U.K.'s Medical Research Council (MRC). Prior to taking up the post of chief executive, Sir John was the first vice-principal and head of the College of Medicine and Veterinary Medicine, University of Edinburgh, having held this position since 2002. Between 2008 and 2010, Sir John also worked part-time as the chief scientist for the Scottish Government Health Directorates. He was knighted in the 2008 New Year's Honours List for services to clinical science. Sir John has had a long association with the MRC. Early in his career he completed an MRC Clinical Training Fellowship, he has chaired two research boards as well as serving on the MRC Council between 2002 and 2008. Sir John started out in his career with a degree in Physiological Sciences from Oxford University in 1978, followed by a post-graduate degree in Medicine at the University of Sheffield in 1981 and received a PhD from the University of London in 1989. After junior hospital appointments in Sheffield, Nottingham and London, he spent seven years in the Department of Medicine at the Royal Postgraduate Medical School (RPMS), with spells as an MRC clinical training fellow and Wellcome Trust senior clinical research fellow. In 1993, he moved to the chair of Medicine, Nottingham, and then in 1998 became professor of Medicine, Edinburgh, where he was the first director of the University of Edinburgh/MRC Centre for Inflammation Research, directing a group interested in the molecular cell biology of renal inflammation.

Susan B. Shurin, M.D., is the Acting Director of the U.S. National Heart, Lung, and Blood Institute (NHLBI). Dr. Shurin is responsible for the scientific and administrative management of the intramural and extramural activities of the NHLBI and oversight of the Institute's clinical research portfolio. Dr. Shurin represents the NHLBI in activities across the National Institutes of Health and the Department of Health and Human Services. Before joining the NHLBI in 2006, Dr. Shurin was professor of Pediatrics and Oncology at Case Western Reserve University; director of Pediatric Hematology-Oncology at Rainbow Babies and Children's Hospital; director of Pediatric Oncology at the Case Comprehensive Cancer Center; and vice president and secretary of the Corporation at Case Western Reserve University in Cleveland, Ohio. Dr. Shurin received her education and medical training at Harvard University and the Johns Hopkins University School of Medicine. Her laboratory research focused on the physiology of phagocyte function, recognition and killing of pathogens; mechanisms of hemolysis; and iron overload. She has been active in clinical research in many aspects of pediatric hematology-oncology, including participation in the Children's Cancer Group, Children's Oncology Group, multiple studies in sickle cell disease and hemostasis.

Mark Walport is Director of the Wellcome Trust. The Wellcome Trust funds innovative biomedical research, in the U.K. and internationally, spending over £600 million each year to support the brightest scientists with the best ideas. Before joining the Trust he was Professor of Medicine and Head of the Division of Medicine at Imperial College London. His own research career focused on the immunology and genetics of rheumatic diseases. He is a board member of the U.K. Clinical Research Collaboration (U.K.CRC), U.K. Research Base Funder's Forum, Health Innovation Council and the Prime Minister's Council for Science and Technology. He is also a member of a number of international advisory bodies, including the Grand Challenges in Global Health Scientific Board and the Council of the Global HIV Vaccine Enterprise. He chaired the Academic Careers Sub-Committee of the U.K.CRC and Modernising Medical Careers which reported in 2005. More recently, at the request of the Prime Minister and Secretary of State for Justice, he co-chaired with the Information Commissioner an independent review on the use and sharing of personal information in the public and private sectors. In early 2010 he completed chairing an Expert Group on Science and Learning supporting the delivery of the U.K. Government's Science and Society Strategy. He received a knighthood in the 2009 New Year Honours List for services to medical research.

Scientific Advisory Board

The Scientific Advisory Board guided the overall scientific process of this Initiative, including selection of members for the Delphi Panel; questionnaire development; data synthesis; and, reporting of results. Leaders in scientific disciplines relevant to neuropsychiatric disorders were nominated to the Board for their contributions to relevant research themes and disciplines and to diverse global regions.

