Editor’s Note: This is Part Two of “Ask the Mental Health Editors”, where editors within the mental health and psychiatry sector offer their thoughts on the current landscape of scholarly publishing and how it is impacting our discussions and actions around mental health. Part One yesterday introduced our participants, and today they discuss the changes within the field and thoughts from the Editors on their own insights and experience.
What major changes have you seen over the last 5-10 years in mental health?
Anne Doherty (University College Dublin, Royal College of Psychiatrists Books Editor): The field of mental healthcare is quite a dynamic one, and there are constant changes in the evidence base and in overall approaches to how we view mental health and ill-health. It has been an exciting time for our knowledge of the role of neuroscience, especially neuroplasticity and the gut-brain relationship. The past ten years have seen a dramatic increase in the accessibility of psychological therapies.
While psychiatry has always considered problems from a biopsychosocial perspective and especially considered how events in early life can form adult personality and experience, the past ten years has seen a huge shift in how we consider the social determinants of health across the interface of mental and physical health.
The face of medicine has changed dramatically in the past 4 years with the COVID-19 pandemic. While a hugely difficult time for most people, it has had the positive effect of drawing attention to the mental health of people with physical illnesses, and the mental health of healthcare professionals.
Gin Malhi (University of Sydney, British Journal of Psychiatrists Editor-in-Chief): Mental health has become a battleground for a host of matters that are not necessarily psychiatric in nature. We should be fighting to better resource clinical practice, destigmatize mental illness, and improve the quality of life of those individuals fighting psychiatric disorders. The suffering associated with serious mental illness is immense and yet it is afforded little attention.
The term “mental health” is sometimes confusing as it encompasses those that are healthy and want to enhance their wellbeing. The designation should stand for psychiatric disorders or mental illness, but its meaning has been diluted. As such, all manner of initiatives can be positioned under the umbrella of mental health even if they have little to do with psychiatric disorders per se. In my opinion, the problem is that research and adequate clinical care requires substantive funding.
I want to see more research in the underlying causes of mental illnesses and investments in discovering treatments that modify the disease. Unfortunately, there is still discrimination and stigma of mental illness, and psychiatric disorders. This is one thing I would like to see change dramatically – and there are many efforts and good people endeavoring to achieve just this – and the journals have a key role to play in this enterprise.
Adam M. Brenner (Academic Psychiatry Editor-in-Chief): On the one hand, there have been exciting advances in neuroscience that are translating into more effective and targeted neuromodulation treatments. There has also been a decrease in stigma and concomitant increase in visibility of depression in our culture. On the other hand, many people with psychiatric disorders never succeed in accessing any treatment, and this is often worse in communities that are historically marginalized and under-resourced. This was worsened by the pandemic.
At the same time, several major mental health issues have spiked in the past ten years, most importantly opioid addiction and overdoses, and youth suffering from mental distress. These have become public mental health crises. We also have a severe shortage of workforce to provide mental health care for a rapidly aging population, and this projects to become more acute over the next decade.
Karli Montague-Cardoso (PLOS Mental Health Executive Editor): I can come at this question from a personal perspective and, more recently, a professional perspective. But my answer from both perspectives would be the same. The biggest change for me, which has been the catalyst for many other changes, is the shift towards increasing the impact of lived experience voices. The value of these perspectives in determining the direction of research and policies, and indeed publishing, has really started to be appreciated and embraced. Although we still have a long way to go.
JMIR Mental Health Team (Taiane de Azevedo Cardoso, Shruti Kochhar, John Torous): Since the COVID-19 pandemic, there has been an increased focus on digital mental health. The physical distancing restrictions imposed by the COVID-19 pandemic contributed to an increased adoption of telehealth services. The efficacy of telehealth services was investigated in a recent systematic review and meta-analysis published in JMIR Mental Health. This study showed that telemedicine interventions for mental health conditions were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates. However, digital literacy remains a challenge in the field, and healthcare providers and scientists should make efforts to guarantee that the treatment options are accessible to people in need.
