#MHForAll Webinar: Mental health research funding
Chair
Niall Boyce, Lancet Psychiatry
Panel
Danielle Kemmer, International Association of Mental Health Research Funding
Vikram Patel, Harvard School of Public Health
Miranda Wolpert, The Wellcome Trust
Kwame McKenzie, Wellesley Institute
The report referred to in this webinar can be found here, and the accompanying comment piece by Vikram Patel here.
Top priority actions
Miranda Wolpert, Wellcome Trust
To make sure we do this again within 2 years, to hold ourselves to account to see if anything has changed.
To ensure organisations such as IAMHRF and UnitedGMH are appropriately supported and enhanced to make sure that capacity building continues.
To put in the hard work and build foundations that allow us to work with communities we are not yet connected to.
Kwame McKenzie, Wellesley Institute
Most research wants to do good, but we are currently increasing disparities. More research in low income settings, on children's mental health, and more research on clinical interventions, social policy and social determinants. Need to change the curve of the Inverse Research Law.
Vikram Patel, Harvard School of Public Health
We need indicators that align with the findings of this paper. Not only focussing on the amount of research funding but how it is spent. We need to be able to show that research investments make a difference to population mental health .
Danielle Kemmer, IAMHRF
Bring report to as many people as possible, and broaden the study, to be more inclusive, and globally relevant. We need to facilitate connections to organisations that are based in different parts of the world.
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Niall Boyce, Lancet Psychiatry
Danielle, what was the motivation to undertake this study?
Danielle Kemmer, IAMHRF
We wanted this report to give guidance to all, not just to research funders, but others that have so far been making assumptions in lieu of the data.
The headline from the report is the inequities and inequalities in research finance are stark. Nearly all research funding is being raised and spent in High INcome Countries (HICs), going well beyond the 10-90 divide
Niall Boyce
What should change to increase the impact and make mental health research funding more equitable?
Danielle Kemmer
Research is almost entirely funded by governments. In the mental health field we are advocating for increased investment by philanthropists and private donors. Over the last few years we have all experienced a great change, with much more attention and airtime for mental health, but mental health research investment has stayed stagnant over the last few years.
Niall Boyce
Almost all funding worldwide seems to come from the government, except the UK. Should other countries follow in the UK’s footsteps with more charity and philanthropy funding?
Vikram Patel, Harvard School of Public Health
This applies to any area of health research; this is the structure of health research funding. In order to better understand this we need to understand these broader power structures. There should be more health research funding from governments; we shouldn't rely on philanthropists and private donors, as they don't reflect what the country needs, whereas the state has a mandate to fund what their country needs.
Niall Boyce
Miranda, do private funders skew the landscape?
Miranda Wolpert, The Wellcome Trust
The Wellcome Trust thinks a lot about its responsibility, and who it answers to in terms of the wider public. Funds such as Wellcome do have more flexibility, which brings more opportunity, but also more risk. We need people prepared to take risks in health science in order to move forward.
We need to create a giving model for individuals to form a basis for philanthropic funding. One promising initiative is the Healthy Brains Global Initiative - a global fund specifically for Mental Health research.
Niall Boyce
Communication is a very important aspect of this research. For example with oncology it is a lot clearer about the need for research, and the benefit of funding it. We need strong communication to help people see the potential of mental health science. We need to explain to the public what the role of health research can be, and why it should be funded. Vikram, you wrote a comment piece about the IAMHRF report, what should change to increase impact, and make research more equitable?
Vikram Patel
Researching diverse populations can help us address the grand challenges of mental health. Implementation science is most important. Most of the money is still going to basic science though. It is incredible that 99% has been spent entirely on research of a very narrow population - caucasion people in a few countries, all with similar ancestry and social situations.
Niall Boyce
Kwame - do you agree, has the scope been too narrow and restricted?
Kwame McKenzie, Wellesley Institute
Yes I agree. It's so good to have this conversation about democracy in controlling funding, fairness in funding and systemic racism in research. But we haven't talked about the fact our conversation is skewed by the lack of data on this.
Inverse Resarch Law says that funding goes to high income countries despite the need for more research in poorly resourced settings, plus research is mainly in basic sciences, though the implementation science is really important. Science, system research, cost effective interventions and of course we mustn't forget social factors that make people ill and stop people getting better account for 85% of risk of developing a mental health condition.
Most research is not on children's mental health though most mental health problems start in childhood. We need to rebalance research efforts to make it more efficient and equitable. Need to think about low income settings, children's mental health and we need to think about clinical interventions, social policy and social determinants of health, all of which are more likely to improve world mental health.
