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Transforming the understanding and treatment of mental illnesses.

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Celebrating 75 Years! Learn More >>

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From Breakthroughs to Best Practices: How NIMH Transforms Research Into Real-World Care

Patricia Arean, Susan Azrin, Michael Freed, Adam Haim, Jennifer Humensky, Stephen O’Connor, Jane Pearson, Mary Rooney, Matthew Rudorfer, Joel Sherrill, and Belinda Sims, on behalf of the Division of Services and Intervention Research. 

February 26, 2024 • 75th Anniversary

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For 75 years, NIMH has transformed the understanding and treatment of mental illnesses through basic and clinical research—bringing hope to millions of people. This Director’s Message, guest written by NIMH’s Division of Services and Intervention Research , is part of an anniversary series celebrating this momentous milestone.

More than one in five adults in the United States live with a mental illness, and this number is expected to rise in the coming decades. Since its establishment, the National Institute of Mental Health (NIMH) has known that people need more than exciting scientific discoveries—they need access to effective treatments and the best quality of care available. After all, finding new treatments and cures means little to the millions of people impacted by mental illnesses if there is no way to translate these breakthroughs into policy and practice.

In the Division of Services and Intervention Research (DSIR) , we provide the critical link between basic and clinical science and explore the best practices to implement those evidence-based treatments. We’re dedicated to growing and investing in this field of science, and although much work is still to be done, we’ve had some notable successes impacting real-world public health practices and policies.

Improving outcomes for people with early psychosis

One example of research that has bridged the divide between science and policy is the Recovery After an Initial Schizophrenia Episode , or RAISE, studies. Research has shown that young people with schizophrenia and related psychotic disorders have much better outcomes when they receive effective treatment within months of their first symptoms. The RAISE studies, which NIMH supported, focused on methods to detect and treat early psychosis in a timelier fashion. These studies found that a type of care called coordinated specialty care (CSC)—a recovery-oriented, team-based approach to treating early psychosis—was more effective than the typical care used at the time.

NIMH engaged extensively with members of the early schizophrenia care community to ensure RAISE findings would be relevant and actionable for rapid translation into practice. These efforts created the momentum for the broad expansion of CSC treatment programs nationwide. In 2023, the creation of associated billing codes further supported this model of mental health care, allowing for increased adoption by care providers.

From CSC programs in two states in 2008, the United States now has more than 360 such programs, allowing more people to receive this evidence-based care.

Removing barriers to schizophrenia treatment

Clozapine, the only drug approved for treatment-resistant schizophrenia, is underutilized in the United States, particularly among African American communities. Many reasons have been linked to this disparity, including provider bias, lack of trust in the mental health care system for African American clients, and an overprescribing of first-generation antipsychotic medication for African Americans with schizophrenia. Additionally, clozapine has been associated with an increased risk of the onset or exacerbation of neutropenia, a condition that affects white blood cells and impairs the body’s ability to fight infection. Benign ethnic neutropenia is a chronic form of neutropenia that's present from birth and commonly seen in people of African descent.

In 2015, NIMH supported a large, multinational study  that investigated the use of clozapine in individuals of African descent who have benign neutropenia  . Individuals with treatment-resistant schizophrenia who had benign neutropenia had previously been declared ineligible to receive clozapine treatment due to the Food and Drug Administration’s prescribing guidelines related to this medication. The finding of this NIMH-supported study opened up clozapine treatment to a whole new group of individuals with schizophrenia, allowing them to benefit from this important medication.

Building upon these findings, NIMH is currently funding research that evaluates the effectiveness of an educational program for clinicians about clozapine  . Hundreds of prescribers and clinicians throughout the state of Maryland are participating in an innovative educational tele-mentoring program that connects them with centralized experts. The prescribing activity of clinicians participating in the educational program will be compared with those who have not participated to see if the program is effective at increasing the use of clozapine among those who would benefit from it.

Given the real-world context of this study, the findings can potentially inform clinical practice and make a needed treatment more accessible to many African Americans.

Preventing mental illnesses in youth

Recognizing that many mental health conditions have their origins early in life, NIMH has supported several seminal studies showing the effectiveness of interventions designed to prevent conduct disorder and other behavioral conditions in youth. These include evaluations of a classroom-wide behavioral intervention called the Good Behavior Game   , a school-home wraparound intervention called Fast Track  , and a brief family-based intervention for toddlers called Family Check-up  .

Today, NIMH continues to support the analysis of data from participants in these studies who have been followed into adulthood   . Initial results from these longitudinal analyses show sustained effects of the interventions on conduct disorder and unanticipated positive impacts on other mental health outcomes, such as reductions in adolescent and adult depression, anxiety, and suicide risk, thus demonstrating the broad and enduring effects of early prevention efforts.

Early intervention represents an important pathway to making quality care accessible to everyone, particularly when embedded within a broader approach that addresses social determinants of health . NIMH is currently supporting research that tests strategies to improve access to prevention services, including primary care-based depression prevention for adolescents  and mental illness prevention for at-risk Latinx youth  .

Suicide prevention in emergency departments

An estimated 20% of people who die by suicide visit the emergency department in the 60 days before their death, making these settings an important target for suicide prevention efforts. Given the importance of emergency departments as a place to identify and provide support for people at risk for suicide, NIMH has supported research establishing the effectiveness of suicide prevention services in these settings.

An example of this research is the multisite Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study. ED-SAFE demonstrated  that providing universal screening for suicide risk and a brief safety planning intervention in emergency departments, combined with limited follow-up contacts once people had been discharged, decreased subsequent suicide attempts by 30% compared to usual care.

A follow-up study also supported by NIMH, called ED-SAFE 2  , tested the integration of universal screening for suicide risk and safety planning into the clinical workflow of eight emergency departments. Study results  indicated that integration of this clinical workflow resulted in sustained reductions in suicide deaths and subsequent acute health care visits.

These landmark studies convey the power of providing relatively brief, well-timed interventions during emergency encounters to reduce the risk of later suicide. NIMH continues to fund research to expand the reach of emergency department-based interventions, including the use of digital health technologies and strategies to overcome workforce shortages and other barriers to implementing suicide screening and intervention (for instance, digital technology to increase the reach of ED-SAFE  ; a multi-component, tailored strategy for suicide risk reduction  ). NIMH works closely with public and private partners to take recent data, like those collected during the ED-SAFE studies, and help translate them into real-world practice   .

Moving forward

The studies and projects shared here are only a few examples of exciting areas of investment that have resulted in real-world changes in care. Although we’ve made progress, we recognize the need to continue supporting research with near-term potential and cultivating a vibrant workforce to lead the next generation of services and intervention research.

