Mental health innovation diplomacy: An under-recognised soft power

Mental health innovation may provide soft diplomatic power for managing a range of global issues. Soft power is the ability to persuade, attract and co-opt with culture, values and policies, as opposed to coercion with economic or military ‘hard power’. Mental health innovation may be a soft power asset because it can improve patient access and outcomes, optimise psychological capital, increase economic productivity and create entrepreneurial ecosystems and jobs. There are also opportunities for international trade and investment in mental health innovation which may further multinational economic and cultural ties. However, the soft power value of mental health innovation is under-recognised due to stigma associated with mental health disorders and the relative novelty of technologies like genomics, sensors, machine learning and smartphones.

Lost productivity and disability due to mental health issues are major. Mind, brain and nervous system conditions are responsible worldwide for 32% of all years of disability and 13% of all disability adjusted life years (Arjadi et al., 2018). Disorders within this group include depression, anxiety disorders, schizophrenia, bipolar disorder, alcohol and drug use disorders, mental disorders of childhood, migraines, dementias and epilepsy. Persons with these disorders face increased rates of morbidity from general medical conditions (e.g. heart disease). Access to care is poor in many parts of the world. Treatment is trial and error with inadequate rates of improvement. A recent World Health Organization–led study estimates that depression and anxiety disorders cost the global economy US$1 trillion each year in lost productivity (CB Insights, 2017). Clearly, innovations are required to reduce the burden of global mental health issues.

Technology has opened a new frontier in mental healthcare. For example, mobile devices like cell phones, smartphones and tablets provide the public new ways to access help and education. Advances in genetics allow doctors to guide patients’ medications with their genetic information to improve outcomes and reduce side effects. Many of these technological developments can help mitigate the reluctance to seek care of patients facing stigma by enabling more discreet treatment. Free open-access medication education on the Internet allows for improved training of mental health clinicians internationally. The development of the mental health innovation entrepreneurial sector is encouraging and exemplified by start-up numbers and investments. Funding to mental health tech start-ups has risen every year since 2013, nearly hitting US$200 million in 2016 (Chisholm et al., 2016). Tech companies of various sizes are now investing in mental health innovation (Chisholm et al., 2016). These companies are variously leveraging their engineering skills, computing power, machine learning expertise, social media platforms and large capital reserves. There are ongoing ethical debates (surrounding privacy and appropriate consent) about negative mental health effects of social media and simultaneous engagement by social media companies in mental health therapy. Table 1 provides examples of mental health innovation programmes which have soft power benefits.

Table 1.

Examples of mental health innovation programmes with soft power benefits.

Internet-based behavioural activation with lay counsellor support for treatment of depression in Indonesia: A 10-week randomised clinical trial which investigated the efficacy of Internet-based behavioural activation with lay counsellor support compared with online minimal psychoeducation without support for depression in Indonesia (Vigo et al., 2016). Online behavioural activation with lay counsellor support reduced symptoms of depression, that is at 10 weeks, PHQ-9 scores were significantly lower in the Internet-aided lay counsellor group than in the Internet-only group (mean difference −1.26 points [95% confidence interval (CI) = [−2.29, −0.23]]; p = 0.017). Therefore, this approach could help to bridge the mental health gap in low-income and middle-income countries. This is an example of effective task sharing and task shifting, enriched by digital technology, of simple interventions to lesser trained personnel.

Tianqiao and Chrissy Chen Institute (TCCI; www.cheninstitute.org): Promoting a holistic and interdisciplinary approach, the Chen Institute drives fundamental brain research through three key areas – brain discovery, brain treatment and brain development. TCCI partners with universities and research institutions to uncover neuroscience mechanisms and specifically how informational input translates into behavioural output. Examples include the Chen Neuroscience Research Centre at Caltech and The Chen Tianqiao Brain Disease Research Institute at Fudan University.

Psychiatic Genomics Consortium (PGC; www.med.unc.edu/pgc): The purpose of the PGC is to unite investigators around the world to conduct meta- and mega-analyses of genome-wide genomic data for psychiatric disorders. The PGC began in early 2007 and has rapidly become a collaborative confederation of most investigators in the field. The PGC includes over 800 investigators from 38 countries. There are samples from more than 900,000 individuals currently in analysis, and this number is growing rapidly. The PGC is the largest consortium and the largest biological experiment in the history of psychiatry.

The Asia-Pacific Economic Cooperation (APEC) Digital Hub (https://mentalhealth.apec.org/): The APEC Digital Hub is a public–private intergovernmental partnership that aims to advance mental health to support sustainable economic growth in the Asia-Pacific region. The partnership’s mission includes capacity building and research. One current project called Enhanced Measurement–Based care Effectiveness for Depression (EMBED) aims to integrate digital technology–supported measurement of depression to improve clinical decision-making in Shanghai, China. Because it is a hybrid implementation–effectiveness study, the researchers aspire for implementation findings to be translated beyond the local setting. The study has the potential to advance the implementation science literature.

Brainstorm, The Stanford Laboratory for Brain Health Innovation and Entrepreneurship (https://www.stanfordbrainstorm.com/): Brainstorm is the world’s first academic laboratory dedicated to transforming brain health through entrepreneurship. Based in Stanford School of Medicine’s Department of Psychiatry, Brainstorm applies expertise from academia and patient care to fuel innovation outside the bounds of the traditional healthcare system. We unite medicine, business, technology and design to help create innovative products that optimise health and human potential. Brainstorm has three core focus: Education, Designing Solutions and Creating an Ecosystem.

Mental Health Innovation Diplomacy as a soft power asset should be recognised. Its value will continue to grow as smartphones, social media, microprocessors and genomic testing become more widely available and as greater investment enters the field by private and governmental institutions. Greater involvement and training of the mental health workforce with a new set of skills are required to ensure they are prepared to engage and use these technologies.