COVID-19 and global mental health

We welcome the review in The Lancet Psychiatry by Lola Kola and colleagues¹ on COVID-19 and mental health in low-income and middle-income countries (LMICs). Our view is that this could have gone further to call on universities in high-income countries (HICs), and academics working within them, to make changes to improve equity with universities and academics in LMICs. Given that universities in HICs hold disproportionate power and funding, we propose that a fundamental shift is needed. Imbalances in power and privileges are seen right across global health, with one study finding that 80% of leaders of global organisations active in health were citizens of HICs, 90% were educated in HICs, and 70% were men.² Grants are disproportionately held by institutions in HICs, with institutions or investigators in LMICs as subawardees.³ Authors of the 2018 Lancet Commission on global mental health were predominantly academics working in universities or other institutes of higher education in HICs; far fewer authors were global mental health leaders from LMICs.⁴ Re-imagining also requires acknowledging these past mistakes.

Looking toward a better future for global mental health, we call on universities in HICs to proactively look for ways to play a more mutual role. This will require disruption of existing structures to allow for redistribution of power. Many institutions in HICs acknowledge the interdependent nature of partnerships between academics in HICs and LMICs, but translating this into action requires changes to policies. For instance, we would like leaders in universities in HICs to work with partners in LMICs to advocate to funders for more research grants to be led and administered by institutions in LMICs. This will require institutions in HICs to create helpful incentives for faculty who receive subawards from institutions in LMICs, rather than owning the whole grant. We would like a change in performance frameworks so that investigators in HICs and senior investigators in LMICs are rewarded for authorship on publications in which they had an authentic mentoring role, rather than the current policies, which are weighted, in our view, too much towards being first or senior author. We would like to see a culture of research capacity building and mentorship of researchers from LMICs.⁵ Learning from capacity building in LMICs can inform ways to support researchers with a variety of intersectional identities to redress historical inequities in academic success in both HICs and LMICs. Affordable joint master's and PhD programmes between universities in HICs and LMICs, as well as mutual capacity building, would enable universities and academics in LMICs to directly feed into decolonising curricula. Alongside training and completion of degrees, energy should be directed to creating pathways to long-term careers for mental health researchers in LMICs, and building up supportive research institutions.⁵ To improve on the past in global mental health, institutions in HICs must champion equity, solidarity, and true partnerships between people with different experiences, knowledge, and needs from around the world. It will be necessary to find ways to establish and monitor this new, reciprocal global mental health.

We declare no competing interests.