Abstract

The globalized and interdependent nature of mental health and its large-scale social and economic drivers make international diplomacy key to solutions in the modern world. As technology plays a burgeoning role in mental health care, so too is it key to Mental Health Diplomacy (MHD), the practice of engaging and influencing the global policy environment for mental health. While the field of innovation diplomacy emphasizes the political, economic, and cultural influence of innovation, MHD has not yet embraced this opportunity, despite the pressing mental health innovation needs made salient by the COVID-19 pandemic. This article addresses recommendations for a working model of MHD in the age of technological acceleration, with the aim of engaging governments and other major movers in mental healthcare and social policy via leveraging public-private partnerships, entrepreneurship, and current innovation needs to improve public mental health outcomes. 

Background

The COVID-19 pandemic has brought the challenges of global mental health to the forefront. Globally, it appears increasingly likely that substantial increases in anxiety and mood disorders, bereavement, substance use, domestic violence, and child abuse will occur. As articulated by the United Nations ‘COVID-19 and the Need for Action on Mental Health’ Policy Brief, these consequences will continue to affect people and communities beyond the pandemic, requiring broad mental health service expansion (UN, 2020). Before the current crisis, mental illness already carried the largest global economic cost of all non-communicable disease, and within the next decade, it is expected to surpass the annual cost of all other global health challenges (Bloom et al., 2011). As globalization progresses, low- and middle-income countries (LMICs) are disproportionately wedged between these large-scale drivers of mental illness and persistent communicable and non-communicable disease burdens.  

To address these unsustainable disparities, the field of Mental Health Diplomacy (MHD) has developed in recent years to bridge the disciplines of global mental health, neuroscience developments, international affairs, law, and economics. MHD focuses on multi-disciplinary negotiations that aim to influence and impact the global policy environment for mental health (Turekian, C., Moore, & Rasenick 2014).

However, the field of MHD does not adequately account for the growing importance of innovation, entrepreneurship, and public-private partnerships for mental health. The exponential growth of technology, growing clinical evidence of its efficacy, and increasingly streamlined approaches by healthcare systems to gain access to new technologies combine to drive the integral role of technology in the future of mental health care and of its diplomatic reduction of disparities. COVID-19’s impact hastens this integration, as emerging technological solutions are accelerating to meet mental health and social needs. These tools for mental health screening, prevention, diagnosis, and management now include telemedicine, phone- and computer-based psychosocial resources, biotechnology such as neuroimaging and genomics, and such ‘deep’ technologies as machine learning, virtual reality, and augmented reality (Eyre et al., 2017). Whether addressing healthcare, economic, or human rights crises, the burgeoning role of technological innovation is an increasingly necessary and integral solution to global health inequities.

Repurposing Innovation Diplomacy to Benefit Global Mental Health

Innovation diplomacy can be broadly defined as using the full spectrum of state tools to achieve national and international innovation interests in the geopolitical arena. It uses diplomacy to facilitate innovation and, furthermore, uses innovation as a lever to improve relations between countries (Miremadi, 2016). Innovation diplomacy, which seeks to optimize the benefits of emerging technologies and to responsibly mitigate their drawbacks, is more critical than ever in an era where COVID-19 has compounded existing barriers and amplified health inequities for older adults, vulnerable groups, and those in developing countries. 

In contrast, MHD addresses the diversity of mental illness from youth to advanced age, including substance use, traumas, and suicidality. The practice of MHD must be updated to leverage public-private partnership, entrepreneurship, and innovation to improve global mental health outcomes. These key components have ‘soft power’ influence on politics, culture, and economics via mental health advocacy, investment, productivity impact, enhanced quality and access of care, destigmatization efforts, and socioeconomic inclusion of people living with mental health issues.

A Model for Advancing Mental Health Diplomacy

The practice of individual Mental Health Diplomats may be guided by the NESTA Innovation Policy Toolkit (Ternes et al., 2020). A multi-tiered approach is recommended for developing MHD and increasing its international influence, one drawn from the extant literature evaluating factors that have contributed to the success of global health initiatives (Frenk, Gómez-Dantés, & Moon; Frenk & Moon; Gómez & Atun; Vigo et al., 2019). Stakeholders to engage in MHD include multilateral organizations, governments, financial institutions, expert organizations in mental health, health delivery organizations, mental health technological organizations, multi-cultural professionals, researchers, and global non-governmental organizations representing those with lived experience of mental illness.

Patient involvement in design, research, and advocacy for MHD is particularly urged in order to maximize opportunity for personalized solutions, advocacy, and human rights protections. To advance the ability of patients, practitioners, and innovators to adopt the roles of MHD practitioners, we recommend innovative models of community care that increase ease of communication across socioeconomic barriers. Examples include rapidly emerging telehealth and mHealth models, which offer a plethora of useful, evidence-based interventions to those with smartphones. In addition to their positive impact on individual users, these models benefit governments by potentially cutting healthcare costs, decreasing variability of care, and increasing workforce capacity and economic output. 

