Center for Global Mental Health Research Webinar Series: Establishing an Independent Career in Global Mental Health Research
SUSANNAH ALLISON: I'm Susannah Allison, and I'm the training director for the Center for Global Mental Health at the National Institute of Mental Health. Thank you all so much for joining us today for the fifth webinar in the Center for Global Mental Health Research 2022 Webinar Series.
Just to recap, our first webinar discussed the submission and peer review of NIH grant applications. In our second webinar, grants management presented on pre-award considerations. Our third webinar reviewed awards for graduate students and postdocs, and the most recent or fourth webinar, we talked about awards for early career scientists, and you can access recordings of the webinars on our Center's website.
Today we will be talking about how to establish yourself as an independent global mental health investigator. First, we'll be hearing from Dr. Leo Cubillos, the director of the Center, as well as some of the Center's current program officers. Following those talks were honored to be joined by Dr. Lynsey Bilsland from Wellcome. She will be sharing information about Wellcome's priorities in global mental health research. Dr. Bilsland's lunch talk will be followed by a panel discussion with three currently independently funded researchers who have all obtained grant funding from NIH to support their global mental health research. And I'll be talking with them about their journeys to research independence, what hurdles they've had to overcome. And they'll be sharing tips with you all about how you also can become a successfully funded independent investigator.
So, without further ado, I'm going to turn the microphone and camera over to Dr. Leo Cubillos. Dr. Cubillos is the director of the Center for Global Mental Health Research at NIMH and will be sharing some information with us about the Center, its priorities, and current funding opportunities. Leo Take it away.
LEONARDO CUBILLO: Thank you, Susannah. Thank you for these opening remarks. And good morning, good afternoon, and good evening to all of you guys who are doing this webinar. Today, I will be talking to a little bit about the research priorities of the Center for Global Mental Health Research.
So, the National Institute of Mental Health envisions a world in which mental health illnesses are prevented and cured, and that entails a whole array of different sciences that we support from basic neurosciences all the way to implementation research because our mission is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention recovery and cure.
The National Institute of Mental Health Research has a strategic plan that can be accessed on the internet. The URL, the address, is at the bottom of the slide. It has four strategic objectives and has several cross-cutting research themes. Some of those cross-cutting research themes are prevention of mental illnesses, environmental exposures, comorbidities, computational approaches, and global mental health. Global mental health is embedded within the strategic plan of NIMH, a component that allows us to achieve those higher-level objectives, that I mentioned earlier that complete the mission of NIMH.
Along those lines, NIMH, as I said earlier, has the portfolio all the way from basic sciences to implementation research. And you can see this slide, a similar depiction that indicates that NIMH encompasses all the way from discovery research, on the right, to services research, on the left, meaning longer-term discoveries or nearer-term discoveries. As it relates to global mental health, there are different units within NIMH that have portfolios in global mental health. For example, the basic Neuroscience Division supports some research outside of the US global mental health research in this discovery portfolio, in the space of neuroscience research.
However, today we are focusing on the Center for Global Mental Health's research priorities. And as it relates to the Center, we focus mostly on implementation research and effectiveness research, or services research, and a little bit of translational research.
So, the messages are, NIMH has a broader global mental health portfolio, encompassing different sciences applied to public mental health research. And the Center, as part of that portfolio, focuses mostly on near-term research implementation research with the lens of expanding the capacity of low- and middle-income countries to do their own research and to serve their own communities.
The Center for Global Mental Health Research programs and portfolio can also be found under the NIMH webpage. And the address is listed there underneath, on the bottom of the slide. And broadly speaking, our objectives are to generate knowledge to improve the lives of people living with or at risk of developing mental illness in low- and middle-income countries. To expand and inform culturally appropriate, and equitable access, availability, affordability, and quality of preventive, diagnostic, therapeutic, and rehabilitative evidence-based interventions, in different health systems. And to contribute - and this third objective is very important. It's not only about supporting science, but also supporting research capacity building in low- and middle-income countries so that researchers can, over time, do their own research. But that also high-income countries, namely the US, can learn from the methods and discoveries that are done and developed in low- and middle-income countries. We believe that the potential for multidirectional knowledge exchange from high-income countries to low- and middle-income countries is one way, but also from low- and middle-income countries to high-income countries.
The portfolio for the Center for Global Mental Health Research, as I said earlier, is heavily focused on implementation research. And along those lines, we believe that it is important to support those high-priority global health goals that are known by all of us in the global health community that are available, for example, at the level of the Sustainable Development Goals, or from the UN, or at the level of the Universal Health Coverage Goals, WHO, including some of the goals that specifically the Department of Mental Health that WHO has listed in their more recent documents.
As it relates to the Sustainable Development Goals, there are 18 of them, but Goal Number 3 is directly related to health. And of course, there are other Sustainable Development Goals that have an important intersection with health that are not specifically the Goal 3.
Two of these targets within Goal 3 are particularly important for the Center for Global Mental Health Research. Target 3.4 speaks about reducing one third of premature mortality from noncommunicable diseases through prevention and treatment and promotion of mental health and well-being. And one of the indicators in Target 3.4 specifically talks about suicide rate.
Another target with Goal 3 is Target 3.8, which is the achievement of universal health coverage, including financial risk protection. So, implementation science in the Center focusing on developing knowledge that can be used by decisionmakers to support evidence-based decisions that allow low- and middle-income countries to achieve this higher level of global health.
The Center issues funding opportunities that we will be mentioning further down in this presentation. But before mentioning them - we're talking specifically about our interest - I also want to mention that the Center partners with other NIH institutes and partners with other NIH initiatives, to consolidate efforts to further these joint goals of replication.
So, we just listed three of them. There is one partnership or alliance with Fogarty Center, and you can see that that is called the Global Brain and Nervous Systems Disorders Research Across the Lifespan. Currently the application due date is November 15th of this year, 2022. But we will also be receiving applications next year and the year after that. So, NIMH and Center partners in Fogarty, but also, for example, partners with the National Cancer Institute.
And there is another - U54 Global Implementation Science for Equitable Cancer Control, and their name and numbers are listed there for you to browse on the internet. And the applications, we will be receiving them until November 9th of 2022.
And the Center also partners and signs on NIH initiatives or broader initiatives. For example, the Global Alliance for Chronic Diseases. And that alliance has an open call that closes on November 30th of 2022, which focuses on prevention and things.