Further, NIMH is committed to working with researchers, communities, payors, advocacy groups, state policymakers, federal agencies, and others to help support intervention and services science that will significantly impact mental health policy and care practices—ultimately helping people access better mental health care.

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Mental health and the pandemic: What U.S. surveys have found

The coronavirus pandemic has been associated with worsening mental health among people in the United States and around the world . In the U.S, the COVID-19 outbreak in early 2020 caused widespread lockdowns and disruptions in daily life while triggering a short but severe economic recession that resulted in widespread unemployment. Three years later, Americans have largely returned to normal activities, but challenges with mental health remain.

Here’s a look at what surveys by Pew Research Center and other organizations have found about Americans’ mental health during the pandemic. These findings reflect a snapshot in time, and it’s possible that attitudes and experiences may have changed since these surveys were fielded. It’s also important to note that concerns about mental health were common in the U.S. long before the arrival of COVID-19 .

Three years into the COVID-19 outbreak in the United States , Pew Research Center published this collection of survey findings about Americans’ challenges with mental health during the pandemic. All findings are previously published. Methodological information about each survey cited here, including the sample sizes and field dates, can be found by following the links in the text.

The research behind the first item in this analysis, examining Americans’ experiences with psychological distress, benefited from the advice and counsel of the COVID-19 and mental health measurement group at Johns Hopkins Bloomberg School of Public Health.

At least four-in-ten U.S. adults (41%) have experienced high levels of psychological distress at some point during the pandemic, according to four Pew Research Center surveys conducted between March 2020 and September 2022.

Young adults are especially likely to have faced high levels of psychological distress since the COVID-19 outbreak began: 58% of Americans ages 18 to 29 fall into this category, based on their answers in at least one of these four surveys.

Women are much more likely than men to have experienced high psychological distress (48% vs. 32%), as are people in lower-income households (53%) when compared with those in middle-income (38%) or upper-income (30%) households.

In addition, roughly two-thirds (66%) of adults who have a disability or health condition that prevents them from participating fully in work, school, housework or other activities have experienced a high level of distress during the pandemic.

The Center measured Americans’ psychological distress by asking them a series of five questions on subjects including loneliness, anxiety and trouble sleeping in the past week. The questions are not a clinical measure, nor a diagnostic tool. Instead, they describe people’s emotional experiences during the week before being surveyed.

While these questions did not ask specifically about the pandemic, a sixth question did, inquiring whether respondents had “had physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart” when thinking about their experience with the coronavirus outbreak. In September 2022, the most recent time this question was asked, 14% of Americans said they’d experienced this at least some or a little of the time in the past seven days.

More than a third of high school students have reported mental health challenges during the pandemic. In a survey conducted by the Centers for Disease Control and Prevention from January to June 2021, 37% of students at public and private high schools said their mental health was not good most or all of the time during the pandemic. That included roughly half of girls (49%) and about a quarter of boys (24%).

In the same survey, an even larger share of high school students (44%) said that at some point during the previous 12 months, they had felt sad or hopeless almost every day for two or more weeks in a row – to the point where they had stopped doing some usual activities. Roughly six-in-ten high school girls (57%) said this, as did 31% of boys.

On both questions, high school students who identify as lesbian, gay, bisexual, other or questioning were far more likely than heterosexual students to report negative experiences related to their mental health.

Mental health tops the list of worries that U.S. parents express about their kids’ well-being, according to a fall 2022 Pew Research Center survey of parents with children younger than 18. In that survey, four-in-ten U.S. parents said they’re extremely or very worried about their children struggling with anxiety or depression. That was greater than the share of parents who expressed high levels of concern over seven other dangers asked about.

While the fall 2022 survey was fielded amid the coronavirus outbreak, it did not ask about parental worries in the specific context of the pandemic. It’s also important to note that parental concerns about their kids struggling with anxiety and depression were common long before the pandemic, too . (Due to changes in question wording, the results from the fall 2022 survey of parents are not directly comparable with those from an earlier Center survey of parents, conducted in 2015.)

Among parents of teenagers, roughly three-in-ten (28%) are extremely or very worried that their teen’s use of social media could lead to problems with anxiety or depression, according to a spring 2022 survey of parents with children ages 13 to 17 . Parents of teen girls were more likely than parents of teen boys to be extremely or very worried on this front (32% vs. 24%). And Hispanic parents (37%) were more likely than those who are Black or White (26% each) to express a great deal of concern about this. (There were not enough Asian American parents in the sample to analyze separately. This survey also did not ask about parental concerns specifically in the context of the pandemic.)

Looking back, many K-12 parents say the first year of the coronavirus pandemic had a negative effect on their children’s emotional health. In a fall 2022 survey of parents with K-12 children , 48% said the first year of the pandemic had a very or somewhat negative impact on their children’s emotional well-being, while 39% said it had neither a positive nor negative effect. A small share of parents (7%) said the first year of the pandemic had a very or somewhat positive effect in this regard.

White parents and those from upper-income households were especially likely to say the first year of the pandemic had a negative emotional impact on their K-12 children.

While around half of K-12 parents said the first year of the pandemic had a negative emotional impact on their kids, a larger share (61%) said it had a negative effect on their children’s education.

• Coronavirus (COVID-19)
• Happiness & Life Satisfaction
• Medicine & Health
• Teens & Youth

John Gramlich is an associate director at Pew Research Center .

How Americans View the Coronavirus, COVID-19 Vaccines Amid Declining Levels of Concern

Online religious services appeal to many americans, but going in person remains more popular, about a third of u.s. workers who can work from home now do so all the time, how the pandemic has affected attendance at u.s. religious services, economy remains the public’s top policy priority; covid-19 concerns decline again, most popular.

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ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

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• Mental illness

Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life, such as at school or work or in relationships. In most cases, symptoms can be managed with a combination of medications and talk therapy (psychotherapy).

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Signs and symptoms of mental illness can vary, depending on the disorder, circumstances and other factors. Mental illness symptoms can affect emotions, thoughts and behaviors.

Examples of signs and symptoms include:

• Feeling sad or down
• Confused thinking or reduced ability to concentrate
• Excessive fears or worries, or extreme feelings of guilt
• Extreme mood changes of highs and lows
• Withdrawal from friends and activities
• Significant tiredness, low energy or problems sleeping
• Detachment from reality (delusions), paranoia or hallucinations
• Inability to cope with daily problems or stress
• Trouble understanding and relating to situations and to people
• Problems with alcohol or drug use
• Major changes in eating habits
• Sex drive changes
• Excessive anger, hostility or violence
• Suicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems, such as stomach pain, back pain, headaches, or other unexplained aches and pains.

