Growing recognition of the global impact of mental illness has led to a movement to find solutions.
Depression, anxiety, and other mental illnesses are among the leading causes of death and ill health worldwide, contributing both to human suffering and to lost opportunities for economic development and prosperity. And, in recent years, researchers have tracked a disturbing increase in mental health disorders.
A growing recognition of the global impact of mental illness has led to a movement to find solutions, a movement with deep roots in the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School.
In one of five symposia exploring the evolution of social medicine at Harvard over the past 150 years, GHSM faculty members this year explored how the department has addressed mental health care delivery challenges around the world through the legacy of Paul Farmer, the former head of the department who died unexpectedly on Feb. 21 from a sudden cardiovascular event.
The symposium featured a roundtable discussion moderated by Vikram Patel, HMS Pershing Square Professor of Global Health and co-director of the University-wide Global Mental Health @Harvard initiative.
“The world is experiencing a mental health crisis,” Patel said in introductory remarks. “This crisis disproportionately affects those who are already on the margins.”
People who are young, poor, LGBTQ, and those exposed to war or other violence are especially vulnerable to mental illness, Patel said, adding that key mental health metrics, including the prevalence of substance use disorder and self-harm, had been worsening in most countries for two decades before the COVID-19 pandemic, which Patel said only “added more fuel to the fire.”
While the specific causes of this increase in mental health disorders are not fully known, Patel noted that the likeliest explanation is a complex array of causes, including an increase in risk factors, such as stress from violence, poverty, and environmental catastrophes, and the disappearance or reduction of protective factors, such as supportive family relationships, stable communities with a sense of common purpose, and governmental social safety nets. But he suggested there are solutions.
“Social medicine is the beating heart of mental health care,” Patel said.
This theme was echoed and reinforced throughout the symposium as participants highlighted how finding effective solutions to the mental health crisis will require social, economic, and cultural solutions in addition to greater access to diagnosis and treatment for individuals.
Other panelists included Anne Becker, HMS dean for clinical and academic affairs and the Maude and Lillian Presley Professor of Global Health and Social Medicine; Byron Good, HMS professor of medical anthropology; Mary-Jo DelVecchio Good, professor of global health and social medicine, emerita; Arthur Kleinman, HMS professor of medical anthropology; and Giuseppe Raviola, HMS assistant professor of global health and social medicine and director of the department’s Program in Global Mental Health and Social Change.
While global, equitable access to clinical diagnosis and treatment for mental health is a crucial part of any solution, successful efforts must also involve addressing the inequality, injustice, violence, and extreme poverty that is fueling increases in rates of mental illness, the panelists said.
A way forward
Panelists, who included Farmer’s mentors, mentees, and colleagues, referred to the core values that he brought to all of his work, including a dogged focus on health equity and an adherence to approaches that connect and combine people, forces, and resources to tackle complex problems. They cited his faith in the ability of medical education and training, research, and service to deliver health care solutions to the world’s most vulnerable people.
Speakers gave examples of how this paradigm informed the growth of a movement to study and improve access to mental health care and inspired their own work. They highlighted ways that Farmer’s vision might continue to guide the improvement of global mental health care delivery and the integration of that care into comprehensive, community-based health care for all.
Kleninman outlined a new project he is leading that seeks to engage a multidisciplinary community of researchers, caregivers, and technology experts in efforts to create high-tech tools for improving care for older people in China and around the world.
Mary-Jo DelVecchio Good and Byron Good discussed the importance of clinical, social science, and delivery science training at the master’s, doctoral, and fellowship levels for mental health workers from around the world and advocated for the development of human resources and skills necessary to address growing mental health care demands.
Raviola, who is also director of mental health for Partners In Health, highlighted the importance of Farmer’s sense of a moral calling to respond with empathy to people living in poverty and to those without adequate health care or social support by doing whatever is necessary to deliver care wherever it is needed.
Becker highlighted her experiences working on a pilot study in Haiti that sought to measure the effectiveness of training teachers to promote mental health for children after the devastating 2010 earthquake.
She said one of the teachers told her they were happy to participate in a study but wished they could just skip to the part where they could take action to solve problems.
Becker said she agreed that taking direct action was the most effective response under the circumstances, recalling her own thought that “we're not here to publish or get NIH grants, we're here to mitigate suffering.”
“Paul was able to create a community where this kind of impact is valued,” Becker said.