So, when you look for opportunities coming from the Center, not only look at those specifically at the Center, but we may have joint opportunities with other centers and institutes.
So specifically, about the research priorities of the Center, again, implementation science, and we have identified five important priorities for us: suicide prevention, the integration of mental health care, social determinants of mental health, human mobility and mental health, and global mental health systems. And I say five because those are the five research priorities, but of course we have a sixth very important priority, which is training and career development.
The priorities mentioned there, you see there speak about the higher-level strategy of the Center, and focus on research, but we do important efforts in research capacity building, in partnerships, working with funders across the world. For example, today we are honored with the presence of Lynsey from Wellcome. And we also have some efforts in communication. We target research and capacity building in (inaudible).
Let me finalize, before I transition to my colleague Holly Campbell-Rosen, with one of these five research priorities, global mental health systems, service delivery occurs in the context of broader societal arrangements. These societal arrangements are usually called health systems, but they can be outside of the health system. And we are aiming to improve service delivery and quality and outcomes. It is important to understand these broader societal arrangements and having knowledge that allows us to improve that particular service delivery. So, this research priority encourages research on, for example, financing, purchasing of mental health services, purchasing of mental health services, human resources, governance, and service delivery organization.
We have a concept note that was approved by our NIMH Council in June of 2022 around developing measures to advancement of healthcare access and outcomes.
Thank you, Susannah, and I would like to introduce my colleague, Holly Campbell-Rosen, who is a program officer and program director or program chief of two of our programs. Take it away, Holly.
HOLLY CAMPBELL-ROSEN: Thank you. Good morning, or good day, everyone. As Dr. Cubillos mentioned, I'm going to review a couple of our programs or research areas. The first one is the Global Mental Health and Human Mobility Program. This supports research on the mental health challenges faced by mobile populations at all stages of migration. This includes refugees, asylum seekers, internally displaced persons, migrants, and other mobile populations. We know that there are approximately 1 billion migrants globally. That's equivalent to one out of eight people. And we know that globally, millions of refugees and migrants in vulnerable situations face poorer health outcomes than their host communities.
The COVID-19 pandemic reminded us of the strong connection between health and migration, where many health-related and social challenges developed for refugees and migrants as a result of the pandemic.
The challenges faced by migrants map onto the Sustainable Development Goals depicted on the right of the slide. And two examples are gender equality and ending poverty. This program supports research on a range of topics, including epidemiological studies to understand the natural history or development of mental disorders in mobile populations, the development and validation of reliable mental health assessments, and the development and testing of preventive and treatment interventions for mechanisms and pathways by which mobility contributes to mental disorders, and for modifiable targets of social and structural determinants of mental disorders in the context of mobility.
We also support research on the intersection of mental illness and comorbidities in the context of mobility. And we have a list of priority populations, currently, which includes children, adolescents, youth, girls, women, sexual and gender minorities, people with disability, older adults, and separated families, as well as those living with serious mental illness.
We're interested in strategies for improving access and availability of mental health care for mobile populations or in humanitarian settings. And as I mentioned, we are very interested in engagement with stakeholders in the priority populations I just listed.
On the bottom left is a link to an RFA that we recently published in May. The applications are due in October, so it may or may not be timely for you, but if you're interested, I encourage you to get in contact with me. The RFA focuses primarily on preventive interventions and assessments in mobile populations in humanitarian settings.
Now I'm going to give you an overview of the social determinants of mental health research that we oversee or are interested in. We know that mental disorders are one of the most significant public health challenges and that social determinants are key factors in the development or prevention of mental disorders. Social determinants are the conditions in the environment where people are born, live, work, play, worship, and age that affect the range of health, functioning, and quality of life outcomes and risks. In other words, the non-medical factors that affect health outcomes.
Examples include both social determinants of mental health at distal and proximal levels of effect on mental health outcomes such as gender, poverty, hunger, work conditions, economic inequality, war, climate change, social supports, and education. There's a very long list, but there are many others.
As you can see on the slide, we are interested in a range of areas to include study of social drivers of poor mental health and their influence on mental health outcomes, intervention development and testing, examination of downstream social outcomes related to improve mental health, research on inequities that stem from social determinants of mental health, things like gender-based violence and poverty, homelessness, and the impact on mental health.
We are also very interested in the identification of social determinants of mental health and ways of mitigating their impact, as well as the barriers to engagement with mental health care. The colorful wheel on the right represents the Sustainable Development Goals and the social determinants of mental health map nearly onto all of the SDGs. In addition, specific Sustainable Development Goals are also recognized as social determinants of health.
So, in summary, we're very interested in a wide array of determinants and how they impact mental health, and I encourage you to connect with me if you're interested. Thank you. And I'll now turn it over to Dr. Horvath-Marques.
ANDREA HORVATH-MARQUES: Hi. Good morning. Good afternoon. Good evening, everybody. It's a pleasure to be here and present and share with you a little bit of those programs that I have the honor to be leading here. One of them is integrated mental health care. So, in that sense, we are using the implementation science approach to aim to integrate mental health care into health care systems and community-level platforms, because we understand that is a strategy to increase access to care, to enhance service users, to improve continuum of care, and also to reduce costs.
So more importantly, you understand that also is going to meet the people where they are and address not only the treatment of mental illness, but also point to coexisting conditions. So, I want to remind that this approach is also aligns with WHO and United Nations as reflected by reports since 2008, when WHO had a report about integrating mental health into primary care. And more recently, a few days ago in September, WHO and United Nations also have a new report about the importance about integrating perinatal mental health care in maternal and child health service.
So, as you see, this approach aligns with the growing recognition that the international community, that mental illness is one of the most neglected yet essential development issues that's going to help to achieve the UN Development Goals. So therefore, this broadened support in innovative research, using implementation science to develop strategies to implement, scale up, and sustain effective mental health care, integrated in different systems, either in health care systems or also in community health systems.
As Dr. Cubillos already said, all our programs in the Center for Global Mental Health also expect the long-term goals to increase and strengthen research capacity in those settings, which we think is essential for the continuous of the research and also the multidirectional knowledge of research, so we can all learn with each other. So, stay tuned. More information is coming about this program online. But meanwhile, I just want to highlight one of the calls that were recent to expire, where you can also see here and take a look online about our priorities on that call.