Co-Chairs

Pamela Y. Collins, MD, MPH is the Director of the Office for Research on Disparities and Global Mental Health and the Office of Rural Mental Health Research at the U.S. National Institute of Mental Health. She completed her medical education at Cornell University Medical College and subsequently trained in psychiatry and public health at Columbia University. Dr. Collins studied cultural psychiatry and applied medical anthropology as a research fellow in the Department of Social Medicine at Harvard Medical School. She retains a faculty appointment at Columbia University in the College of Physicians & Surgeons, Department of Psychiatry and the Mailman School of Public Health, Department of Epidemiology. Over the past 15 years her work has focused on the mental health and psychosocial aspects of the AIDS epidemic in the United States and Sub-Saharan Africa. In the United States, her studies have addressed social stigma related to mental illness, ethnicity, and women's HIV risk; the HIV prevention needs of women of color with severe mental illness; and the mental health needs of African immigrants living with HIV. Dr. Collins has conducted training of health care providers in mental health and HIV/AIDS transmission, prevention, and counseling in Argentina, Zambia, Uganda, Rwanda and South Africa. In South Africa Dr. Collins's research examined the role of mental health care providers in the development of HIV prevention interventions in psychiatric settings. She continues to study the integration of HIV and mental health services in sub-Saharan Africa.

Vikram Patel is Professor and Wellcome Trust Senior Research Fellow at the London School of Hygiene & Tropical Medicine (U.K.). He is the Joint Director of the School's Centre for Global Mental Health. He is also Professor at the Public Health Foundation of India. He serves on the WHO's Expert Advisory Group for Mental Health and the Global Agenda Council for Chronic Conditions and Mental Health and is co-chair of the Scientific Advisory Board of the Grand Challenges in Global Mental Health. He serves on the board of Sangath, an Indian NGO which he founded. He was editor of the Lancet Series on Global Mental Health (2007) and the PLoS Medicine series on packages of care for mental disorders (2009) and led the efforts to launch the Movement for Global Mental Health. He is based in India where he leads a program of mental health research and capacity development.

Members

Isabel Altenfelder Santos Bordin, MD, MSc, PhD, is a child and adolescent psychiatrist, researcher in Clinical Epidemiology applied to Child and Adolescent Mental Health, and head of Social Psychiatry Division at the Department of Psychiatry, Federal University of São Paulo, Brazil. After completing a two-year research training and obtaining a masters degree in Clinical Epidemiology at McMaster University, Canada (1995), she became a member of the International Clinical Epidemiology Network (INCLEN). Dr. Bordin's responsibilities at the University include research and teaching/training activities (thesis supervision). Her main research interests are related to at-risk children and adolescents for mental health problems, such as those living under disadvantaged circumstances, exposed to poverty and domestic violence. Additional research interests include anti-social behavior, crime involvement, pregnancy in adolescence, and barriers to receive mental health care. In the past 20 years, Dr. Bordin had the opportunity of developing Brazilian versions of international screening and diagnostic questionnaires in child/adolescent mental health, and of participating in national and international research initiatives.

Elizabeth Jane Costello is a developmental epidemiologist whose work takes as its focus the integration of developmental science and psychiatric epidemiology, with the goal of understanding and preventing mental illness. Dr. Costello was educated at Oxford and the London School of Economics, with postdoctoral training in psychiatric epidemiology at the University of Pittsburgh. She is currently a Professor of Medical Psychology in the Department of Psychiatry at Duke University in North Carolina. She is the Principal Investigator of the Great Smoky Mountains Study, a longitudinal study of the development of psychiatric and substance abuse disorders and access to mental health care in a representative sample of 1400 children and adolescents living in the southeastern United States. Dr. Costello is editor-in-chief of Frontiers in Child and Neurodevelopmental Psychiatry. In 2009 NARSAD awarded her (jointly with her husband, Adrian Angold) the Ruane Prize for Child and Adolescent Psychiatric Research.