In addition, education and training opportunities, from undergraduate to professional across stakeholders, are critical to developing the MHD field and to tracking its measurable outcomes. Key examples of relevant opportunities include the iDiplomats Program at the Massachusetts Institute of Technology (https://innovation.mit.edu/opportunity/innovation-diplomats/), the Leadership and Innovation in Mental Healthcare course available to Stanford University medical students (https://explorecourses.stanford.edu/), the Science Diplomacy Dialogue Series at Tufts University, the Digital Health Elective and Innovation to Impact Program at Yale University (https://medicine.yale.edu/psychiatry/digital/), and Recommendations for Value-driven Innovation in Global Mental Health Training discussions hosted by the Society for the Study of Psychiatry and Culture (https://psychiatryandculture.org/#!event-list).

Measurable outcomes for tracking MHD research may include the impact of tools and projects on the burden of psychiatric disorders; academic output; number of investigators trained in MHD; countries where invested companies are headquartered; funding by governments, non-profits, and for-profit organizations; as well as clinical tools developed, disseminated, and scaled to market. The production of global knowledge-related tools for international standardization, guidelines for mental health innovation best practices, and comparative research evaluating implementation, are all critical to optimizing the capacity of nations to adopt innovative mental health initiatives. A Mental Health Index was recently developed (https://onemindatwork.org/mental-health-index/) to provide a monthly measure of US workplace mental health. The Mental Health Index findings are based on the Total Brain Assessment, which uses standardized, scientifically-based digital tasks and questions to measure a person’s twelve brain capacities across the areas of emotion, feeling, cognition and self-control. The assessment also screens for risk of seven common mental health conditions. The Mental Health Index: U.S. Worker Edition is the first in an ongoing series to be reported across multiple sectors and geographies.

It should be noted that public-private partnerships in mental health are highly adaptive models that are key to facilitating MHD as future versions of mental health care progress. These partnerships often employ the strengths of both sectors, using basic science and funding from the public sector as well as entrepreneurship and in-depth research from the private sector. Key examples of these public-private projects with potential for MHD include the Psychiatric Genomics Consortium (https://www.med.unc.edu/pgc/), the Healthy Brains Financing Initiative (https://milkeninstitute.org/articles/collaborative-research-path-healthy-brains-all), the Mental Health Innovation Network (https://www.mhinnovation.net/), the Global Brain Health Institute (https://www.gbhi.org/), the Stanford Brainstorm Laboratory (https://www.stanfordbrainstorm.com/), the Stanford Mental Health Technology and Innovation Hub (https://www.stanfordmhtech.com/about), the Harvard Division of Digital Psychiatry (https://www.digitalpsych.org/), the Global Mental Health @ Harvard Initiative (https://globalhealth.harvard.edu/mentalhealth), and the Asia-Pacific Economic Cooperation (https://mentalhealth.apec.org/about).

However, to mitigate the risk of inadvertent harm that too often comes with technological acceleration to those made vulnerable to its de-regulation, the Responsible Innovation movement has recently been introduced. Key to the facilitation of MHD internationally, Responsible Innovation calls for stakeholders to collaboratively commit to identified ethical and social principles. This entails designing products and services that help identify and manage risks in order to sustainably address the needs and challenges of consumers. Significant technological, ethical, and cultural issues justifying the need for MHD as guided by Responsible Innovation include fake news and the proliferation of unverified information impacting mental health, cybersecurity and hacking, the relation of social media communities to disordered eating habits and suicide contagion, suicide threat screening and alert programs based on machine learning, and the provision of digital tools to global mental health practitioners. MHD is uniquely placed to address these issues, their drivers, and current regulations.

MHD calls for transnational, multicultural alliances of public-private stakeholders, with the potential for treatment, service delivery innovation, research cooperation, development financing, and humanitarian relief in response to such collective traumas as the COVID-19 pandemic. Given that government resources are scarce in LMICs, advocating for increased financial investment by LMICs in mental health innovation would be ineffective, making cost-effective and distributed solutions with global solidarity and responsible collaboration for this cause critical to addressing the mental health crisis globally. Such a global community would promote responsibly innovative mental healthcare to underserved populations when their own governments are unwilling or unable to do so, with pooled and shared resources (Frenk et al.). Furthermore, establishing role clarity on which MHD stakeholders will carry out which functions is necessary for maximizing technological impact and addressing the global drivers of mental illness. Given that progress in global mental health has been hindered by fragmented, divergent, or even contradictory messages passed to governments by stakeholders, formal mechanisms to negotiate multidisciplinary differences must be developed to sustain collaboration and allow coherent recommendations (Vigo et al., 2019). The principles of health interdependence demand that stakeholders share the technological resources, risks, duties, and potential of supporting mental health as a borderless human right.

Diab Ali graduated in 2020 from the University of Queensland - Ochsner Doctor of Medicine program after a partnered education in both Australia and the United States. Entering as a psychiatry resident in 2021, he is president of the Mental Health Initiative for Diplomacy, with interests in global mental health, trauma, and innovation toward treatment equity.

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