I'm also overseeing a program in suicide prevention together with the suicide team here at the NIH. We are honored to push this agenda. We know that more than 700,000 people die per year by suicide. This is more than malaria, breast cancer, and HIV. And about 77 percent of those occurs in low- and middle-income countries. So, the Center strives to prevent suicide and globally pursuing the United Nations Sustainable Development Goals, Target 3.4 as highlighted before, which aims to reduce one third of premature mortality by 2023.
To advance this goal, I highlighted here some of the activities that the Center has been working together with other partners as we interest in reducing in research on those areas in 2021. We just had a concept note that means also again, highlighting to the field that we are interest in those kind of research. And also, we can see on the right-hand side here that we are partnering with PAHO to for a new conference that's coming - so stay tuned - related to suicide prevention. And also want to highlight that another annual meeting that is coming in suicide prevention in Guyana in November.
So, we have a lot of things going on right now in suicide prevention and we are looking forward to support research that's going to be helping to implement culture adapted, multilevel preventive, therapeutic, and service research. And the preventive and research we are really looking to support research in a population level all the way from universal prevention to individual level and selective prevention.
I am looking forward to talk to you. Please reach out to us. It's very important to reach out to us as soon as you have some ideas so we can move forward. Thank you.
SUSANNAH ALLISON: Thank you so much, Andrea. All right. I'm just going to talk a little bit about some of the - now that Dr. Cubillos, Campbell-Rosen, and Horvath-Marques have talked about some of the Center's priorities - I was going to talk just a little bit about, what are some of the different kinds of awards or we call them mechanisms that you should know about, that you could apply for from NIMH.
So here we're really trying to focus on folks who are past their training so people who are considered independent researchers. So, an independent researcher would be someone who has an advanced degree in an appropriate area of research, has a publication record, and a history of overseeing projects in the field in which they are applying. And this shows reviewers that you're ready and able to lead a project and disseminate the findings, and that you work in a research institution that has the resources that you will need and has committed space for the project, or you have collaborations with individuals with the space and resources needed for your research.
As you can see here, we really have different kinds of awards that span from one year up to five years and from budgets up to $50,000 a year to budgets that can go over $500,000 a year. But it's important to know what kind of research matches the kinds of awards. And this slide lays out the information about the different kinds of awards.
So, for example, if you had a couple of different databases that you were looking to combine and then analyze, R03 might be the most appropriate because you're analyzing existing data. If you are trying to develop a new measure, then an R21 might be a good mechanism. If you are developing a new intervention, then you might want to look into an R34. And if you already have data on an intervention, you've done a pilot and it was feasible and it shows some promise, then you might want to consider applying for an R01, which would be to evaluate the efficacy or effectiveness of that intervention.
So where do you find out about all of these different funding opportunity announcements? Well, we've had some of them highlighted for you in this webinar, and you can also use the NIH guide to find funding opportunity announcements. You'll see here, if you just Google NIH guide, you'll be able to search for different funding opportunity announcements.
We have different kinds of funding opportunity announcements. The two main sort of categories are RFAs or Request for Applications. These are typically just a onetime request. We set aside money to fund the grant applications that score well, that come in for that call. And they tend to be on a narrow area of research that the NIH feels like really needs to be grown.
And then we also have program announcements. These typically do not have set aside money. They're typically open for up to three years. So, you can apply multiple times. You can resubmit if you don't get funded the first time for a program announcement. And then we also have somewhat relatively new, these notices of special interest. And these are not funding opportunity announcements, but they are ways of us indicating areas of research priorities to the field. So, I also encourage you to review the notices of special interest when you're applying to NIH to see if you can find areas where we would like to see more research.
And then the last point I just wanted to make is that NIH it is competitive when applying to NIH. So, I really encourage you to be sure to reach out to one of us before you submit to discuss your concept and to make sure that you are submitting the most competitive application possible. But if you're not funded, definitely understand that you're in good company. It's good to sort of regroup and get advice from mentors, from peers. And again, reach out to your program officer to talk about potential next steps, whether that is resubmission or whether that means taking your research in a new direction.
So, I next want to turn the speaker and my camera and mic over to Dr. Lynsey Bilsland. Dr. Bilsland is Island as the head of Mental Health Translation at Wellcome. The team aims to develop new and improved interventions for anxiety, depression, and psychosis, plus novel tools to enable precision psychiatry.
Previously, Lynsey was deputy head of the Innovations Program Team, which funded targeted translational research to maximize patient impact. Prior to joining Wellcome, Lynsey was a postdoctoral research fellow funded by the Motor Neuron Disease Association and Cancer Research UK. Her research focused on developing in-vivo imaging methods to evaluate the contribution of defective exonal transport in motor neuron disease.
Lynsey gained her Ph.D. in neuroscience from University College London, and also holds a Bachelor of Science in Pharmacology from the University of Glasgow. So, Dr. Bilsland, take it away.
LYNSEY BILSLAND: Thanks, Susannah, for the introduction and good morning, good afternoon, good evening, everyone. It's a pleasure to join you today. So as Susannah mentioned, I'm the head of Mental Health Translation at Wellcome in London in the United Kingdom.
In my presentation, I'm going to start by giving you an overview of Wellcome and our new strategy. And then I'll go into some different opportunities that we have for funding global mental health, both through our mental health team and also our Discovery Research team.
So, for those of you that don't know, Wellcome is a global charitable foundation that was established by Sir Henry Wellcome back in 1936. And we're politically and financially independent and we're supported by an endowment that's currently worth over £36.2 billion. The Wellcome mission is to improve human health, and we aim to do this through funding or providing funding for research, through building global partnerships, and through supporting advocacy. And very recently we announced that we've got 16 billion to spend on our charitable activities over the next ten years.
So, we spent the last couple of years developing a new strategy and it is great to be able to announce it to the world. And so, our vision is to support science and to solve urgent health challenges that face everyone. So, we've got three global health challenges. We've got mental health, infectious disease, and climate and health. And then we will also continue to support Discovery Research to advance knowledge in relation to life, health, and wellbeing. And we look to embed diversity and inclusion and the building of a positive research culture and all the work that we fund and that we do.
So then if I focus on mental health, our focus here is to drive a step-change in early intervention. And we're focusing on anxiety, depression, and psychosis. But we're using these terms in a very broad way. So, we will fund research, focusing on any anxiety, depressive, or psychotic disorder. And we're aiming to build a more integrated field of mental health science. We're aiming to fund research that helps increase our understanding of how depression, anxiety, and psychosis develop and resolve. And then we're also looking to drive the development of new and improved ways to intervene early. And so, this might be novel pharmacological interventions, but also non-pharmacological interventions. And we're looking for agents that could be applied within health care settings and also in non-health care settings.