When to see a doctor

If you have any signs or symptoms of a mental illness, see your primary care provider or a mental health professional. Most mental illnesses don't improve on their own, and if untreated, a mental illness may get worse over time and cause serious problems.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with some mental illnesses. If you think you may hurt yourself or attempt suicide, get help right away:

• Call 911 or your local emergency number immediately.
• Call your mental health specialist.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.
• Seek help from your primary care provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Suicidal thinking doesn't get better on its own — so get help.

Helping a loved one

If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns. You may not be able to force someone to get professional care, but you can offer encouragement and support. You can also help your loved one find a qualified mental health professional and make an appointment. You may even be able to go along to the appointment.

If your loved one has done self-harm or is considering doing so, take the person to the hospital or call for emergency help.

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Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:

• Inherited traits. Mental illness is more common in people whose blood relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.
• Environmental exposures before birth. Exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When the neural networks involving these chemicals are impaired, the function of nerve receptors and nerve systems change, leading to depression and other emotional disorders.

Risk factors

Certain factors may increase your risk of developing a mental illness, including:

• A history of mental illness in a blood relative, such as a parent or sibling
• Stressful life situations, such as financial problems, a loved one's death or a divorce
• An ongoing (chronic) medical condition, such as diabetes
• Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head
• Traumatic experiences, such as military combat or assault
• Use of alcohol or recreational drugs
• A childhood history of abuse or neglect
• Few friends or few healthy relationships
• A previous mental illness

Mental illness is common. About 1 in 5 adults has a mental illness in any given year. Mental illness can begin at any age, from childhood through later adult years, but most cases begin earlier in life.

The effects of mental illness can be temporary or long lasting. You also can have more than one mental health disorder at the same time. For example, you may have depression and a substance use disorder.

Complications

Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Complications sometimes linked to mental illness include:

• Unhappiness and decreased enjoyment of life
• Family conflicts
• Relationship difficulties
• Social isolation
• Problems with tobacco, alcohol and other drugs
• Missed work or school, or other problems related to work or school
• Legal and financial problems
• Poverty and homelessness
• Self-harm and harm to others, including suicide or homicide
• Weakened immune system, so your body has a hard time resisting infections
• Heart disease and other medical conditions

There's no sure way to prevent mental illness. However, if you have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control. Follow these steps:

• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends to watch for warning signs.
• Get routine medical care. Don't neglect checkups or skip visits to your primary care provider, especially if you aren't feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.
• Get help when you need it. Mental health conditions can be harder to treat if you wait until symptoms get bad. Long-term maintenance treatment also may help prevent a relapse of symptoms.
• Take good care of yourself. Sufficient sleep, healthy eating and regular physical activity are important. Try to maintain a regular schedule. Talk to your primary care provider if you have trouble sleeping or if you have questions about diet and physical activity.
• Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed April 8, 2019.
• Dual diagnosis. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis. Accessed April 8, 2019.
• Practice Guidelines for the Psychiatric Evaluation of Adults. 3rd ed. Arlington, Va.: American Psychiatric Association; 2013. http://psychiatryonline.org. Accessed April 1, 2019.
• Understanding psychotherapy and how it works. American Psychological Association. https://www.apa.org/helpcenter/understanding-psychotherapy. Accessed April 1, 2019.
• Asher GN, et al. Complementary therapies for mental health disorders. Medical Clinics of North America. 2017;101:847.
• Complementary health approaches. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Treatment/Complementary-Health-Approaches. Accessed April 4, 2019.
• Warning signs of mental illness. American Psychiatric Association. https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness. Accessed April 4, 2019.
• Helping a loved one cope with mental illness. American Psychiatric Association. https://www.psychiatry.org/patients-families/helping-a-loved-one-cope-with-a-mental-illness. Accessed April 4, 2019.
• What is mental illness? American Psychiatric Association. https://www.psychiatry.org/patients-families/what-is-mental-illness. Accessed April 4, 2019.
• For friends and family members. MentalHealth.gov. https://www.mentalhealth.gov/talk/friends-family-members. Accessed April 4, 2019.
• For people with mental health problems. MentalHealth.gov. https://www.mentalhealth.gov/talk/people-mental-health-problems. Accessed April 4, 2019.
• Brain stimulation therapies. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml. Accessed April 4, 2019.
• Mental health medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Accessed April 4, 2019.
• Psychotherapies. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml. Accessed April 4, 2019.
• Muesham D, et al. The embodied mind: A review on functional genomic and neurological correlates of mind-body therapies. Neuroscience and Biobehavioral Reviews. 2017;73:165.
• Suicide in America: Frequently asked questions. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml. Accessed April 10, 2019.
• Types of mental health professionals. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Treatment/Types-of-Mental-Health-Professionals. Accessed April 8, 2019.
• Risk and protective factors. Substance Abuse and Mental Health Services Administration. Accessed April 8, 2019.
• Newman L, et al. Early origins of mental disorder — Risk factors in the perinatal and infant period. BMC Psychiatry. 2016;16:270.
• Treatment settings. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Treatment/Treatment-Settings. Accessed April 10, 2019.
• Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. May 18, 2019.
• Intervention: Help a loved one overcome addiction
• Mental health providers: Tips on finding one
• Mental health: Overcoming the stigma of mental illness

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• Published: 10 May 2023

Mental health awareness: uniting advocacy and research

Nature Mental Health volume  1 ,  pages 295–296 ( 2023 ) Cite this article

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Mental Health Month has been observed to reduce the stigma that is associated with mental illness and to educate the public and encourage individuals to make their mental health and wellbeing a priority. It is an important moment to bring the strengths of advocacy groups and researchers together to promote mental health awareness and to improve equity.

Observances have become a popular tool to garner media and notice for topics deserving attention, from medical conditions to public health concerns, commemoration of notable events, or celebration of cultural groups. Codifying the scope and needs connected to an issue or illness through awareness campaigns can provide opportunities for imparting useful information, reducing stigma and marshalling support for policy change. The impact of awareness campaigns can be difficult to measure beyond tallying social media mentions or news stories. Effective advocacy, however, extends beyond traffic and paves the way for the creation of knowledge and partnerships among allies and with those whose interests are being represented. When the magnitude of an issue and the potential for improvement are great and are matched by broad involvement and recognition by stakeholders, the possibility for impact is also great.

