SciDev.Net (London)
Katherine Nightingale
25 January 2008
(Page 2 of 2)
"[Infectious diseases] are things that you can cure -- and if you can do research that demonstrates that you can control disease, then you make a huge impact," says Whitworth.
With chronic diseases, such as mental health, it is much harder to demonstrate an impact, and this usually requires a sustained intervention rather than a simple short one, he adds.
The agendas of Western funding bodies such as the Gates Foundation are often very different from agendas in developing countries, says Patel. In poor countries, they have to be donor-driven.
"What's ironic is that the people who are making health policy for developing countries are implying that the health needs of these countries are different to those of their own families... heart disease, depression etcetera," he says.
Patel says that once countries develop and become free of donor money, mental health is prioritised -- a situation he has seen in India.
But Whitworth argues that agencies do not make their funding decisions from ivory towers. They don't dream up their own priorities without any regard for what the morbidity burden or priorities might be in developing countries, he says.
He says funding agencies often "get out and about", talking to researchers and policymakers in countries.
One of the problems is that research into how to deliver treatment, he says, is "difficult to do well" and often not particularly exciting or appealing to some funding bodies who want to be seen as at the cutting edge.
The Wellcome Trust spent five per cent of its total mental health research budget on global mental health between 1994 and 2004 -- about US$55 million.
For Whitworth, it's a case of not receiving enough quality applications for mental health research in developing countries. "If we saw more quality applications in that area, then I think we'd fund more."
Getting it out there
But even when research is being carried out in developing countries, researchers often find it difficult to publish in peer-reviewed journals and are therefore unable to use their publications as scientific 'currency' to build up their reputation.
When researchers are trying to get published, limited access to quality and up-to-date information, lack of training in trial design and protocol, and writing in a foreign language (English), all compound issues already thrown up by a lack of material and financial resources.
Mental health researchers are not alone in this regard; those in all fields in developing countries suffer similar problems. But the publishing community seems to be coming to mental health researchers' aid.
In 2004, 42 editors of journals that publish mental health research signed a statement, along with the WHO, saying they aimed to reduce the gap between developed and low- and middle-income countries in published research by helping authors overcome impediments to publication (see 'Journals to bolster mental health research').
"It's probably too early to say whether this [2004 statement] has had an effect," says Patel. He studied publication rates in six journals in 2001 and then in January 2007 and found no difference in publication rates.
But journals should be careful not to publish work that is sub-standard simply because of its origin, says Patel. "When [editors] are reviewing research from a developing country, there needs to be a sensitive review group, that's a critical thing, but that cannot be in lieu of a minimum acceptable quality of research."
Finding a way forward
But how to get research done?
"I'm hoping that some of the biggest donors will adopt mental health and look at capacity building, not necessarily mental health research capacity building, but to integrate mental health into existing research programmes," says Patel.
"We're really looking at opportunities for 'piggy-backing' mental health."
Whitworth agrees, "One of the things that's important is that we get mental health into the mainstream of healthcare and research."
After all, mental health problems -- and those associated with them -- have long been stigmatised, isolated and made to feel different. Maybe now is the time for integration.
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