For Dr. Pamela Collins, the mind and its workings have always been the most compelling area of medicine. She went off to med school knowing she’d be a psychiatrist with a strong interest in cross-cultural issues.
She also had a strong global health interest. At the time, she didn’t necessarily know how those two would come together in a career.
Then, as a medical student, Collins went to Haiti on an AIDS-related project. It opened her eyes to the world of global health, which in the late ‘80s was focused almost exclusively on infectious disease.
“I had this challenge: I'm really interested in global mental health, but it didn’t exist as it does today,” Collins said. “But I wanted to figure out how to do it.”
It’s safe to say she did. Collins helped put mental health on the global agenda as an office director at the National Institute of Mental Health. After eight years at NIH, she arrived here in January to lead the UW Global Mental Health Program.
Just ahead of World Mental Health Day, Collins sat down to discuss her vision for the program and her passion for global mental health.
Q: What about that trip to Haiti was so transformative?
A: It was the early part of the AIDS epidemic, and I had a chance to witness how people were managing something that still had no options for treatment. And I was intrigued by working in a very different context. Being there made me think about how our social context influences our health, particularly our mental health.
Q: What’s your vision for the UW Global Mental Health Program?
A: We want to build a program that can help reduce the burden of mental disorders in low-resource settings around the world — through prevention and through care. We want to conduct high-quality research that can inform the best ways that we as a global community can address mental health issues while also training the next generation of providers to do that.
No matter where you are in the world, whether it’s Seattle, New York City or Johannesburg, people struggle with finding good mental health care. Sometimes it’s because of a fragmented health system or the stigma of seeking care, but in most places, there are inadequate resources devoted to mental health. But what I think is exciting about this era of global mental health is that we have more capacity to collaborate to solve these problems together. And we’re moving beyond the clinic to consider how, in addition to innovative models of care, addressing social determinants can help promote mental health and prevent mental illness. That’s what we want to do at UW.
Q: How do you do that?
A: One way is to sustain, strengthen and create partnerships in Seattle, throughout the region and globally. It’s important to remember we’re part of the globe.
We also want to build on all the strengths we have here at UW. It’s not just about the departments of psychiatry and global health coming together. We ultimately want the entire university to be involved.
Q: What are the key challenges facing the field?
A: We have a wonderful evidence base showing that many of our interventions can work in a diversity of populations. But one tremendous challenge is taking the next step. So once one finishes a successful clinical trial that shows you can do this effective psychotherapy in this very low-resource setting, the question becomes what’s next. We need to address how to scale up services for mental health care.
Another issue we need to address is not just care but prevention. Most mental illnesses begin early in life. The question is how one can intervene early enough so you’re not simply focusing on treatment and rehabilitation but actually changing the course of the problem before it forms. Perinatal mental health — ensuring the health of mothers — is another approach to prevention that UW is already engaged in.
A continuing challenge for the field is numbers. Most countries do not have enough providers in mental health care. A lot of research lately shows that it would take a very long time to populate the world with psychiatrists or clinical psychologists, and that’s not necessarily the best approach. In fact, we do have evidence that nurses, community health workers and other non-specialists can effectively deliver psychological interventions. So how can we find sustainable ways to reliably equip the human resources that already exist in a country?
Q: What can your colleagues across UW Medicine do to help?
A: First, recognize that whatever you’re doing, whether it’s maternal child health or infectious diseases work, mental health conditions are extraordinarily common. And addressing them is going to make it easier to address other medical conditions as well. Just taking depression as one example, we know that when you have cardiovascular disease and depression, or stroke and depression, or HIV and depression, your outcomes are worse than if you didn’t have depression. UW is the home of the collaborative care model, so we have the tools for managing chronic care.
Second, recognize that the work you are doing in early child development, poverty alleviation, education or community development can also lay the foundation for good mental health. We need to strengthen and scale up both of these approaches domestically and globally.