Held annually in May, Mental Health Month , also called Mental Health Awareness Month, is an observance with such reach, resonating with many people. Nearly everyone has experience with the challenges that are associated with mental health, either first-hand or through loved ones or in their community. There is a need for education, support and initiative to improve our understanding of the causes of mental health disorders and to increase the availability of resources for prevention and treatment. Mental Health Month also offers the possibility of bringing together groups who often work in parallel, such as mental health advocates and mental health research organizations, that can mutually benefit from each other’s functions and expertise.

Mental Health Month was first established in the US in 1949 by the National Mental Health Association, now known as Mental Health America . At a time more often associated with the outset of the Cold War and Marshall Plan than setting an agenda for domestic mental health and wellbeing advocacy, in the more than 70 years since, Mental Health Month has grown into an international event designed to reduce exclusion, stigma and discrimination against people with mental health conditions or disorders. Mental Health America are joined by other prominent mental health advocacy groups to sponsor related observances: Mental Health Awareness Week Canada (1–7 May, 2023) and Europe (22–28 May, 2023); and federal agencies such as the Substance Use Abuse and Mental Health Services Administration ( SAMSHA ) in the US, promoting related public education platforms, including National Prevention Week (7–13 May, 2023).

Observances and awareness campaigns also provide occasions to put mental health in context. Increasing acknowledgment of the role of social determinants, for example, as mechanisms that can increase vulnerability for developing disorders and that drive disparities in mental health are an important framework to underscore as part of promoting mental health awareness. Given the complex and broad scope of people, disorders, conditions and issues under the umbrella of mental health, observances also give us the chance to focus more closely on specific problems or experiences. The theme for Mental Health Month in 2023 is ‘Look Around, Look Within’, which emphasizes the interdependence of mental health and wellness with an individual’s internal and external experiences and environments.

“The ‘Look Around, Look Within’ theme builds on the growing recognition that all humans have mental health needs and that our available resources to build resilience and heal come in many forms — including in the natural world,” explains Jennifer Bright, Mental Health America Board Chair and President of Momentum Health Strategies. “Mental Health America’s strategic plan, focused on NextGen Prevention, carries a similar theme — that the social factors supporting mental health are essential building blocks. These encompass basic needs like healthy food, stable housing, and access to treatment and supports, but they also include spirituality, connection with peers with lived experience, and safe and natural spaces.”

Overlapping with Mental Health Month, Mental Health Foundation sponsors Mental Health Week in the UK (15–21 May, 2023), dedicating this year to raising awareness around anxiety. It shares an individual-centered approach to advocacy. In addition to providing toolkits and resources that point to how prevalent stress and anxiety can be to reduce stigma, it also promotes the accessibility of coping strategies for managing anxiety. As part of the Mental Health Awareness Week campaign, Mental Health Foundation and others use the international symbol of wearing a green ribbon or clothing to physically raise awareness around mental health. Nature Mental Health also incorporates the symbol of the green ribbon on the cover of this month’s issue and as our journal theme color. Green evokes the ideas of vitality, growth, new beginnings and hope — powerful imagery in mental health awareness.

Alongside stories, sponsorships and social media resources, mental health advocacy toolkits and strategy documents include fact sheets and messaging that are shaped and informed by research. Yet, there is often a perception that a divide exists between the mental health advocacy and research spaces, but observances such as Mental Health Month can bridge the two.

According to Lea Milligan, Chief Executive Officer of MQ: Transforming Mental Health , an international mental health research organization, there are complementary approaches and priorities in advocacy and research: “Mental health research can be used to bolster awareness by providing evidence-based information and resources that can help individuals and communities better understand mental health and the factors that contribute to mental health problems. This can include information on risk factors, prevention strategies, and available treatments.”

In addition, increased efforts to involve people with lived experience of mental illness in the research enterprise is a goal that is well-served through connection with advocacy. “While MQ is primarily focused on promoting mental health research, it also recognizes the importance of advocacy in advancing the mental health agenda” suggests Milligan. “MQ advocates for increased funding and support for mental health research, as well as policies that promote mental health and wellbeing. Additionally, MQ seeks to empower individuals with lived experience of mental health conditions to be involved in research and advocacy efforts, and to have their voices heard in the development of policies and programs that affect their lives. MQ provides resources and support for individuals with lived experience who wish to be involved in research or advocacy efforts, including training programs, research grants, and opportunities to participate in research studies.”

Involvement or engagement is certainly one of the most important metrics of advocacy. By strengthening collaboration between advocacy and research organizations and identifying the mutual areas of benefit, such as engagement and increased funding, we may find new ways to green light mental health awareness and action toward mental health equity.

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Mental health awareness: uniting advocacy and research. Nat. Mental Health 1 , 295–296 (2023). https://doi.org/10.1038/s44220-023-00072-6

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What to do about mental health crisis among black males.

During the daylong “Black Men and Mental Health” symposium, Bryan Bonaparte discussed the church’s role.

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Symposium examines thorny, multifaceted dilemma from systemic racism in policing, healthcare to stigma attached to psychotherapy in community

Amid a mental health crisis affecting both younger and adult Black males, the Hutchins Center for African & African American Research held a daylong symposium on May 13 to have critical conversations untangling the complexities of the problem and examining potential solutions.

According to the National Institute of Minority Health and Health disparities, Black men are four times likelier to die by suicide than Black women. The American Academy of Child and Adolescent Psychiatry has seen a 60 percent rise in suicide rates among Black boys over the past two decades.

“While we see a significant rise in our young people experiencing feelings of sadness, anxiety, anger, or hopelessness, we know that young people of color are having an even harder time compared to their peers,” Boston Mayor Michelle Wu ’07, J.D. ’12, said in a video message as part of the opening ceremonies. “Black boys and Black men face the additional challenges of stigma and systemic racism so entrenched that it affects the quality of mental health care they receive.”

Michael Rain , a joint fellow at the Edmond & Lily Safra Center for Ethics and the Hutchins Center, said often these issues are “compounded and diluted, leading to a lack of solutions that address our particular needs.”

In various sessions, panelists discussed issues including the impact of “the talk” many Black parents have with their children on how best to safely deal with interactions with police to the stigmatization of psychotherapy in the Black community. Nearly 54 million U.S. residents age 16 or older had police contact in 2020, with Black people accounting for 18 percent.

“We are committed to ensuring that the mental health of Black men and boys is not only a conversation, but it’s at the forefront of the work that we are pursuing.” Frank Farrow, Mayor’s Office of Black Male Advancement

Some speakers debated the role religion plays in tackling mental health issues, with some saying that God and not therapy allowed them to overcome their traumatic experiences. Participants at a session on psychotherapy, however, pushed back on the notion of religion as a cure-all to mental health challenges.