Marcelo Cruz graduates from Central University School of Medicine in Quito, trained in clinical neurology at Boston University in the U.S., and obtained Neurology Board certification. He also trained in epidemiology at the University of Minnesota and at the Mayo Clinic, Rochester. He was also a Fellow at the Institute for Epidemiology and Tropical Neurology, University of Limoges, France. Dr. Cruz has served on the Advisory Panel in Neurosciences, World Health Organization; the Committee on Nervous System Disorders in Developing Countries of the National Academy of Sciences/Institute of Medicine, Washington, DC; as President of the Global Network for Research in Mental and Neurological Health, and as President of the Ecuadorean Academy of Neurosciences. Dr. Cruz served as Ecuador's Minister of Health in 1996-1997, and as Secretary of the Committee on Health and Environment, National Congress of Ecuador, in 2007. He is currently Professor of Neurology at the School of Medicine, Eloy Alfaro University in Ecuador.

Maureen Durkin is an epidemiologist specializing in population-based studies of the frequency, prevention, antecedents and consequences of developmental disabilities. She is also Professor of Population Health Sciences and Pediatrics at the University of Wisconsin-Madison. Dr. Durkin received her PhD in anthropology from the University of Wisconsin-Madison, and her MPH and DrPH degrees in epidemiology from Columbia University. She contributed to the development of the Ten Questions, a cross-cultural tool for screening for developmental disabilities; directed international studies of the prevalence and causes of neurodevelopmental disabilities in low income countries; and contributed to the development of methods for surveillance of childhood injuries, autism and cerebral palsy in the United States. She has served as a consultant on issues related to global health and disability for the World Health Organization, the United Nations Statistics Division, UNICEF, the World Bank, the Centers for Disease Control and Prevention, the Institute of Medicine, the National Academy of Sciences, the National Institutes of Health and other organizations. Dr. Durkin currently directs projects devoted to surveillance of autism spectrum disorders and cerebral palsy, and birth cohort studies of neurodevelopmental outcomes.

Christopher Fairburn is Wellcome Principal Research Fellow and Professor of Psychiatry at the University of Oxford. He has three research interests: first, the nature and treatment of eating disorders; second, the development and evaluation of psychological treatments; and third, the dissemination of effective psychological interventions. He has an international reputation in these fields. Professor Fairburn has twice been a Fellow at Stanford's Center for Advanced Study in the Behavioral Sciences and he is a Fellow of the U.K. Academy of Medical Sciences. He has held grants in the U.K., U.S. and Australia and has published extensively. Professor Fairburn is also a Governor of the Wellcome Trust, one of the largest and most influential biomedical research foundations.

Roger I. Glass, MD, PhD is Director of the Fogarty International Center and Associate Director for International Research at the U.S. National Institutes of Health NIH). He received his MD from Harvard Medical School and his MPH from the Harvard School of Public Health. Dr. Glass joined the U.S. Centers for Disease Control and Prevention (CDC) as a medical officer assigned to the Environmental Hazards Branch, and later was a Scientist at the International Center for Diarrheal Disease Research in Bangladesh. After returning from Sweden where he received his doctorate from the University of Goteborg, Dr. Glass joined the NIH Laboratory of Infectious Diseases, where he worked on the molecular biology of rotavirus. He subsequently returned to the CDC to become Chief of the Viral Gastroenteritis Unit at the National Center for Infectious Diseases. Dr. Glass's research interests are in the prevention of gastroenteritis from rotaviruses and noroviruses. He has maintained field studies in India, Bangladesh, Brazil, Mexico, Israel, Russia, Vietnam, China and elsewhere. His research has been targeted toward epidemiologic studies to anticipate the introduction of rotavirus vaccines. Dr. Glass has received numerous awards, including the prestigious Charles C. Shepard Lifetime Scientific Achievement Award presented by the CDC in recognition of his 30-year career of scientific research application and leadership, and the Dr. Charles Merieux Award from the National Foundation for Infectious Diseases for his work on rotavirus vaccines in the developing world. He is a member of the Institute of Medicine of the U.S. National Academies of Science. Dr. Glass has co-authored more than 500 research papers and chapters.

Wayne Hall is National Health and Medical Research Council (NHMRC) Australia Fellow in addiction neuroethics at the University of Queensland Centre for Clinical Research. He was formerly Professor of Public Health Policy in the School of Population Health (2005-2010) and Director of the Office of Public Policy and Ethics at the Institute for Molecular Bioscience (2001-2005) at the University of Queensland; and Director of the National Drug and Alcohol Research Centre at UNSW (1994-2001). He has advised the World Health Organization on the health effects of cannabis use; the effectiveness of drug substitution treatment; the scientific quality of the Swiss heroin trials; the contribution of illicit drug use to the global burden of disease; and the ethical implications of genetic and neuroscience research on addiction. He was awarded an NHMRC Australia Fellowship in 2009 to research the public health, social policy and ethical implications of genetic and neuroscience research on drug use and addiction.