So, the remit of the mental health team is to fund global research. And as I said, we're focusing on anxiety, depression, and psychosis using the broad definitions. So, we recognize the importance of funding research across a number of levels. So, from the subcellular to the social. But also seeking input across a wide range of disciplines that are relevant to mental health. So, this would include obviously psychiatry, psychology, neuroscience, but also social science, history, and economics, for example.
We look to fund both basic and clinical research that will help us move the needle on early intervention. And this research can involve a whole range of methodologies, but it must meaningfully involve people with lived experience, because we believe that meaningfully involving lived experience actually results in better science.
Wellcome as a member of the Common Measures Board, which is led by the International Alliance for Mental Health Research Funders. And so, we request that the common measures of GAD-7 and the PHQ-9 are involved in any research that we fund and that focuses on anxiety and depression. And we're looking to develop common measures for research focusing on psychosis. But these are still in development at the moment. We will consider applications that don't include these common measures. But we really want to work with you to explore why you didn't want to include them.
And then importantly, what we don't fund. So, as I mentioned, we focus on anxiety, depression, psychosis. We won't fund projects that don't focus on anxiety, depression, psychosis. In contrast to the National Institute for Mental Health Center for Global Mental Health, and we primarily focus on basic core translational science and will not fund proposals that are solely focused on implementation science. Although we do encourage our applicants to consider uptake from a very early stage so we can include some aspects of implementation science. So, for example, health economics or cost effectiveness analysis. But the proposal cannot be solely focused on implementation science. We also don't fund health care reorganization or service provision. And we don't fund activities that don't have potential to advance early intervention.
So, these are some of our upcoming calls. The top is currently open. So, this is looking to integrate sleep and circadian science into our understanding and treatment of mental health problems. The deadline for this is the 19th of October.
We also have a number of calls that are under development at the moment. So, we have a call that is, I think, likely to be launched mid-to-late November, looking at development of biological, psychological, social, or digital markers that will help us stratify people suffering from anxiety, depression, psychosis. Then next summer, we will be launching a call that looks at the different developmental pathways that might lead to anxiety, depression, and psychosis. In winter 2023, we'll have a call that focuses on unlocking the potential of neuroscience to help eliminate and resolve anxiety, depression, and psychosis. And then in summer 2024, we will be launching a call and that's focusing on really harnessing the potential of digital technology to aid early intervention.
These are all on our website and I'll share the links for them in a minute. Our plan is to share quite far in advance the kind of calls or at least the kind of headlines for the calls to give you time to plan if you want to apply. But it's just to highlight that these calls, the ones coming, are still under development. And so, the specific scope, assessment criteria, or timing hasn't been finalized. And so, they are subject to change. But do keep an eye on our website because all the information will be there.
And then I think it's also worth highlighting that these calls are open to applications from anywhere in the world except for mainland China and sanctioned territories. And we can also fund both academics and companies.
So, we also have a number of mental health commissions that are currently open. So, the first is looking to review and summarize the most influential, clinically relevant biological, psychological, and social mechanisms that have been proposed to underlie mental health conditions over the 20th and the 21st centuries. And the aim behind this is to help inform our knowledge of the theories that are now being revisited by the research field. The deadline for this is the 21st of October.
The second commission is looking to identify potential ethical issues of mental health data collection and identify mitigating strategies. And the deadline for this is 30th of September. That's quite soon. And then the final commission that we have open at the moment is helping us to identify the technical and the non-technical challenges in the mental health research and development ecosystem, and that might create barriers to the development of mental health interventions. And the deadline for this one is the 12th of October.
So, I've included here lots of relevant links. The top link is our Wellcome webpage, and you can then search for mental health on that main page. But there's information on there about our strategy, about kind of what would be within remit. And then also the funding calls and the commissions that I mentioned. We have a generic email address, firstname.lastname@example.org, so you're very welcome to send any queries to that. I will say, when you're searching for Wellcome, don't mix us with Wellcome Leap which is US-based, and it is a subsidiary of Wellcome. We do we do regularly communicate, but they don't currently have any mental health calls open that I'm aware of.
It's also worth noting that we also have a suggestions box. So, if you've got any great ideas that you think could help us advance our strategy, please do submit these through the suggestions box. And again, you'll find a link to this on our webpage.
I just wanted to highlight some of the schemes that we also have available through our Discovery Research team, because these are also open to mental health applications. So, the Discovery Research team are looking to build a portfolio of creative and risk-taking research that leads to significant shifts in our understanding of health, life, and wellbeing. And that obviously includes mental health.
This team aim to give researchers the time and the resources to be ambitious, to take risks, and to apply innovative approaches to tackle difficult problems. They're looking for research that has the potential to open up, to build, or to shape new fields of inquiry, whether this is through significant shifts in our understanding or through the development of new research tools, technologies, methodologies, or enabling platforms. And they're really looking to encourage diverse disciplines, teamwork, and collaboration, because we know that the greatest opportunities for discovery come from greater diversity of people, places, and approaches, and having a thriving research culture for research that is inclusive, ethical, and engaged.
So just to note that the Discovery Research that Welcome supports may, but does not have to, link to our three health challenge areas of mental health, infectious disease, and climate change. But there does ultimately need to be a link to human health, even if it's a very long-term goal.
This just gives you a bit more information on the open mode schemes that Discovery Research have. And they have three different schemes that aim to support researchers across a wide range of career stages, across multiple disciplines, and across diverse backgrounds and geographies.
Just to give you a bit more detail on these schemes, on the left, we have the Early Career Awards, which is aimed at researchers that are ready to develop their research identity and are looking to be ready to lead an independent program by the end. And here we can provide salary and up to £40,000 pounds for research expenses. The average award length is five years, but this can vary.
Just to give you a bit more information on the eligibility, we'd expect applicants to have completed a substantial period of research training. You should have completed a Ph.D. or have at least four years equivalent research experience, and we might expect you to have some post-doctoral experience as well in your proposed field of study. But for this early-stage award, we wouldn't want you to have more than three years postdoctoral experience.
Then for the scheme in the center, the Career Development Awards, these are aimed at mid-career researchers with the potential to be international research leaders, and the scheme is looking to develop research capabilities and drive innovative programs. And these awards provide salary, and they'll also provide the resources that you need for your research program, and they can be for up to eight years in length, although this does vary depending on the discipline.