Individuals with mental health conditions are vulnerable to experiencing a worse prognosis if mental health conditions are untreated for prolonged periods. Many individuals do not seek treatment due to their lack of awareness. In this context, the ability of digital tools (e.g., smartwatches that can evaluate sleep quality and physical activity) to detect early signs of mental health conditions has been investigated lately, which may facilitate early interventions. However, poor engagement with mobile-based intervention remains a challenge in the context of mental health. Studies involving patients in the design of mobile-based interventions have been conducted, and the preliminary findings are promising in terms of increased engagement and reduction of mental health symptoms. Lastly, researchers are now excited about the potential use of large language models (e.g., ChatGPT) in the field of mental health. A recent study showed that ChatGPT-4 was able to estimate the likelihood of suicide attempts similarly to evaluations provided by professionals. Although these results are promising and may indicate how chatbots can be helpful tools for clinicians to use for clinical assessments, concerns about the ethical implications of adopting such tools in clinical practice are largely being discussed in the field.
Is there anything else you’d like to share with our readers and community?
Anne Doherty: Working with the Books Program of the RCPsych has been hugely rewarding, and it has been a great privilege to work with talented colleagues in publishing both in the RCPsych and at Cambridge University Press. It is enriching to balance clinical and academic work with a role in editing a Books Program, as it presents a constant flow of new ideas and challenges. Without this role, I would never have been involved in the authoring and editing of a book, a task I undertook only because the colleague I was hoping to commission the book from, told me to write it myself!
Gin Malhi: I’m optimistic by nature, but even so I am realistic in believing that there are good things on the horizon in psychiatry. We have excellent tools to interrogate the brain and understand the mind and we are on the threshold of making important discoveries. We can connect people from around the world and bring together ideas and values like never before. These abilities will enrich our profession, but we must be brave enough to embrace new thinking and not hold on to myths and practices that don’t work. We also need to be vigilant of being exploited politically, commercially, and morally. Psychiatry offers us an opportunity to improve the lives of patients and elevate those that arguably suffer the most. The daily feats of the people that I help and those that I work with are a constant source of inspiration and a reminder of what ultimately matters.
Adam M. Brenner: One major change in providing mental health services in response to workforce shortages has been the decline of the single practitioner and the rise of mental healthcare multidisciplinary teams including social workers, advanced practice providers, licensed counselors, and others. Academic psychiatry departments are increasingly faced with the need to provide training and education across professional disciplines. As a result, our journal is always reassessing the boundaries of our scope.
Another response to the shortage of psychiatrists has been rapid growth in new residency programs. Many of these programs are centered at non-academic health care systems or community mental health services. Such programs can be challenged to provide the full range of teaching, supervision, and scholarship required for accreditation. There is promise, however, in the use of emerging technologies to share teaching and supervisory resources and create new models of training that optimize sharing of human resources.
Karli Montague-Cardoso: As an Editor, a challenge that I sometimes come across is convincing authors and readers that we do genuinely care about the communities that our journals are trying to serve. And I can understand why this is a challenge. However, at PLOS Mental Health, all of our Editors, from our co-Editors-in-Chief, to our Section Editors, to our Academic Editors, deeply care about their work and the differences that they are trying to make. Many bring their own lived experiences to the role and many have expressed the fact that they only agreed to join the journal because they felt that it was trying to fill an important gap in publishing (the lived experience focus) that they recognized as essential. In order to actually make a difference, our journal is also intending to be dynamic and adapt as and when needed so that we move with the field and help to steer the field, rather than being left behind or being a passive voice. We want our author’s work to make a difference. To this end, I am always happy to have people reach out to me with suggestions or comments if they feel there is something we could do differently.
JMIR Mental Health Team: Open-access research serves as a powerful tool to empower individuals with the knowledge they need to make informed decisions about their well-being. This accessibility ensures that researchers, practitioners, policymakers, and the public can benefit from the latest scientific advancements. This is particularly important in mental health research, where awareness of available resources, as well as information regarding their safety and efficacy, is paramount. Easy and equitable access to clinically backed, peer-reviewed research democratizes knowledge, ensuring that information reaches everyone, regardless of their geography or socio-economic background. This transparency not only fosters trust in the research community but also in the patient and care-giving community, ultimately leading to increased engagement. Ultimately, it helps take effective steps towards addressing global mental health challenges. All journals published by JMIR Publications provide immediate open access to their content on the principle that making research freely available to the public supports a greater global exchange of knowledge and accelerates research.
