Who is Tackling the World’s Biggest Overlooked Health Crisis?

When it comes to global health’s primary concerns, most people might not put mental health at the top of the list. But in fact, just two of the most common mental health issues—depression and anxiety—contribute to more than half of the world’s total burden of ill-health.

Depression and anxiety affect over a half-billion people worldwide, and although there are effective treatments, including pharmacological and behavioral interventions, many people don’t respond to them, or may respond to some but not others. Clinicians often rely on trial and error to work out the best treatment without being able to explain why one patient’s response differs from the next.

U.K.-based Wellcome Trust says this hit-and-miss approach to treatment is unacceptable in an era of personalized medicine, and that the failure to understand underlying mechanisms has kept mental health treatment and research behind other fields.

This stance is behind Wellcome Trust’s pledge last month of £200 million ($258.8 million) over five years in support of mental health research. The funding will support efforts to advance understanding of basic mechanisms of mental health and improve treatments for depression and anxiety, including what works and why, and how best to tailor treatments to individuals who need them.

A Critical Funder

As Inside Philanthropy has often observed, mental health has never been high on philanthropy’s priority list. That makes Wellcome’s leadership in this space so important. One of the largest foundations in the world with an exclusive focus on health, Wellcome has long been among the top private funders of mental health research worldwide, providing over £300 million in funding over the last 10 years. Its grantmaking has included support for research on specialized cognitive therapies in the U.K., including establishing the Improving Access to Psychological Therapies program, and research into mindfulness training in schools to prevent the onset of mental health problems.

Why Mental Health?

Mental health problems are predicted to be the main cause of global mortality and morbidity by 2030. One in four people will experience a mental health problem in any given year—615 million people worldwide—and 75 percent of these people develop mental health conditions before age 24. Only one in five people receives appropriate treatment for depression and anxiety in high-income countries, and one in 27 in low- and middle-income countries.

"Mental health affects everyone, either directly or through our relatives and close friends. There has been great progress in improving awareness over the last few decades, but too many people are still left behind. We know too little about the underlying causes, how treatments work, why they work for some and not others, and how to make them more effective,” said Wellcome director Jeremy Farrar in a press release. "To take on this huge challenge, we need broad expertise, with researchers from different backgrounds and experiences and different countries, alongside governments, businesses and wider society.”

Doing Things Differently

Some underlying problems need to be addressed before the field can make significant progress. Mental health research is fragmented, with problems described and measured in different ways. Wellcome wants to follow the example of cancer research, in which collaboration across sectors has driven innovation. Much like the work we have reported through the Chan Zuckerberg Initiative and the Michael J. Fox Foundation for Parkinson’s Research, Wellcome will bring together psychiatrists, neurologists, public health specialists, neuroscientists, data scientists and cell biologists to share knowledge with the “aim of breaking down silos and creating a culture in which seamless collaboration across disciplines drives new approaches to treatment, prevention and better outcomes.”

Creating a New “Super-Discipline” of Mental Health Science

“The money is to think about doing things in a different way,” said Andrew Welchman, who oversees neuroscience and mental health work at the Wellcome Trust, in a press release. “The goal isn’t just to understand why treatments work or fail—it’s also to figure out how to tap into those findings to make treatments more effective.”

While medication and psychotherapy can be effective, many patients simply don’t respond, while some find treatments that work, but only for a limited period of time. This can create a dispiriting and costly cycle of patients going from one treatment to another, hoping to find something that works. And scientists don’t fully understand why that’s the case.

To address this problem, Wellcome funded scientists who will find new ways to back-translate (that is, determine the key mechanisms that make a treatment work) successful psychological therapies, so that the biological and neurophysiological underpinnings are better understood.

To transform treatment of depression and anxiety, grants will fund the development of common assessment standards for depression and anxiety to enable more meaningful comparisons between groups. Wellcome will also create a new global database of mental health data to enable researchers to carry out large-scale data mining. Notable for this initiative is its focus on psychological therapies that can be delivered early in life and at the onset of mental illness, typically around ages 15 to 24, because the longer someone has a condition, the harder it is to provide effective help.

The Path Forward

Wellcome Trust is the second-largest foundation in the world, with assets around $29 billion. Funding at Wellcome supports innovative global health projects addressing unmet healthcare needs. It has a strong track record of success—especially around infectious diseases.

The foundation has recently been looking to raise its game by thinking bigger and taking more risks. Not so long ago, we reported on the Wellcome Trust’s new LEAP program, which backs “risky research, including that which crosses disciplines.” The organization also has a $332 million fund devoted to life sciences to support new and unconventional ideas and directions that could lead to scientific breakthroughs. Mental health is as complex an area as any in medicine, and meaningful advances will likely require such multidisciplinary and novel research.