It is not clear that we have an agreement on research priorities. We cannot follow this scattergun approach, where the people with the most connections and power and access to the people nearest money, get the money. We need to rebalance this.
Niall Boyce
Danielle how do you hope this report will have an effect?
Danielle Kemmer
We need to put the report in front of the people that need to see the data - as research funders we have a niche opportunity. Members of the IAMHRF can use the report to inform the large funding decisions they make, and encourage them to diversify funding.
We can advocate for more publishing of research data - we need access to data to make a change. I want to redefine the research classifications that are being used as these are designed for the global north and not for the rest of the world.
Miranda Wolpert
The report could have not come at a better time as mental health is one of the three areas Wellcome is investing in. This means that Wellcome are going to broaden the scope of research, engage new researchers with new ideas, across the world and spectrum of mental health research.
Niall Boyce
Kwame - what are the remaining gaps in research?
Kwame McKenzie
We need to be careful how we use the data we have, as it is incomplete; it does not cover women, or ethic minorities, very well. The current data cannot be used as the foundations for mental health research, as it will only lead to magnifying the gaps and inequalities.
Niall Boyce
What is mental health research, what counts?
Kwame McKenzie
The report does not cover things like positive mental health, social determinants, policy, etc. these need to be included in the framework of mental health research. We are pushed into mental illness research only.
Danielle Kemmer
This is the first baseline report, we are all aware of the gaps, there are certainly things they want to mention but the data is not there. Also, the descriptions are not good enough. It is not just about the funding, but how the research is described. We need to revisit classification beyond the diagnostics classification system. IAMHRF wants to redo the report in a few years to see change.
Niall Boyce
Miranda - what are the immediate opportunities to address these inequities in mental health funding?
Miranda Wolpert
There is an open offer from Wellcome to anyone who has suggestions for how Wellcome funding can reach more people and be more equitable. There will be funding calls coming up in the next year or so. We have a Common Measures Board - a group that has come together to discuss measures, but maybe this should extend to descriptions.
Niall Boyce
Vikram - what are the immediate opportunities to address these inequities in MH funding?
Vikram Patel
Disseminating the report far and wide is very important. The entire prevention world is not counted in these research areas as they are counted by physical health. Far more equity is needed in mental health research funding. More needs to be spent on people who are already ill, and lived experience voices need to be heard.
Audience questions:
Has the report been shared with NIHR?
Danielle Kemmer
Yes they are part of our group.
Is there a risk that increasing focus on public mental health funding happens at the expense of mental illness funding?
Vikram
We need to collaborate with both groups because currently the mental health field is very fragmented, e.g. six different fields for child mental health, and they don’t communicate.
How do we curb fragmentation?
Kwame McKenzie
When there is not enough money there is always competition, therefore, increased and more equitable finance will help bring people together.
Miranda Wolpert
Sometimes there is a false dichotomy between illness treating, and prevention but take the first instance of psychosis. We need to encourage researchers and funders to share data - we are working with Open Science and others to deal with this and create open access data.
This report is so important as a first step in understanding the impact of mental health research efforts - but as Danielle has so eloquently said, we need help in encouraging funders to share data - Ideas?
Miranda Wolpert
We must follow the FAIR principles [findable, accessible, interoperable and reusable], and give more status to individual researchers sharing their data. Currently researchers get rewarded for publications but not for sharing their research with others.
What about creating a specific community of health researchers to bring into the fold of GMH, who aren't currently in it? Folks from the African Academy of Sciences for example, and other trusted and legitimized groups that already exist?
Kwame McKenzie
One of the things that sometimes happens is we say we want more research on racialized and indigenous populations, but then don't get much research through. You have to build the capacity of not just researchers but the surrounding teams. We need to build the apparatus around researchers so they can do the work. If we are serious about diversifying, then we need to be serious about building capacity to do real and relevant research in low income settings. It is hard to do that, but there is much more that we can do.
This is a wonderful discussion. you have argued for equity in terms of data curation (e.g. better descriptions). Great point- but what are the common standards for inclusion of information etc?
Danielle Kemmer
I don't know that there are any guidelines right now that everyone adheres to. One of the things we are driving is harmonisation and creating standards for each area. For example including lived experience. The good thing is, when you work with many research funders from around the world their reach is large. There are no guidelines or quality standards which is part of the problem. This is definitely somewhere we could move the needle.
