Terrific overview! I’ll offer some feedback with the hope that some of it may be helpful:
Big Picture Thoughts
In general, I thought the report did a great job summarizing some of the major themes/ideas that are fairly well-established in global mental health. I wonder if it could be useful to include a section on more experimental/novel/unestablished/speculative ideas. Sort of like a “higher risk, higher potential reward” section.
Relatedly, I’d be interested in seeing bolder and more specific recommendations for future work. As an example, Box 2 (“Promising Research Directions”) lists important goals, but they’re too broad to really know how to act on (e.g., “improve treatments and expand access to care.”). I’d be more curious to see HLI’s subjective opinions on the most impactful next steps (more similar to the list of project ideas that you have, rather than the goals in Box 2).
I’d love to see more analysis on key issues/controversies (see last section for examples).
Potentially useful points that I didn’t see in the report:
A lot of suffering is caused by subclinical/subsyndromal mental health problems. In the case of mood disorders, “subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor’s visits and suicide attempts than the full syndromes.” (Ruscio, 2019). This point is especially important because there are debates about how funding should be allocated (e.g., how much should we spending on treatments that target people with diagnosable disorders vs. mental health promotion strategies and prevention programs that reach broader audiences?)
Recent work has suggested that the “latent disease” view of depression (and other mental disorders) may be flawed (e.g., Borsboom, 2017). A related body of work has suggested that some depressive symptoms may be more impairing than others (e.g., Fried & Nesse, 2014). This could have important implications for measuring the effectiveness of interventions—e.g., estimating SWB weights for each symptom, rather than using sum-scores.
The evidence on task-sharing/task-shifting is strong, so I understand why you spent a lot of space covering it. At the same time, it could be useful to spend more time discussing some of the more novel approaches. Some examples include unguided self-help interventions and single-session interventions (Schleider & Weisz, 2017). Although the evidence for guided interventions and longer interventions is stronger, unguided interventions are substantially cheaper. This might make them more cost-effective, even if longer/guided interventions are more effective (discussed further in this preprint).
The digital interventions studied in meta-analyses and reviews are very different than those that have been disseminated widely. We know a lot about the effectiveness of digital interventions developed by professors, but much less about the effectiveness of Headspace, Calm, and other popular apps (Wasil et al., 2019).
There’s are some important gaps in the digital mental health space: popular interventions tend to focus on relaxation/mindfulness and rarely include other empirically supported treatment elements (Wasil et al., 2020). This reminds me that I really should write up a digital mental health forum post at some point :)
Examples of questions/controversies that HLI could address:
Broadly, what does HLI see as some of the most important open questions in the mental health space?
Which delivery formats be used? Is HLI optimistic or pessimistic about unguided self-help interventions? Are they likely to be more cost-effective than task-sharing interventions?
Does HLI see mental disorders as diseases, networks of symptoms, or something else? Do you think this matters, or not really?
Broadly, what does HLI think that a lot of people interested in mental health “get wrong” or “don’t yet know” about the most cost-effective ways to make an impact?
How long do the effects of interventions last? How should the uncertainty around this estimate affect our cost-effectiveness calculations? (assuming that the effects of an intervention will last <1 year seems like it would yield radically different conclusions than assuming it would 1-3 years, 3+ years, 10+ years 30+ years, etc.)
I hope that some of this was helpful & I’m looking forward to seeing future reports!
Terrific overview! I’ll offer some feedback with the hope that some of it may be helpful:
Big Picture Thoughts
In general, I thought the report did a great job summarizing some of the major themes/ideas that are fairly well-established in global mental health. I wonder if it could be useful to include a section on more experimental/novel/unestablished/speculative ideas. Sort of like a “higher risk, higher potential reward” section.
Relatedly, I’d be interested in seeing bolder and more specific recommendations for future work. As an example, Box 2 (“Promising Research Directions”) lists important goals, but they’re too broad to really know how to act on (e.g., “improve treatments and expand access to care.”). I’d be more curious to see HLI’s subjective opinions on the most impactful next steps (more similar to the list of project ideas that you have, rather than the goals in Box 2).
I’d love to see more analysis on key issues/controversies (see last section for examples).
Potentially useful points that I didn’t see in the report:
A lot of suffering is caused by subclinical/subsyndromal mental health problems. In the case of mood disorders, “subsyndromal symptoms are impairing, predict syndrome
onset and relapse, and account for more doctor’s visits and suicide attempts
than the full syndromes.” (Ruscio, 2019). This point is especially important because there are debates about how funding should be allocated (e.g., how much should we spending on treatments that target people with diagnosable disorders vs. mental health promotion strategies and prevention programs that reach broader audiences?)
Recent work has suggested that the “latent disease” view of depression (and other mental disorders) may be flawed (e.g., Borsboom, 2017). A related body of work has suggested that some depressive symptoms may be more impairing than others (e.g., Fried & Nesse, 2014). This could have important implications for measuring the effectiveness of interventions—e.g., estimating SWB weights for each symptom, rather than using sum-scores.
The evidence on task-sharing/task-shifting is strong, so I understand why you spent a lot of space covering it. At the same time, it could be useful to spend more time discussing some of the more novel approaches. Some examples include unguided self-help interventions and single-session interventions (Schleider & Weisz, 2017). Although the evidence for guided interventions and longer interventions is stronger, unguided interventions are substantially cheaper. This might make them more cost-effective, even if longer/guided interventions are more effective (discussed further in this preprint).
The digital interventions studied in meta-analyses and reviews are very different than those that have been disseminated widely. We know a lot about the effectiveness of digital interventions developed by professors, but much less about the effectiveness of Headspace, Calm, and other popular apps (Wasil et al., 2019).
There’s are some important gaps in the digital mental health space: popular interventions tend to focus on relaxation/mindfulness and rarely include other empirically supported treatment elements (Wasil et al., 2020). This reminds me that I really should write up a digital mental health forum post at some point :)
Examples of questions/controversies that HLI could address:
Broadly, what does HLI see as some of the most important open questions in the mental health space?
What content should be included in interventions? Does HLI believe that specific elements should be the focus of interventions? Or are common factors driving effects?
Which delivery formats be used? Is HLI optimistic or pessimistic about unguided self-help interventions? Are they likely to be more cost-effective than task-sharing interventions?
Does HLI see mental disorders as diseases, networks of symptoms, or something else? Do you think this matters, or not really?
Broadly, what does HLI think that a lot of people interested in mental health “get wrong” or “don’t yet know” about the most cost-effective ways to make an impact?
How long do the effects of interventions last? How should the uncertainty around this estimate affect our cost-effectiveness calculations? (assuming that the effects of an intervention will last <1 year seems like it would yield radically different conclusions than assuming it would 1-3 years, 3+ years, 10+ years 30+ years, etc.)
I hope that some of this was helpful & I’m looking forward to seeing future reports!