“I was raised Christian, but I see that the church — in whatever way you want to describe it — can be a stick to beat yourself with,” Bryan Bonaparte, a senior lecturer in psychology at the University of Westminster, argued. “If you’re not doing things in the way that the church wants you to, or you think the church wants you to, then there’s no other way.”  

He continued: “Just go and pray is often the response that you get. Do not go and seek someone that has a medical degree, because you’re not going to get your answers from a book. You’re going to get your answers from up there.”

Psychologist Martin Pierre noted that Black men should be allowed to not only identify and feel their emotions, but to make connections and relationships that will allow them to cope with the stresses of being a Black American. He also called for a more culturally responsive approach to mental health issues in the Black community.

“Black Men and Mental Health” was the brainchild of the Rev. Professor Keith Magee from the University College London’s Black Britain and Beyond think tank. Magee planned the conference with Hutchins Center director Henry Louis Gates Jr. after receiving thousands of responses from Black men and those who care about Black men about his CNN op-ed . The city of Boston also partnered in the event.

“It’s an honor for us to convene this symposium, which is providing a vital public service by giving voice to the complex, often difficult, yet crucially important set of issues surrounding Black men and mental health at a time in our country that can only be described as gruesome,” said Gates, who is also the Alphonse Fletcher University Professor.

Attendees pushed panelists and organizers to continue these conversations and encourage policy changes that will help Black men and boys on local and national levels. In response, former Democratic U.S. Representative Kendrick Meek from Florida promised to use his connections to make positive change.

Earlier in the day, Frank Farrow, executive director of the Mayor’s Office of Black Male Advancement in Boston, had also noted the importance of retaining focus on marshaling resources and finding solutions.

“We are committed to ensuring that the mental health of Black men and boys is not only a conversation, but it’s at the forefront of the work that we are pursuing,” Farrow said. “We know that Black men and boys face deep inequities, disparities, and we want to make sure that we’re leading and that our voice is at the forefront.”

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Gen Z’s Mental Health, Economic Distress and Technology

Mental health indicators for younger generations have worsened in the past decade. Poor mental health can have economic consequences (PDF)  for individuals, their families, workplaces and communities. It can also be a barrier to finishing school and to entering or staying in the labor market, and it can reduce labor productivity, all of which could result in long-term consequences for young adults’ professional development and earnings.

For example, the 2024 State of Economic Equity  reported that in 2022 the rate of depression in young adults, 18-24 years old, who are members of Generation Z, was over 12% compared with 8% for adults 25-64 years old. This difference can deepen economic disparities between the two groups.

Rise in Depression: Young Adults vs. Older Adults, 2010 to 2022

SOURCE: 2024 State of Economic Equity, which used data from the National Health Interview Survey (2010-22) and authors’ calculations.

NOTES: Young adults are ages 18 to 24. The 2022 group consists of members of Gen Z. Older adults are ages 25 to 64. Data show weighted mean values for the percentage of adult respondents who felt depressed monthly. Rates prior to 2019 should not be directly compared because survey calculations changed in 2019.

What do we know about the relationship between mental health and economic factors?

• A 2011 report from the Harvard School of Public Health and the World Economic Forum projected that the cost of mental illness globally would be $6 trillion by 2030. The most common disorder is depression, a 2022 article in Applied Health Economics and Health Policy found.
• Research from 2020 indicates that the economic cost per treated person (PDF) , which includes treatment costs as well as loss of productivity, equates to between $1,180 and $18,313, depending on the condition. Costs are lower per person for those with the most common conditions of depression or anxiety disorders.
• In the U.S., poorer work performance due to depression can cost a company an average of $5,524 per person per year , which also impacts afflicted individuals by limiting career progression, income growth and job stability.

Rent and Student Loan Debt as Economic Distress Factors for Young Adults 

Two potential sources of economic distress that might impact young adults’ mental health are rent costs and student loan debt. Just over 80% of young adults are renters, according to data from the U.S. Bureau of Labor Statistics.

According to a 2024 report on U.S. rental housing (PDF) from the Joint Center for Housing Studies of Harvard University:

• In the past 20 years or so, median rents have increased over 20% while median income has risen just 2%.
• Of the young adults who were household heads, 61% were cost burdened (spending more than 30% of their income on housing and utilities) in 2022.
• At the same time, unit shortages grew by 2.9 million units from 2001 to 2021, which means that there have been both increases in costs and fewer affordable rental units than in the past.

These challenges could result in young adults making financial sacrifices by cutting back in other spending categories to make ends meet or moving away from networks to find affordable housing. They could also result in the young adults not being able to pay their full rent.

The cost of housing, compounded with debt like that from student loans, can constitute a heavy financial burden. Tuition and board for a four-year college increased by 40% between 2001 to 2023, going from $22,118 in the 2000-01 school year to $30,884 in the 2022-23 school year, according to data from the National Center for Education Statistics. Median personal income has not kept pace, helping lead to student debt growth of over 230% between 2006 and 2020. Furthermore, after controlling for other types of debt, student loan debt was found to be negatively associated with life satisfaction and psychological well-being. In fact, student loan debt alone has been described as a significant motive for delaying family formation and decreasing homeownership depending on the level of debt.

Evolving Technology and Young Adults’ Mental Health

Another reason for the higher prevalence of depression among young adults may be certain types of internet use and interactions. Research has been emerging on gaming and social media effects on mental health. For instance, gaming disorder is now part of the International Classification of Diseases 11th Revision. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition also established criteria for internet gaming disorder but recognizes it as a condition that needs additional research. While causality has not been determined, research shows that 1 in 3 individuals who have a gaming disorder also have depression. Furthermore, while it is not part of the diagnostic manual, social media use has been associated with depression in adolescents and young adults.

As the long-term effects of social media use are still being understood, we are experiencing the emergence of another technology with generative AI, a type of artificial intelligence. Already, teens deem it acceptable to use some generative AI platforms to write essays (20%), solve math problems (39%) and conduct research (69%). Many young adult students and workers may need to quickly adapt their behaviors, such as by regulating use to protect critical thinking skills, working to better discern fact from fiction, and finding uses to hone, rather than stifle, creativity. For instance, only 35% of adults ages 18-29 could demonstrate full awareness of AI in daily life. With the risk of deepfakes and misinformation, this could place both the mental health of young adults and the quality of their work at risk.

Additional research is needed to understand the impact of past and emerging technologies on mental health and their effects on worker productivity.