Yueqin Huang received her MD, MPH and PhD from Peking University and did postdoctoral research at the Department of Psychiatry and Human Behavioral Medicine at the University of California, Irvine in 1993-95. She has worked at the Institute of Mental Health at Peking University since graduation in 1987. In 2003 she became the deputy director of the Institute of Mental Health, director of the National Center for Mental Health of China's Centers for Disease Control, and an honorary Professor of the University of Hong Kong and international member of American Psychiatric Association. She is the principal investigator of a series of national and international research projects on mental health and mental disorders. She has published over 130 papers and written 5 books as the editor-in-chief.

Steven E. Hyman, MD is Provost of Harvard University and Professor of Neurobiology at Harvard Medical School. From 1996 to 2001, he served as Director of the National Institute of Mental Health (NIMH), the component of the U.S. National Institutes of Health charged with generating the knowledge needed to understand and treat mental illness. Before serving as Director of NIMH, Dr. Hyman was Professor of Psychiatry at Harvard Medical School, Director of Psychiatry Research at Massachusetts General Hospital, and the first faculty Director of Harvard University's Mind, Brain, and Behavior Initiative. In the laboratory he studied the regulation of gene expression by neurotransmitters, especially dopamine, and drugs that act on dopamine receptors. Dr. Hyman is a member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences, and a Fellow of the American College of Neuropsychopharmacology. He is Editor of the Annual Review of Neuroscience and first President of the Neuroethics Society. He received his BA from Yale College in 1974 summa cum laude, and his MA from the University of Cambridge in 1976, which he attended as a Mellon fellow studying the history and philosophy of science. He earned his MD from Harvard Medical School in 1980 cum laude.

Kay Redfield Jamison is the Dalio Family Professor in Mood Disorders, Professor of Psychiatry at the Johns Hopkins University School of Medicine and co-director of the Johns Hopkins Mood Disorders Center. She is also Honorary Professor of English at the University of St. Andrews in Scotland. She is co-author of the standard medical text on manic-depressive (bipolar) illness, which was chosen in 1990 as the most outstanding book in biomedical sciences by the American Association of Publishers, and author of Touched with Fire, An Unquiet Mind, Night Falls Fast, and Exuberance. Dr. Jamison has written more than 100 scientific articles about mood disorders, suicide, creativity, and lithium. Her memoir, An Unquiet Mind, which chronicles her own experience with manic-depressive illness, was cited by several major publications as one of the best books of 1995. It was on The New York Times bestseller list for five months and translated into twenty languages. Night Falls Fast: Understanding Suicide was a national bestseller and selected by The New York Times as a Notable Book of 1999. Exuberance: The Passion for Life was selected by The Washington Post, The Seattle Times, and The San Francisco Chronicle as one of the best books of 2004 and by Discover magazine as one of the best science books of the year. Her most recent book is Nothing Was the Same: A Memoir. Dr. Jamison is the recipient of numerous national and international scientific awards, including a MacArthur Award.

Sylvia Kaaya serves as the Head of the Department of Psychiatry and Mental Health, Muhimbili University College of Health Sciences (Dar es Salaam, Tanzania-East Africa). Dr. Kaaya holds a Doctor of Medicine, Master of Science in Medicine, and a Diploma in Psychiatry. Supported by Carnegie Foundation grants, she has completed two fellowship programs in Health and Behavior through Harvard Medical School. Areas of expertise include epidemiology, adolescent sexuality, biostatistics and health services research. She is a member of the Advisory Committee of the National Mental Health Programme (Tanzania), Secretary of the Social Science and Medicine Programme of the University of Dar es Salaam, and serves as a representative of the Academic Board in the Academic Appointments Committee. Dr. Kaaya is a member of the Medical Association of Tanzania, as well as a founding member and treasurer of the Mental Health Association of Tanzania.

