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Post by Former NIMH Director Thomas Insel: Disorders Without Borders

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NIMH is increasing its commitment to global mental health.  The Institute is already invested in research around the globe.  In 2009, NIMH supported nearly 200 grants in 51 countries.  Our portfolio has included AIDS prevention in sub-Sahara Africa, studies of autism in Saudi Arabia, and research on mental health systems in Chile.  With such a broad international portfolio, so many unmet needs for mental health research in the United States, and so little new money available for research, why would NIMH want to invest more globally?

There are at least three reasons.  First is scientific opportunity.  Mental disorders, even more than many infectious or immune disorders, occur everywhere.  There are unique opportunities to study genetic isolates, environmental exposures, and health care policy questions in other countries.  Some questions about mental disorders and their treatment can be answered more efficiently in other parts of the world, and what we learn globally can be applied locally.  This may be especially true for disparities in care that are found in all countries, including our own.  Research on care for disadvantaged populations in Asia or Africa can teach us how best to deliver care to disadvantaged people anywhere.  

Second is the increasing interconnectedness among people in developed and developing nations.  As we consider immigrant populations in the United States or the rapid travel of people and ideas across this “flat world,” the term “global” no longer means “foreign.”  An earthquake in Haiti or Chile or genocides in Africa involve mental health consequences for all of us, whether we are providing care in a danger zone or coping with immigrants following trauma.  In an interconnected world, global health is a form of medical diplomacy.  It is also an increasing awareness of the global determinants of health, from climate change to migration.   

And third is what Kleinman has called the moral mandate.1  While other areas of medicine have long recognized the public health needs of the developing world, researchers and clinicians in our field have rarely ventured far from their own communities.  It is evident that suffering from mental disorders is everywhere--you don’t have to leave a wealthy neighborhood in the developed world to find mental anguish.  It is also evident that because suffering from mental disorders is everywhere, the disparities in care are particularly egregious.  The World Health Organization (WHO) Project Atlas mapped these disparities, including a 200-fold variation in the access to mental health professionals between parts of the developed and developing worlds.

Each of these reasons and many more were explored in the special series of articles published in the September 2007 Lancet, which argued that there can be no health without mental health. NIMH will be creating several initiatives in global mental health under the leadership of Dr. Pamela Collins, head of our new Office for Research on Disparities and Global Mental Health. We are using 2010 to identify best opportunities.

Earlier this week, NIMH convened a meeting of distinguished leaders in global mental health from nongovernmental organizations, WHO, government agencies, and academia to map the landscape of current research activities.  Throughout this year, NIMH will be leading a Grand Challenge project with the Global Alliance for Chronic Disease to identify best opportunities in global mental health research.  By the end of 2010, we hope to have developed a strategy for global mental health research.  The implementation will, of course, “take a village.”  We look forward to working with WHO, the new Center for Global Mental Health in London, and many other partners as we develop this new important area for the NIMH portfolio.

1 Kleinman A.  Global mental health: a failure of humanity.  Lancet, 2009 Aug 22;374(9690):603-4.