In terms of eligibility, we would expect you to have completed one or two substantial periods of research after your initial training. We would like you to have made important contributions to your area of research and have some experience of working collaboratively. And for these career development awards, you may have directed each or closely guided the work of others. At the point of application, you might also have been appointed to your first permanent position or a long-term rolling contract. And ideally, you'll have been appointed within the last three years.
And then the final open award scheme offered by Discovery are the ones on the right. So, the Discovery Awards and these are for established researchers and teams to pursue bold and creative research ideas, to deliver significant shifts in understanding. And to be eligible, you should have international standing in the field. We would look to you to submit with a diverse team on your application. Again, you can request the resources that are needed for the program of work, which can be up to around eight years.
And for each of these schemes, there are three rounds per year, and we look for the principal investigator to either be based in the UK or to be based in a low- and middle-income country. But the wider team members can be international. And I don't sit in the Discovery Research team, so I would definitely encourage you to look at our webpage. So, if you go to the Wellcome page and you search for Discovery Research, you'll find all the eligibility criteria and also guidance on what's offered by each of these different schemes.
I would like to flag that Discovery Research are open to any application focusing on mental health, so it doesn't have to be anxiety, depression, psychosis. It's any mental health problem at all.
And then just to finally flag that Discovery Research can also fund directed activities to overcome specific scientific bottlenecks and barriers, and this accounts for about a third of that expenditure. So, some of the examples here include significant investments that they've made in institutes such as the Wellcome Sanger Institute, our world leading edge genomics institute, and there's also the Francis Crick Institute here in London. And there's a number of Wellcome centers, each of which has a specific scientific focus.
They've also invested in a number of other significant programs. So, for example, the UK Biobank and the Human Cell Atlas, which would not be suitable for support through our open award schemes.
Then just to give you a bit more information on the remit of Discovery Research, their remit is very broad and allows them to support a broad range of the best ideas. And these can range from focusing on fundamental processes that underpin biology through to understanding more about how life works, and also looking at the complexities of human health and disease, including both clinical and population-based approaches. They also can fund the development of methodologies, conceptual frameworks, technologies, tools or techniques, anything that benefits health-related research.
They really look to prioritize the needs and the values of the people in the communities that are affected. And they also want the social, cultural, political, and historical context of human health and disease to be considered.
There are some exclusions. They will not fund purely translational research or purely an implementation science. But then, if you consider that actually basic translational implementation science is all sitting along the one pipeline, you actually find that a lot of the work that Discovery supports actually sits along that pipeline. So, it's not quite as clear cut as excluding translational research. But they do say that the focus should be translational or implementation. And actually, the main driver of Discovery Research should be the generation of new knowledge approaches and tools.
I was just going to finish by saying thank you very much for having me today. I hope this was helpful. There are lots of links on an earlier slide, and here is my email and also the generic mental health team email. And I'm unfortunately not able to stay for the Q&A today, but I'm very happy for anyone to reach out if there's any questions. And I'm also on Twitter and LinkedIn, so I'm happy to be contacted through those platforms as well. Thank you.
SUSANNAH ALLISON: Thank you so much, Dr. Bilsland. That was a wonderful talk and great to hear about all of the different opportunities at Wellcome. And yes, I just want to reiterate, please reach out to Lynsey if you have any questions, and we'll try to keep track of any questions that might have come in for her and send them her way. But I would really encourage you to reach out directly to her since she's unable to stay on for the Q&A. Thank you so much.
Next, we are going to hear from three independent global mental health researchers. So, I'm going to introduce them, and if they could all come on camera, that would be great. Annika Sweetland is an assistant professor of psychiatry and public health at Columbia University. She's obtained several NIH funding mechanisms throughout her career. She was a T32 post-doc fellow. Then she got a four-year K01 Career Development Award, and she just started the second year of her first R01.
Within the fields of global mental health, her specialty is the intersection of tuberculosis and depression, and she's the training director of a newly established Columbia Psychiatry in New York State Psychiatric Institute Mental Wellness Equity Center. She's a junior training director for a T32 postdoc fellowship in Global Mental Health, and she's a faculty member on a U19 mental health hub grant in Southern Africa. So welcome, Dr. Sweetland.
The next panelist is Dr. Proscovia Nabunya. She's an assistant professor at the Brown School at Washington University in Saint Louis. She also co-directs the International Center for Child Health and Development at the Brown School. Dr. Nabunya's research agenda focuses on global mental health, HIV stigma, and family and community-based support systems. She has over 17 years of research experience conducting research among children, youth, and families impacted by HIV and poverty in sub-Saharan Africa. And she was recently funded by NIMH to develop a mobile health app to address issues of depression and to improve treatment outcomes among youth living with HIV in Uganda. So welcome Proscovia.
And last but not least, Dr. Ryan McBain is a policy researcher at the RAND Corporation and a health economist and faculty member at Harvard Medical School. He focuses on the design and evaluation of health policies and programs meant to reach vulnerable populations, including those coping with mental health conditions, HIV, homelessness, and poverty.
To achieve this, Dr. McBain has utilized a wide range of methodologies, including econometric approaches for quasi experimental analysis, cost effectiveness analysis, and decision analytic models, as well as key informant interviews and focus group discussions. He's worked with the W.H.O., World Bank, and Partners in Health, mostly in sub-Saharan Africa and Haiti. And he has a Ph.D. and MPH in public health from Harvard.
So, thank you all again for agreeing to be on this panel and to share your experiences in successfully having moved to this sort of mid-career and independent phase of your research funding. I thought we'd start with a more general question. Maybe, Dr. Sweetland, you could start us off. What advice do you have for researchers who want to establish a career in global mental health?
ANNIKA SWEETLAND: Yeah, sure. Hello, everyone. So, one of the greatest challenges for me personally, and I think a lot of people based in high-income countries face, is how to strike the work life balance when doing global work. And there's a few different ways to do it. So historically, anthropologists would go live in the country. And that's certainly an option to go live in the country in which you're doing the research. But increasingly, people are based in one country and doing research in another, like I'm doing. So, I'm based in New York, and I do work in Mozambique, South Africa, and Brazil.
One of the things about this is that the going and living in the country as a essential piece is really more of a colonial model, in the idea that you have to be there every second to be able to ensure that the research. And more and more we've moved towards a partnership model where you have strong local partnerships. And our job is to build capacity locally and then rely on their local expert knowledge to do the interpretation of the research. And so, the capacity of your local team might determine how much time you spend in-country. And certainly, going is important. The relationships are incredibly important but building a very strong local team is critical to success in this space.