Shitij Kapur, MBBS, PhD, FRCPC, FMedSci is currently the Dean and Head of School at the Institute of Psychiatry, King's College London, U.K. He moved to this post after serving as Canada Research Chair for Schizophrenia and Therapeutic Neuroscience, Chief of Research at the Centre for Addiction and Mental Health, and a Professor of Psychiatry at the University of Toronto. Prof. Kapur's expertise and interest is in the use of brain imaging and animals models to understand the basis of schizophrenia and its treatment. His work has led to a better understanding of antipsychotic action, its relationship to D2 blockade, and has led to the development of the 'salience' framework of psychosis and given rise to the 'early onset' hypothesis if antipsychotic action. Dr. Kapur has published over two hundred peer-reviewed papers, made dozens of presentations worldwide, served in advisory capacity to public and private companies and has received national and international awards.

Arthur Kleinman is Esther and Sidney Rabb Professor of Anthropology at Harvard University and Professor of Medical Anthropology and Psychiatry, Harvard Medical School, and Victor and William Fung Director of Harvard's Asia Center. Kleinman has conducted research in East Asia since 1968, almost all of it in Chinese society, on depression, neurasthenia, schizophrenia, epilepsy, and other disorders. He was a member of the Culture and DSM-IV Taskforce; he was in charge of the World Mental Health Report (1995); and he is a member of NIH's Council of Councils and of the Institute of Medicine.

Adesola Ogunniyi, Professor of Medicine, University of Ibadan, Nigeria and Consultant Neurologist, University College Hospital, Ibadan received his medical degree from the Obafemi Awolowo University, Ile-Ife, Nigeria in 1978. He had residency training in Internal Medicine and obtained the Fellowship of the Nigerian Postgraduate Medical College (FMCP) in 1985 before proceeding to the National Institute of Health, Bethesda, Maryland, United States of Americaon a World Health Organization - Fogarty International Fellowship in Neuroepidemiology. Dr. Ogunniyi is a member of many learned societies including the Nigeria Medical Association, World Federation of Neurology, Pan African Association of Neurological Sciences, Nigerian Society of Neurological Sciences (former President) and the African Research Network on Ageing. He was the Co-Principal Investigator of the Indianapolis-Ibadan Dementia Research Project between 1998 and 2009. Dr. Ogunniyi's research interests include epidemiology of epilepsy and neurodegenerative diseases especially dementia. He has published over one hundred manuscripts in peer-reviewed journals and chapter in books.

Angel Otero-Ojeda was born in Havana, Cuba on August 22, 1940. He obtained his MD degree from the University of Havana in 1966 and in 1976 he graduated as Specialist in Psychiatry from the same university. He is currently a Consulting Professor for the Cayetano Heredia University in Peru, and an Honorary Professor for the Institute of Spanish-Speaking Psychiatrists, in Spain. Professor Otero-Ojeda's main Professional interests have been in the field of Psychiatric Nosology and Taxonomy. He currently chairs the Diagnosis and Classification Sections for both the Cuban and the Latin American Psychiatric Associations. He is also Co-Chair for the Section on Classification, Diagnostic Assessment and Nomenclature of the World Psychiatric Association. As part of these institutional responsibilities, he chairs the current revisions of the Cuban Glossaries of Psychiatry and the Latin American Guide for Psychiatric Diagnosis. Professor Otero-Ojeda has authored a significant number of articles and book chapters in the field of psychiatric diagnosis and classification, and is best known for his leadership in the publication of the Third Cuban Glossary of Psychiatry and the Latin American Guide for Psychiatric Diagnosis.