Young Adults Seek Access to Mental Health Care

In recent years, there has been an increase in the access that patients, such as those in rural areas , have to providers through telehealth. Psychiatry is one of the areas with the most prominent use of telehealth, according to a January 2019 American Medical Association article .

What about mental health care affordability? Progress has been seen in this area as well. Research has shown that after dependent coverage expansion for 19- to 25-year-olds in 2010, there was a modest 2.9% decrease in admissions of uninsured patients for inpatient admissions and emergency department visits for psychiatric disorders. Additionally, increases in the number of mental health providers accepting Medicaid (PDF) have improved affordability across many states. However, updated data could help with examining affordability as an issue for many young adults, whose income and wealth are generally much lower than those of adults as a whole and whose wages have been stagnant.

Data from the National Health Interview Survey provide an illustration of factors around mental health services. While rates prior to 2019 should not be directly compared because survey calculations changed in 2019, the proportion of young adults who saw a mental health provider increased and diverged from that of older adults since 2015, as can be seen in the first figure below.

Saw a Mental Health Care Provider: Young Adults vs. Older Adults

SOURCES: National Health Interview Survey (2010-22) and authors’ calculations.

NOTES: Young adults are ages 18 to 24. The 2022 group consists of members of Gen Z. Older adults are ages 25 to 64. Data show weighted mean values for the percentage of adult respondents who saw or talked to a mental health provider in the last 12 months. Rates prior to 2019 should not be directly compared because survey calculations changed in 2019.

At the same time, the share of young adults seeking treatment but not being able to afford it also diverged from that of older adults, as can be seen in the next figure.

Needed but Couldn’t Afford Mental Health Care: Young Adults vs. Older Adults

NOTES: Young adults are ages 18 to 24. The 2022 group consists of members of Gen Z. Older adults are ages 25 to 64. Data show weighted mean values for the percentage of adult respondents who needed mental health care but couldn’t afford it in the last 12 months. Rates prior to 2019 should not be directly compared because the survey calculations changed in 2019.

The statistics on young adults seeking and not being able to afford mental health care, coupled with their higher depression levels, suggest that while more young adults are seeking treatment and there have been efforts to improve affordability for young adults, they still are struggling to pay for treatment.

Young adults have a long work life ahead and are critical to tomorrow’s economy. Early adulthood is when the work from child-rearing and education (PDF)  come to a confluence where we can see young adults’ economic contribution. However, mental health issues can mean economic setbacks for the individual, family and the community as a whole. Research has shown that early prevention and early intervention can help lessen those setbacks. Perhaps through such measures, education and income disparities that emerge can also be reduced, thereby building a stronger economy for new generations.

Nicole Summers-Gabr is a senior researcher for the Institute for Economic Equity at the Federal Reserve Bank of St. Louis. Read about Nicole’s work .

Violeta Gutkowski is a lead analyst for the St. Louis Fed's Institute for Economic Equity. Read about Violeta's work .

Alice L. Kassens is the John S. Shannon Professor of Economics at Roanoke College and a research fellow at the St. Louis Fed's Institute for Economic Equity. Read more about the author and her work .

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Americans see disparities in mental and physical care, survey finds

Of the respondents: 51 percent reported experiencing depression, anxiety or another mental health condition in the previous 12 months.

When asked, 75 percent of survey respondents said they felt mental health conditions are identified and treated worse than physical health issues, according to a new survey from West Health and Gallup.

The poll surveyed a random sample of 2,266 U.S. adults 18 and older. In addition to perceptions about treatment, the survey also gauged mental health conditions among participants. Of the respondents: 51 percent reported experiencing depression, anxiety or another mental health condition in the previous 12 months.

Overall, 15 percent of respondents said they felt mental health conditions are treated “about the same” as physical health conditions, and 5 percent felt they were treated better than physical health conditions. Respondents were also asked to grade the ability of health-care systems to deal with mental health conditions, and a majority — 57 percent — gave a D or F.

The main barriers, according to those surveyed, were affordability and difficulty in finding an adequate provider. Participants also cited shame and embarrassment as keeping them from treatment. This was particularly felt among participants who had experienced a mental health issue in the past year: 74 percent of those respondents thought people with mental health conditions are viewed negatively.

Additionally, 75 percent of adults 65 or older thought mental health conditions carry a negative stigma, but 53 percent of the participants felt psychological counseling or therapy is “very effective” or “effective.” Fewer adults felt medication was effective.

Participants were also asked about their perceptions of mental health conditions over the past five years in the United States. More than 80 percent of those surveyed said the incidence of problems has risen, with women and respondents younger than 50 more likely to perceive an increase in mental health issues in Americans over the past five years.

“Greater attention to reaching parity between mental and physical health could help further ensure mental and emotional health are given the appropriate attention within the U.S. healthcare system,” Gallup said in a news release .

This article is part of The Post’s “Big Number” series, which takes a brief look at the statistical aspect of health issues. Additional information and relevant research are available through the hyperlinks.

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• Rand Health Q
• v.7(3); 2018 Apr

Understanding mental health in the research environment

Short abstract.

This study aimed to establish what is known about the mental health of researchers based on the existing literature. The literature identified focuses mainly on stress in the academic workforce and contributory factors in the academic workplace.

This study aimed to establish what is known about the mental health of researchers based on the existing literature. There is limited published evidence on the prevalence of specific mental health conditions among researchers. The majority of the identified literature on prevalence relates to work-related stress among academic staff and postgraduate students in university settings.

Survey data indicate that the majority of university staff find their job stressful. Levels of burnout appear higher among university staff than in general working populations and are comparable to “high-risk” groups such as healthcare workers. The proportions of both university staff and postgraduate students with a risk of having or developing a mental health problem, based on self-reported evidence, were generally higher than for other working populations. Large proportions (>40 per cent) of postgraduate students report symptoms of depression, emotion or stress-related problems, or high levels of stress.

Factors including increased job autonomy, involvement in decision making and supportive management were linked to greater job satisfaction among academics, as was the amount of time spent on research. Opportunities for professional development were also associated with reduced stress. UK higher education (HE) and research staff report worse wellbeing, as compared to staff in other sectors, in most aspects of work that can affect workers' stress levels.

The evidence around the effectiveness of interventions to support the mental health of researchers specifically is thin. Few interventions are described in the literature and even fewer of those have been evaluated.

The Royal Society and Wellcome Trust are interested in better understanding the mental health needs of researchers, and what interventions could be used to support them. This reflects the recent focus on mental health among undergraduate students in the UK, and the concern that others in the academic and wider research environment may have mental health needs that have not been as well explored and considered. This study aims to establish what is currently known about the mental health of researchers based on the existing literature.