SUSANNAH ALLISON: Thank you. I am glad to hear you highlighting those collaborations and sort of how important they are. That's definitely something that we try to talk to potential applicants about. And definitely it's something that comes up in review. So definitely something that you want to have well thought out that you've established these collaborations well in advance of submitting an application.
Ryan, would you like to answer the same question? So, any advice that you would have for researchers who are looking to establish a career in this area?
RYAN MCBAIN: Yeah, sure. I think that the point on work/life balance is a really important one. I certainly have found - and this is just speaking from my personal experience - that spending a significant amount of time in the setting where you are doing research, I have found to be very important, very valuable. I try to make sure that any project that I'm doing, I'm spending at least a few months, a year in that that local setting with people.
Even as people have adjusted over time to the Zoom life and other things virtually, I still feel like there's not really a substitute in terms of building rapport and immersing yourself in the culture and having conversations with people and going there and being there and coming alongside, partnering alongside the local partnership teams that you're working with.
And to the point that Annika brought up, I would say too that, Partners in Health, the organization that I mostly work with in my international projects, I would say probably about 98 percent of their employees are people who are local and based in local setting. And I think that more generally speaking, one of my suggestions, advice that I would give is to make sure that on the projects that you are directing, that you have a really strong local partnership team, people who understand the cultural milieu, the context. Sometimes it can be very hard to capacity wise. People might not have the level of training that you might bring in terms of methodologies, for example. But usually, I have found it to be to be very valuable to have somebody who understands the local context very well in driving a lot of the day-to-day decision making on the projects.
The other piece that I'd mention really quickly is just that funding is very challenging and it's really exciting that NIH has a center and is so supportive, but I have personally found that it's not like every R01 or R21 that you submit, you get funded. And so, it's very helpful to try to have a diverse portfolio of opportunities when you're exploring. So not just federal grants but also looking to foundations or other potential sources of support.
In addition, I think about global health as including the United States. And so, for me as a US-based researcher, I try to make sure that some percentage of my portfolio includes domestic work because there is a lot of funding that is focused domestically as well. And so, you have lots of different thoughts on the stove that you're trying to manage. And I think that that can be really important.
SUSANNAH ALLISON: No, that's a great point, Ryan. I think that throughout your career, I think it is important to have some diversity and finding that sweet spot and having enough diversity in the work that you're doing that you're able to have consistent funding but then not have so disparate things going on where it's pulling you in too many different directions. I think trying to figure that out, like what are some skills that you can apply and that things that you are really good at, that you can apply to different research questions, whether that's domestically or in Mozambique or Haiti, and ways that capitalize on those unique skills that you have. That's a great point.
Proscovia, what would you like to add to this discussion?
PROSCOVIA NABUNYA: Thank you. I agree with the points that my colleagues have made, and I wanted to add a couple of things as well. So, for those interested in making this a career, just making sure that this is actually something you want to do, this is something you're passionate about because you don't want to spend a lot of time working on something where you feel like you're going to a job every day.
I'm fortunate to be working in the country where I was born. So, issues of mental health is a passion of mine, and that's what keeps me going, because every single time, I don't take it as a job because I get fulfillment and satisfaction from doing so.
And the second part is to find a mentor who genuinely cares about your own career growth and also advancement. You don't want to be with somebody who puts you in their lab at work on their projects without providing you with the opportunities to develop your own research. Every time you work, it's hard when you're just starting up, whether as a post-doctoral trainee, it's always hard to find that independent research, but find that mentor who is actually genuinely helping you to be able to develop that area, is important.
And the last piece also is, persistent is key. And actually, this goes back to the first point where this has to be your passion. When you try to find someone - the presenter, you mentioned this - and things don't go well, you try again. For the funding that I've received, I have applied at least a minimum of three, putting in the STEM grant and revising and I never give up. So, making sure, believing in the idea that you have, but also being persistent and continuing with that idea until a positive outcome is achieved is important.
SUSANNAH ALLISON: Thanks, Proscovia. I think persistence is key and having a diversity of funding opportunities, whether that's at NIH, exploring different institutes as well can be really helpful. The Fogarty International Center, as Dr. Cubillos mentioned, also has funding opportunity announcements that can include global mental health research and thinking about funding opportunities outside of NIH, as Ryan mentioned, whether that's foundation research or other agencies that could fund work in this space.
Proscovia, you sort of did mention that you do have to find someone who as a mentor, especially when you're in early career, that is willing to help you along but is really helping you to develop into an independent investigator and not keep you under their umbrella for as long as possible. So, it's important to, when you're at that stage, make sure that whoever you're working with, you've vetted them well, you've talked to folks who've worked for them, they have a history of helping people to become independent investigators. So that's a great point.
Ryan, I'm going to turn to you first with this next question. Can you think about what's an obstacle that you've had to overcome in doing the global mental health work?
RYAN MCBAIN: Yeah. I think that very honestly, my upbringing in some sense has been an obstacle. So, I grew up in the US, in a relatively suburban community, and my interest in global health came from a few different life experiences. But working in cross-cultural settings, I think it really necessitates a lot of humility. And as you know, my training is in health economics. And I have personally found that economists tend to be a relatively arrogant breed of folks. They tend to think that they know they have the right question that they want to answer and how to go about doing it. And having that orientation is not a good recipe.
I think that in global mental health, the way that people think about mental health, the way that they talk about it, issues related to stigma and discrimination are really at the center of a lot of this work. And so, in all the work that I do, I try to introduce mixed methods approach, it's like a sandwich where on the front end I do some qualitative work that's understanding the concepts that we want to explore and make sure that our approach is a reasonable one that we think is going to answer our main questions and then quantitative research. And then once we've done the quantitative component, on the back end, once again, talking with people in the community, people who participated in the project, people who deliver the interventions to try to understand what was working, what did they like, what wasn't working, what didn't they like.
I think that this cross-cultural work requires you to listen well and to try to make sure that you are really empowering the folks you're working with. And then logistics is also just a huge, related issue as well. A lot of the work that I do is in Malawi, so that's front of mind right now. But you have things like rainy season and trying to drive somewhere to deliver services and then your car breaks down and you're like, this wasn't part of my NIH proposal or whatever, trying to sort through a lot of these, you sort of learn over time.
