Insights | Real World Research in Mental Health
June 2021 – Mental health disorders remain the highest unmet medical need, surpassing cancer. One in four of us is affected by mental illness. That’s a friend, a partner, a child or maybe even you. Fortunately, health crises this prevalent attract large budgets and significant awareness campaigns.
Usually
In 2019, $3.7 billion was spent around the world researching mental health, which sounds big, but that is only 4% of total global health research. It’s too little, unchanging over time, and disproportionate to the burden of suffering attributable to mental health disorders globally.
It is also too inequitable, with less than 10% of funding being spent in countries that have 90% of global health problems. And more importantly it is too skewed, with more than 50% devoted to biological and aetiological research, and about 7% allocated to health services research, clinical research, and prevention[1]. We continue to chase a pharmaceutical solution to a human problem, with little sign of the kind of success seen in virtually any other disease.
And then came COVID-19. We now have a pandemic within a pandemic. Everywhere you look there is evidence of the massive impact on mental health that lockdowns, loss of loved ones, loss of jobs or just being on the front line of healthcare has had. In 2019, 8% of the US population thought mental health was the most important health issue, 13% thought it was cancer. In 2020 that flipped on its head – 13% now say it’s mental health and 9% say it’s cancer[2].
So, being realistic, mental health will never get the kind of funding that it deserves, so how can we make the most of what funding is available?
Researchers and scientists are expanding current approved therapeutics in new indications as well as looking at non-traditional technologies to help patients dealing with mental health issues and they are increasingly doing this by turning to real-world research (RWR) data. There is a significant opportunity to generate insights from real-world data on mental health disorders to get a much better understanding of the issues facing individuals on a day-to-day level and then to develop novel, scalable solutions to address this increasing burden.
RWR, when done properly, is a low-cost / high-quality alternative to traditional research. Improving mental health across the board needs to focus not just on pharmaceutical interventions. Strengthening the implementation of research evidence and good practice into a range of settings where people seek support is equally important.
A key part of enabling this will be to support mental health delivery staff to be research literate, encourage RWR at the front line and then making research findings accessible and relevant for local implementation. Unfortunately, within the clinical research world the experience and expertise required to deliver high quality real-world research lags behind randomised clinical trials in the same way mental health is the poor cousin to oncology. Developing systems and processes to ensure that money spent on RWR data in mental health carries the same reliability as randomised controlled trials (RCTs) will be equally important.
Although RCTs remain crucial for coverage and reimbursement decisions by payers, RWR can be employed to assess clinically meaningful endpoints, gauge the impact of interventions on the quality of healthcare, and help payers make appropriate data-driven decisions.
The future for mental health research may well be Real.
References:
1. Vikram Patel. Mental Health Research Funding: Too little, too inequitable, too skewed
Lancet, Volume 8, Issue 3, P171-172, March 01, 2021
Link: https://www.thelancet.com/journals/lancet/article/PIIS2215-0366(20)30471-5/fulltext
2. America Speaks – Survey data reflecting the views of Americans on medical, health, and scientific research. Poll Data Summary, Volume 20.
Link: https://www.researchamerica.org/sites/default/files/PollDataSummary_vol20.pdf