Over 6 million working-age people in England have a mental health condition at a given time. The most common diagnosable difficulties among working age adults are anxiety and depression, each of which includes a number of different conditions. Less common but still widespread mental health diagnoses include personality disorders and psychoses such as bipolar disorder and schizophrenia. Many people will have more than one diagnosis at a time, or receive different diagnoses over time.

The causes and triggers of poor mental health are complex and not fully understood. There is evidence that the vast majority of people who experience poor mental health in adulthood first experienced difficulties as children, often from a young age. Risk factors for poor mental health include having a parent with mental health difficulties, growing up in prolonged poverty and housing insecurity, experiences of abuse, neglect and bullying, and traumatic experiences during childhood. Some groups of people have a heightened risk of poor mental health, including some black and ethnic minority communities, people with long-term physical conditions, lesbian, gay, bisexual and transgender people, and people with disabilities.

There is mixed evidence about the extent to which a person's experiences of work contribute to their having a mental health difficulty. Survey evidence suggests that workplace factors such as bullying, insecurity and a lack of control are major causes of mental ill health among staff. On the other hand, there is also evidence that work helps many people to recover from an episode of poor mental health, and there is clear evidence that unemployment is a major risk factor for mental and physical ill health.

Mental ill health and work-related stress are key issues for the labour market as they affect productivity through absenteeism and presenteeism, and are associated with high economic costs for individuals, employers and the economy at large. It has been estimated that poor mental health costs employers in the UK £26 billion nationwide each year, equivalent to £1,035 for every employee in the workforce ( Centre for Mental Health, 2007 ).

Little is known about how mental health needs vary across working environments, or about how to tailor interventions to address different working populations.

The aim of this study was to assess what is known about mental health in research environments through a literature review, and it focused on the UK and comparable research systems. A better understanding of researchers' mental health needs will enable the design of more effective interventions to address them, while a better understanding of evidence gaps can also help guide future research efforts in this area. The following research questions guided the study:

• How are “mental health” and “wellbeing” understood in the context of research environments?
• What is currently known about researchers' mental health and wellbeing, and does it differ from that of other populations?
• What interventions are used to support researchers, and what evidence is there of their effectiveness?
• What are the strengths and limitations of the evidence base in this area?

How Are “Mental Health” and “Wellbeing” Understood in Research Environments?

Overall, the existing literature offers little insight into what sets the research environment apart from other workplaces, or into how mental health, stress, and wellbeing are defined in these contexts. Rather, the majority of the literature identified focuses on describing the levels of stress amongst the academic workforce and, in particular, identifying contributory factors within the workplace. There is little available evidence based on objective clinical assessment about the prevalence of clinically defined mental health conditions and their treatment in this context. The focus on wellbeing raises the issue that although the presence of common mental health conditions does correlate with some of the wellbeing scales used commonly in the literature, more serious (e.g. psychotic) mental illnesses are not necessarily aligned with measurement of wellbeing.

The literature is also almost exclusively focused on universities, with many studies covering all university staff, which will include both researchers and non-research staff. Some studies focused more specifically on researchers, and a more limited group within that looked at particular groups of researchers—most commonly PhD students, reflecting the wider focus on (typically undergraduate) students in the literature around this topic. The majority of the existing research is based on survey data, which is subject to sampling biases, relies on self-reporting, and was not triangulated with other objective indicators, such as absence data.

What Is Currently Known About Researchers' Mental Health and Wellbeing, and How It Differs from Other Populations?

Evidence on the prevalence of work-related stress and mental health problems.

Despite widely reported anecdotal evidence and press coverage of a “mental health crisis” in academia, there is limited published evidence regarding the prevalence of specific mental health conditions among researchers. The majority of the literature on prevalence identified through this review relates to the experience of work-related stress (and arguably the risk of developing a mental health condition as a result of exposure to identified stressors) among academic staff and postgraduate students in university settings.

• Survey data indicate that the majority of university staff find their job stressful. Levels of burnout appear higher among university staff than in general working populations and are comparable to “high-risk” groups such as healthcare workers.
• The proportions of both university staff and postgraduate students with a risk of having or developing a mental health problem, based on self-reported evidence, were generally higher than for other working populations.
• Large proportions (>40 per cent) of postgraduate students report symptoms of depression, emotion or stress-related problems, or high levels of stress.

UK national statistics indicate that only 6.2 per cent of staff disclosed a mental health condition to their university, though academics have been found to be among the occupational groups with the highest levels of common mental disorders with prevalence around 37 per cent. It should be noted, however, that prevalence may generally be over-reported in surveys of occupational groups.

Personal Factors That Contribute to Mental Health Outcomes in the Research Workplace

Gender was the key personal factor that emerged as a determinant for mental health (or its reporting), with women reporting more exposure to stress than men, as well as greater challenges around work-life balance. There was also evidence that personality and perceived competence affect mental health as self-critical personalities are more susceptible to stress, though it is also possible that they are more aware of it or more willing to report it. However, it was unclear whether stress was a result of working conditions in the research environment, or whether research settings attracted particular types of individuals. The results on whether age affects mental health were inconclusive, partly as age is often difficult to disentangle from discussions about rank and seniority. Other factors such as disability, sexuality and minority status were mentioned in a small number of articles in the sample, and these articles indicated that these personal factors generally increase stress.

Environmental Factors Commonly Considered in Surveys of Mental Health and Wellbeing in Workplaces

Based on the Health and Safety Executive's framework, and evidence from the wider literature, we identify six key aspects of work that can affect workers' stress levels: work demands, job control, change management, work relationships, support provided by managers and colleagues, and clarity about one's role.

• These aspects of the work environment can be sources of stress or they can help counteract it.
• Findings from studies of university staff and researchers were consistent with the wider understanding of factors that contribute to stress in workplaces.
• Factors including increased job autonomy, involvement in decision making and supportive management were linked to greater job satisfaction among academics, as was the amount of time spent on research. Opportunities for professional development were also associated with reduced stress.

UK higher education (HE) and research staff report worse wellbeing in most of the six aspects, as compared to staff in other sectors.

• In large-scale surveys, UK higher education staff have reported worse wellbeing than staff in other types of employment (including education, and health and social work) in the areas of work demands, change management, support provided by managers and clarity about one's role.
• The only area where higher education staff have reported higher wellbeing in large-scale surveys is in job control, though even here results are mixed across studies. Wide variability was seen among respondents in relation to the level of support provided by managers and colleagues.
• Job insecurity (real and perceived) appears to be an important issue for those working in the research environment, and particularly for early-career researchers, who are often employed on successive short-term contracts.