SUSANNAH ALLISON: Thanks. Yeah, I think having cultural humility is an excellent point. I think that's important for, as you said, global research. So that's research everywhere. It's so important to have that approach to the work that we're doing regardless of our backgrounds. And it was great to hear Dr. Bilsland talk about their focus on the inclusion of individuals with lived experience, because I think that it is invaluable to the research process.
Proscovia, what would you add to this discussion around an obstacle that maybe you've faced? And how did you overcome it?
PROSCOVIA NABUNYA: Thank you so much. I will speak my own experience in a setting, the way it works. So, mental health in general is not a big priority, if a priority at all. So mental health services and the care are underfunded. Research capacity and infrastructure are underdeveloped. And mental health is still stigmatized in our communities. So, it is rarely talked about in families. And we still use that stigmatizing language and people don't think it is important.
So having to work in a setting where mental health is not prioritized is a challenge. So, part of the solution for me and my colleagues has been to work with communities to make a case for mental health. So, bringing them in the conversations, including families and children, going to the schools where they go to, to the clinics where they get their health care, as well as other community-based organizations in the community to talk about mental health and make a case for it. This is not something that is separate from us but is part of our livelihood. It affects all aspects of their lives, including the way that parent’s parent their children, children's outcomes, their physical and health wellbeing. So, helping them to understand this is not a by the way, but it's part and parcel of our livelihood, and it's important to prioritize mental health.
And also, the other part that is now helping is the funding we are getting from NIMH. Most of my studies have been funded by the NIMH. So, through this work, we've been able to adapt and test interventions and then be able to bring those findings to the community and show evidence that this is where we started. You remember, we were part of this process. And this is why I began. And this is where we find we have these outcomes related to mental health, and we would like to continue this work. So that has been a way of trying to address that challenge around destigmatizing mental health, but also trying to build evidence where we can eventually convince the big stakeholders and the government that this is an issue that needs to be prioritized.
SUSANNAH ALLISON: Thank you for bringing that up, Proscovia. I think stigma that is a big challenge in doing mental health research around the world. And I think that the way that that is manifested in different communities can vary dramatically. So, it's really important that as many of you have talked about the importance of really strong collaborators and teams in-country and in the contexts where you're doing the work to really understand what that is like and how stigma plays out in the communities where you're working and how you need to address that in the work. Thank you.
Annika, what would you like to add to this discussion?
ANNIKA SWEETLAND: Yeah, one of my challenges over the course of my career is that my interest is cross-cutting. My expertise is in TB, tuberculosis, and mental health. And so early on, I found sort of a grantsmanship lesson that I've gained, which is that early, I was applying to mental health funders, and they were saying it's too TB related and then looking to TB funders and they're saying it's to mental health, we're not interested. Thankfully, that's changed over time. And now it's become a more recognized issue.
My T32 and my K were focused on mental health, funded by NIMH with TB as a side note. And then my R01 is funded by NIAID, and framed in a different way. And it's the same study. I could frame it either way. So, it's just a grantsmanship challenge that I've faced and I'm starting to wrap my head around it. And thankfully the field has caught up with me and now it's recognized as more of a need.
SUSANNAH ALLISON: Yes, grant writing is a skill that you definitely get better at over time. And I think the framing can help to fit it into a particular institute or center's priorities. But you're right, sometimes you could write the same grant and be doing exactly the same work, but the way that it's framed would make it fit better, one or the other. So that's a good a good lesson learned and a good lesson for others to think about, that just the framing of the way that you're presenting your study can be really important.
I don't know how many Q&A questions we're getting. We don't have very many. So, I think we'll just continue this discussion. And then if folks have any questions for anyone at NIMH and the Center, or any of the panelists, please go ahead and put them in the Q&A box, and we'll proceed with the question that we have.
We touched on this already, but I was wondering if you could each maybe share one tip for working within communities, in other countries. And Proscovia, you're originally from Uganda, so it's maybe slightly different for you, although now you live in the United States and you're traveling back and forth. But maybe can you share a tip from your perspective as a Ugandan in how best to work with community organizations, ministries of health, other really important key stakeholders for your work?
PROSCOVIA NABUNYA: Thank you to the presenter. And I'll share two interrelated tips. The first one is engage with the community in the research process right from the beginning. They are the experts on their lives. So, they know what is going on and they know what their needs are. Nothing frustrates the community than you, an outsider, going in and telling them what is wrong with them and what is wrong with their community.
It's always important to engage them in the initial discussions, including when you're thinking about writing a grant application. So, it's always important to bring in some of the key stakeholders that this is the idea that we're thinking about. What are your thoughts about these and how it should be done?
The other part that goes with that, invest in the community as much as you can. And by this, I mean engage and train people within the community as part of your research team so that they engage in all research activities from the very beginning. And in my experience, my colleagues and I have worked in the same region for over 17 years. So, you can imagine that we have trained a lot of people, and these are individuals who are born in these communities, so they know the context. And they are ending up being study coordinators and mentors. And we have trained community health care workers within the communities to deliver the interventions that we do. We've trained parents to be part of the research team and deliver the interventions. So, by doing that, communities see this as you're not just going in to collect data, take their information and leave, but you're actually investing in the young people, but also the stakeholders that will step back, even in your program leaves.
So, for me, I think those two things have been very instrumental in my own work.
SUSANNAH ALLISON: Thanks, Proscovia. Yeah, capacity building, as Leo mentioned, is really important for the Center for Global Mental Health Research. And I know that actually all three of you are excellent in doing that in your work.
Annika, would you like to comment on establishing good collaborations?
ANNIKA SWEETLAND: Well, I would say that qualitative research always should be part of every study. Focus groups and interviews right at the beginning, before you get started is just absolutely critical, what you can learn, and it shapes everything in terms of implementation. I do implementation science research, so it's particularly important, but I think qualitative research is essential in global mental health research.
SUSANNAH ALLISON: Thanks. Yes. I think again, all three of you, from knowing your work, are great about integrating qualitative work with quantitative. And I liked Ryan's sandwich comment earlier about starting with the qual, doing them some intervention delivery, and then ending with some qualitative as well.
Ryan anything to add? Or actually, we do have a couple questions in the queue. But if you have something to add to this question -
RYAN MCBAIN: No, I'll just say that I think that what Proscovia and Annika said, 120 percent agree with them. And I think a slightly different framing on what Proscovia was talking about has to do with developing community buy in. You want people to be motivated and excited about the work you're doing. And ways of doing that is making sure that people in the community understand what's going on, that they're motivated and invested in that, that they don't think that something strange is going on and what's happening.