Mu-Ming Poo was born in Nanking, China in 1948. He graduated from Tsinghua University, Taiwan, in 1970 and received his PhD in biophysics from Johns Hopkins University in 1974. He was on the faculty of University of California, Irvine, Yale University, Columbia University, and University of California at San Diego, before joining the University of California, Berkeley in 2000. He has served as the Head of Division of Neurobiology (0207) in the Department of Molecular and Cell Biology at U.C. Berkeley and is currently Paul Licht Distinguished Professor in Biology. Since 1999, he also served as Director of Institute of Neuroscience of Chinese Academy of Sciences in Shanghai. Dr. Poo's research interests focus on cellular and molecular mechanisms underlying axon guidance, synapse formation and synaptic plasticity. He has received the following honors: Javitz Neuroscience Investigator Award of NIH (1998), Member of Academia Sinica (2000), AAAS Fellow (2001), Ameritec Prize (2001), Ray Wu Society Award (2002), and Docteur Honoris Causa from Ecole Normale Supérieure, Paris (2003), and P.R. China International Cooperation Award (2005).

Vijayalakshmi Ravindranath obtained her PhD from the University of Mysore. After completing her Post-Doctoral training at the National Cancer Institute, National Institutes of Health, U.S.A, she joined the Department of Neurochemistry at National Institute of Mental Health and Neurosciences, (NIMHANS) Bangalore. In 1999, the Dept. of Biotechnology (DBT), Government of India sought her help to help establish the National Brain Research Centre (NBRC), an autonomous institution of DBT, Ministry of Science and Technology as a centre of excellence and to co-ordinate and network neuroscience research groups in the country. Dr. Ravindranath continued as Director, NBRC until May 2009, when she returned to Bangalore at the Indian Institute of Science as Professor and Chairman of the newly created Centre for Neuroscience. During her tenure as Director she provided visionary leadership at NBRC, which in a very short period attained a position of being an internationally acclaimed centre of excellence. In a short span of 5 years she established a state-of-the-art institute in a rather remote location and created a new paradigm for research by integrating mathematical and computational science into the understanding complex biological systems. NBRC was granted University status in May 2002 to help promote human resource development in an inter-disciplinary manner. Dr. Ravindranath networked 45 institutions around the country with NBRC with a goal to share resources and promote neuroscience.

Barbara J. Sahakian is based in the Department of Psychiatry and the MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute at the University of Cambridge. She is a Fellow of the Academy of Medical Sciences and was a member of the Medical Research Council Neurosciences and Mental Health Board (2006-2010). Dr. Sahakian was also a member of the Scientific Coordination Team for the Government Office for Science Foresight Project on Mental Capital and Wellbeing (2008) and holds the Distinguished International Scholars Award from the University of Pennsylvania (2009-2010). Dr. Sahakian's current programme of research, funded by the Wellcome Trust, investigates the neurochemical modulation of impulsive and compulsive behaviour in neuropsychiatric disorders, such as attention deficit hyperactivity disorder and obsessive-compulsive disorder.

Shekhar Saxena is Director of the Department of Mental Health and Substance Abuse at World Health Organization, Geneva. He is a psychiatrist by training with about 30 years of experience in research and programme management in the areas of mental health service delivery and information systems, especially in low and middle income countries. He was one of the writers of the World Health Report-2001 on mental health and an editor and author in the Lancet Series on Global Mental Health-2007. He led WHO's Mental Health Atlas and WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) being used in more than 80 countries. He is responsible for implementation of WHO's mental health Gap Action Programme (mhGAP) for scaling up care for mental, neurological and substance use disorders in low and middle income countries.

Peter A. Singer is Professor of Medicine, Sun Life Financial Chair in Bioethics and Director at the McLaughlin- Rotman Centre for Global Health, University Health Network and University of Toronto. Singer's research is on life sciences and the developing world - how technologies transition from "lab to village". In 2007, Singer received the Michael Smith Prize as Canada's Health Research of the Year in Population Health and Health Services. He is Foreign Secretary of the Canadian Academy of Health Sciences, and a Fellow of the Royal Society of Canada, the U.S. Institute of Medicine, and The Academy of Sciences for the Developing World. A member of the Scientific Advisory Board of the Bill & Melinda Gates Foundation Grand Challenges for Global Health Initiative, Singer has advised the UN Secretary General's Office, the Government of Canada, several African governments, and PepsiCo Inc. on issues related to global health.

