What holds innovation back?
Beyond “grand” challenges
In a 2007 Lancet article led by Dr. Benadetto Saraceno, Former Director of the Department of Mental Health and Substance Abuse at the World Health Organization, authors noted slow progress in scaling up mental health care:
"Despite the wide dissemination of high-level reports and evidence for the range of mental health interventions reviewed earlier in this Series, progress in scaling-up has not been as hoped. What hinders progress?"
Four years later, Pamela Collins and colleagues reported on Grand Challenges in Global Mental Health for Nature, summarizing recommendations from a consortium of stakeholders from around the world. More recently, Collins and others have expanded on these recommendations for a PLOS Medicine collection on The Global Challenges of Noncommunicable Diseases.
The challenges described in this literature are indeed “grand”, ranging from organization of services and the public health-priority agenda to poor awareness and a lack of clear biomarkers for most disorders. But how do these challenges impact the day-to-day work of developing new and better services? And further, how do we overcome them?
Learning from MHIN innovators
In December, 50+ Innovations were posted to MHIN’s new online database in time for the 2013 World Innovation Summit for Health. From the sheer quantity of information provided, it became clear that researchers and programme implementers are finding ways to innovate, despite—or perhaps because of— the “grand” challenges inherent to this field. Further, they are identifying in their own work the factors that can help or hinder progress.
The MHIN team decided to undertake an analysis of the challenges and key drivers to success that these first 50+ contributors listed in their innovation pages. Using a combination of inductive and deductive coding, we’re developing a framework to help identify some of the most common themes. This will help us to better understand and prioritize the needs of the innovators using the site, while harnessing some of the knowledge being collected through innovation pages for the benefit of the broader global mental health community.
This research is still underway, but results of our preliminary content analysis are already prompting exciting conversations with innovators, which we plan to share through Podcasts in the Community section. The Ask the Experts feature will enable members to seek advice from some of the best thinkers in the field about how to overcome their own challenges. And MHIN will continue to collect Resources—the tools, manuals, protocols and other everyday materials you use to keep your project running—so that “innovation” doesn’t have to mean “reinventing the wheel” completely.
Translating knowledge into action
This is an exciting time for mental health services research worldwide. Increasing funding opportunities are helping to narrow the so-called 10-90 gap by building an evidence base for mental health interventions in low-resource settings. They are also generating unprecedented levels of knowledge and experience within the global mental health community about how best to implement these interventions.
Researchers are increasingly working to synthesize this knowledge. Kwame McKenzie and Sean Kidd from Canada’s Centre for Addiction and Mental Health (CAMH) have teamed up with Ashoka and other collaborators to conduct a series of in-depth case studies of mental health projects run by social entrepreneurs, like Basic Needs. Together they are investigating the factors underlying “positive deviance”, asking what social entrepreneurs can teach us about innovation in mental health:
"We want to share the strategy, vision, and passion of the Ashoka Fellows in a way that will make it easier for social entrepreneurs and citizens to come up with their own ways of addressing mental health where they live."
Researchers and implementers alike are becoming more systematic and more transparent about the development and execution of their own projects. Earlier this year, the PRIME project published results of the rigorous situation analysis informing their integration of mental health into primary care in five low- and middle-income countries (LMIC). More and more, we are seeing Grand Challenges Canada (GCC) grantees like Uganda’s Wayo-Nero project incorporating qualitative methods into their evaluation strategies in order to better understand the processes behind their outcome data.
Further, new opportunities are arising to exchange the knowledge gathered through these efforts. For example, the upcoming Qualitative Research on Mental Health Conference (QRMH5) in Chania, Greece is being organized around the theme “Practicing mental health: qualitative approaches to investigating services and interventions.” And it is our hope that MHIN will become a durable platform for sharing this kind of knowledge in the long-term, as well as a resource for synthesizing it—as we are testing through our own analysis.
All of these efforts, however, depend on the global mental health community’s willingness to be open and honest about what works—and what doesn’t. What is more, these efforts will be meaningless if the knowledge gathered isn’t translated into action. But if we can collaborate to solve problems and share strategies for overcoming them, perhaps we as a community can make the challenges we face a little less “grand”.
Images courtesy of Valentina Iemmi. Copyright © 2014 Valentina Iemmi. All rights reserved