And so, what that has looked like for me, for example, concretely, has been to have community advisory boards who, even before you begin the project, they know what the project is about, what's happening. It's going into individual communities and meeting with elders in those communities to present it to them. It's meeting with local and district-level ministry officials so that they understand what your plans are. It's also, as mentioned before, trying to find opportunities for people to not just participate in research, but to lead research, which can be a somewhat time-consuming process to make sure - especially if English is somebody's second language and you're targeting an English journal - but spending the time and resources to make sure that others on your team have opportunities to do research and that you're not just coming in doing your research and publishing and then leaving, I think is really, really important.
SUSANNAH ALLISON: Thanks, Ryan. Definitely important additions to this around collaborating and really making sure that as the PI, you're not the one driving the agenda all the time, that it's kind of a collaborative process.
There's a question on advice on enhancing grant writing skills and then identifying and connecting with potential mentors. So maybe I'll just put in a little plug for some of the NIH websites. There are some great resources on grant writing. I'm happy to share them if you want to reach out to me directly. But how have you moved your grant writing skills forward and then maybe some tips for identifying potential mentors? I'll just let you jump in, anyone who feels like they have a good answer.
RYAN MCBAIN: I would just say in terms of grant writing, one thing that's been super helpful for me - and this is also true for publications - is find an example that's been very successful and then treat it like a formula. Like opening paragraph is four sentences long and you have a topic sentence that's - it may feel too formulaic as you're doing it but getting down the rhythm and understanding the flow, I think can be really important. And so that's something that I do very regularly, is I try to find examples of what's been successful and then model that. Even with publications you can go to the journal that you're interested in publishing in and download a couple articles that have been recently published in that journal and look. And I think that grants are very similar in that regard.
SUSANNAH ALLISON: Excellent advice. Anything to, Proscovia, or Annika?
PROSCOVIA NABUNYA: So, I also agree with what Ryan has said that there is that formula. So, if something is not broken, don't fix it. Because their formats don't change that often. And I try to keep to those.
But also, I think the second part was I didn't find -
PROSCOVIA NABUNYA: For me, I've been fortunate that I've had a long relationship with my mentor and that I haven't been in the market for new mentors. But what I find, and maybe other junior researchers have connected through - they've gone through one person who actually made the connections to other potential mentors. So, utilizing the fast time that you have to be able to introduce you to the next person that you want to actually talk to, that has been helpful.
SUSANNAH ALLISON: Networking. You're right. Absolutely, kind of ask the folks you went to graduate school with, that you've been on post-doc with, that you maybe have written with. And then I also definitely recommend using NIH Reporter, which is like a Google search basically of active NIH-funded grants. And you can search for what we're currently funding and find people who are doing similar work.
So actually, this is also kind of in response to a question from Javed, as well about finding kind of teams that you might work on. So, I definitely would encourage you to use NIH Reporter as a way to identify existing grants that might be of interest to you or might be in the area where you live and work.
A question from Michael Goodman.
ANNIKA SWEETLAND: Sorry, I was trying to unmute myself. For me, in terms of finding mentors, I just lucked out with the T32 mechanism because - and the same with the D43 mechanism is those are institutional grants where they get the grant in order to mentor people because that's the hope, that's their orientation. And so, I've had outstanding mentorship. K has also mentored, but the T32, they chose me, and I chose them and that was a very successful mechanism. So, finding people who are involved in those types of grants, Fogarty Grants, D43s, T32s, you find the people who really take mentorship seriously. That's just my experience.
SUSANNAH ALLISON: Thank you for adding that. I think that's an excellent point. In two of the prior webinars, we talked about more individual types of training awards from NIMH, but Annika raises that we do have these institutional training awards. So, T32s, D43s, R25s. Again, it's a little bit of an alphabet soup, so I'm happy to answer questions that you might have about them. But basically, as Annika mentioned, I'm very dedicated to providing mentoring to individuals who are interested in global health research or global mental health research. So as an investigator, as a more senior investigator, I would apply to have a T32 or a D43, and then I would look for trainees to bring into the program and train. So, it's another excellent way to get really good mentorship and good training.
So again, just encourage you, if you're interested in global mental health training, to watch the prior webinars and to reach out to myself to ask about what are some of the options that would be a good fit for you, because it varies a little bit based on if you're a US citizen, where you're doing your work, where you are in your career. So please reach out.
All right. We might have one more question. So, this is from Michael Goodman. I'm curious to see your research, where you kind of think you're going moving forward in the field and your research. Where do you see your work going, and any challenges that you might see?
ANNIKA SWEETLAND: I would like to share some of the best advice that I got from one of my mentors. When I first started working with him, he looked at my resume and said, no, you're doing all of this really interesting work, but that doesn't work in academia. You have to be the person who does this. You have to find your niche. Once you find your niche, you can branch out, but you have to find your topic and you got to find - you're that person. And it's not easy to do that. But once you do, then it's like a light and you move towards the light, and you try to look at that one thing from every different angle and every context. And so that was incredibly helpful to me.
SUSANNAH ALLISON: Great advice. Right, finding that area that makes you invaluable to your work and other people's work. And then people will want you to be on their teams and partner with you. So, yeah, agreed. Find your niche.
Any last parting words from any of the panelists?
RYAN MCBAIN: I think people should pursue global mental health research. I think it's really important. I agree with Proscovia's comment that it is something that is not really a priority or not as high a priority as other things are in some other settings. And so having more people who are passionate about this and trying to advocate for it, even if the funding and some of the other hurdles are challenging, I just encourage people to keep trying to pursue it.
SUSANNAH ALLISON: Thanks, Ryan.
PROSCOVIA NABUNYA: And for me, I'm excited to see where the field is going in terms of new innovations around mental health. So, I work in a (inaudible) setting and to see that now we are leveraging technology to be able to reach populations we haven't been to do so before, via technology, whether it's mobile phones or using the internet, it's exciting and I look forward to see where this will go.
SUSANNAH ALLISON: All right. Well, thank you all so much. I want to thank Ryan and Annika and Proscovia, and I want to thank all of our other speakers for making this webinar such a success. Thank you for joining us. Please keep checking the website. A recording of this webinar will be posted shortly. Have a wonderful day.