Dan J Stein is Professor and Chair of the Department of Psychiatry and Mental Health at the University of Cape Town, Director of the Medical Research Council (MRC) Unit on Anxiety Disorders, and Visiting Professor of Psychiatry at Mt. Sinai Medical School in New York. Prof. Stein did his undergraduate and medical degrees at the University of Cape Town, and his doctorate (in the area of clinical neuroscience) at the University of Stellenbosch. He trained in psychiatry, and completed a post-doctoral fellowship (in the area of psychopharmacology) at Columbia University. His training also includes a doctorate in philosophy. Prof. Stein's research focuses on the psychobiology and management of the anxiety disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, and social anxiety disorder. His work ranges from basic neuroscience all the way through to epidemiological and cross-cultural research. He is particularly enthusiastic about the possibility of clinical practice and scientific research that integrates theoretical concepts and empirical data across these different levels. Prof. Stein's work has been continuously funded by extramural grants for close to 20 years. He has authored or edited over 25 volumes, including "Cognitive-Affective Neuroscience of Mood and Anxiety Disorders", and "The Philosophy of Psychopharmacology: Smart Pills, Happy Pills, Pep Pills". He has contributed to many articles and chapters. He is a recipient of CINP's Max Hamilton Memorial Award for his contribution to psychopharmacology.

Working Group

The NIMH Working Group led the day-to-day functioning of the Grand Challenges in Global Mental Health Initiative, including coordination, data management and analysis, communication, and dissemination of findings.

Pamela Y. Collins, MD, MPH is the Director of the Office for Research on Disparities and Global Mental Health and the Office of Rural Mental Health Research at the U.S. National Institute of Mental Health. She completed her medical education at Cornell University Medical College and subsequently trained in psychiatry and public health at Columbia University. Dr. Collins studied cultural psychiatry and applied medical anthropology as a research fellow in the Department of Social Medicine at Harvard Medical School. She retains a faculty appointment at Columbia University in the College of Physicians & Surgeons, Department of Psychiatry and the Mailman School of Public Health, Department of Epidemiology. Over the past 15 years her work has focused on the mental health and psychosocial aspects of the AIDS epidemic in the United States and Sub-Saharan Africa. In the United States, her studies have addressed social stigma related to mental illness, ethnicity, and women's HIV risk; the HIV prevention needs of women of color with severe mental illness; and the mental health needs of African immigrants living with HIV. Dr. Collins has conducted training of health care providers in mental health and HIV/AIDS transmission, prevention, and counseling in Argentina, Zambia, Uganda, Rwanda and South Africa. In South Africa Dr. Collins's research examined the role of mental health care providers in the development of HIV prevention interventions in psychiatric settings. She continues to study the integration of HIV and mental health services in sub-Saharan Africa.

Sarah S. Joestl is the Project Coordinator of the Grand Challenges in Global Mental Health Initiative. She joined NIMH from the Department of Sociomedical Sciences at Columbia University, where she is completing her Doctorate in Public Health focusing on mental illness stigma. Ms. Joestl has experience in the areas of maternal mental illness and child development, international health, global nutrition, and health disparities. She holds an Adjunct Assistant Professorship in the Edmund A. Walsh School of Foreign Service at Georgetown University, and has served as Project Director on two NIH-funded research studies, as Research Associate and Consultant with the U.S. National Academies of Science, and as Consultant with PepsiCo.

Dana March is a psychiatric epidemiologist with training in history. She has longstanding interests in the relation between place and schizophrenia, mental health disparities within and between countries, and in the processes by which scientific knowledge is produced and disseminated. Dr. March received her PhD in Epidemiology with distinction from Columbia University in 2010. She joined the Office for Research on Disparities and Global Mental Health at NIMH in February 2010 to provide guidance for investment in disparities and global mental health research, of which the Grand Challenges in Global Mental Health initiative is one example, and returned to Columbia University in 2012. Dr. March continues to conduct research on schizophrenia across contexts and on domestic and cross-national health disparities, with colleagues in the Intramural Research Program at NIMH, Columbia University, and the Institute of Psychiatry, Kings College London.

Delphi Panel

We are grateful for the participation of the more than 400 Delphi panelists, who represented a diversity disciplines and contextual expertise. The geographic and disciplinary distribution of the Delphi panel is presented in the Supplementary Information  (beginning on page 6).