PhD students face similar challenges to other researchers and higher education staff.

• The main factors associated with development of depression and other common mental health problems in PhD students are high levels of work demands and work-life conflict, low job control, poor support from the supervisor and exclusion from decision making.
• Believing that PhD work is valuable for one's future career helps reduce stress, as does confidence in one's own research abilities.

Some studies suggested that changes to the UK higher education system had brought increased job stress.

• These studies discussed changes that had occurred in the UK higher education system from the 1990s onwards, and had resulted in increased emphasis on accountability, efficiency and performance management. Study authors suggested that these changes could have brought about increases in job stress for staff working in this system.
• However, data explicitly linking the changes to an increase in stress are limited, partly due to a lack of comparable data from before the 1990s.

Staff who can devote a large proportion of their working time to research have better wellbeing.

• Studies found that spending a larger percentage of one's time on research was associated with reduced stress, and that research-only staff reported lower levels of work-life conflict and had better wellbeing than other higher education institution (HEI) staff. However, this may be to some extent confounded by other characteristics of such researchers (e.g. they may be more senior).

Research on emotionally challenging topics can put staff wellbeing at risk.

• Studies showed that staff involved in research on sensitive topics, such as trauma or abuse, may be emotionally affected by the material they encounter in their work and should receive greater support to mitigate the negative impacts of this work.

Outcomes Related to Poor Mental Health and Wellbeing

In addition to considering the extent to which individuals in research environments suffer from mental health issues, it is important for employers and institutions to recognise that these issues have further implications:

• Job stress and poor workplace wellbeing can contribute to reduced productivity—both through absence and, more importantly, through presenteeism, where researchers attend work and are less productive.
• They can also lead to lower levels of commitment to their research and to institutions—which can be seen in high levels of turnover and through negative attitudes in the workplace.
• Effects on job satisfaction are less clear because of the satisfaction researchers gain from intrinsic factors such as the intellectual stimulation of their work. Several studies note that high levels of job-related stress can coexist with high levels of job satisfaction.
• Effects can also spill over into personal and family life.

The overall effects of these negative outcomes on the sector have not been fully quantified, but estimates drawing on broader experience suggest that the costs could be high. An estimate from Shutler-Jones et al (2008) which has several caveats and assumptions, suggests that the costs to the UK HE sector could be more than £500 million per year (c. 5 per cent of the sector's total annual income). Costs to the economy and the country more widely could also be significant due to the lost potential for scientific advances and due to impacts on the availability of research talent if PhD students fail to complete their studies or choose to leave research subsequently.

What Interventions Are Used to Support Researchers, and What Evidence Is There of Their Effectiveness?

Though poor mental health at work is often related to difficulties that are not caused by work (e.g. childhood adversity, family life and other stressors), support in the workplace can offer benefits. However, the evidence around the effectiveness of interventions to support the mental health of researchers specifically is thin. Few interventions are described in the literature and even fewer of those have been evaluated. Where evaluations have been conducted, they are often of limited utility, either because of the evaluation design or the length of follow-up.

Interventions typically focus on stress and wellbeing rather than clinical mental health conditions, reflecting the wider focus in the literature as described above. In addition, the majority of interventions identified aim to support researchers to deal with workplace stress, but they may not be effective in addressing the root causes of that stress or stresses relating to life outside work. The interventions identified can be broadly classified into four groups: policy changes, communication activities, training, and health-promotion activities.

Focusing specifically on the UK, a range of interventions were piloted and evaluated (to a limited extent) as part of a wellbeing initiative by the Higher Education Funding Council for England (HEFCE) around 2009–2011. These offer scope for further investigation and potentially evaluation now that more time has elapsed. Additionally, the project, though completed in 2011, has spawned a network that is now managed by the Universities and Colleges Employers Association (UCEA), which may offer a route to identify further ongoing initiatives and potentially a space to pursue and evaluate efforts to address these issues in the HE sector.

What Are the Strengths and Limitations of the Evidence Base in This Area?

The existing evidence base is limited, meaning it is not possible to draw robust conclusions about the mental health status and needs of researchers, and how researchers may differ from other populations in this regard. More work is needed to understand both the mental health needs of researchers and how they can be addressed. Particular gaps include the effectiveness of interventions, prevalence of specific mental health needs (rather than stress) among researchers, and any evidence about researchers outside the academic setting. There are also limitations to the quality and design of many of the studies conducted, such as lack of long-term follow-up and absence of control groups.

Based on the evidence gaps identified and the information available, we suggest the following avenues for further research on this topic:

• Study the prevalence of mental health conditions amongst postdoctoral researchers: Further work on prevalence could use a targeted approach building on the recent work by Levecque et al. (2017) , who used a survey to assess the presence of psychological distress and potential psychiatric disorders in a sample of PhD students and compared the results to those of three other sample populations, and Eisenberg et al. (2007) , who surveyed a sample of undergraduate and postgraduate university students to assess prevalence of depressive and anxiety disorders and took steps to address the issue of non-response bias. In particular, we suggest a similar study focusing on postdoctoral researchers, a group that is particularly poorly addressed in the existing literature.
• Map mental health policies and procedures at UK HEIs: The current standard of mental health policies and procedures in UK research institutions is not well understood. We suggest that a mapping of the current policies in place across institutions could be valuable, and could build on standards such as those set out in the Mindful Employer Charter ( Mindful Employer, 2017 ).
• Evaluate the interventions introduced through the HEFCE wellbeing and engagement initiative: The wellbeing initiative established by the HEFCE and subsequently maintained as a network by UCEA offers a range of interventions for evaluation. In the project reporting in 2011, many of the institutions noted that it was too soon to tell whether their interventions had been effective. Though these initiatives generally focus on wellbeing rather than clinical mental health conditions, there is scope to explore with the relevant institutions whether those interventions have developed over the years, and whether data are now available (or could be collected) to provide more useful evaluation of the interventions introduced.
• Investigate and develop the HSE management standards as a framework for workplace mental health management in research environments: As well as providing a framework for workplace stress used in several important surveys, the Health and Safety Executive (HSE) have also set out management standards that describe an approach to identifying sources of workplace stress and addressing them at an organisational level. It could be useful to work through that approach with a university or a research organisation to identify the mechanisms at play in those environments. Doing so could establish the relevance of the approach in this context, and potentially provide a model that could be used more widely in the sector.
• Conduct more and higher-quality evaluations of mental health interventions and publish their results: Broadly, better-quality evaluations are needed to identify what works in this area. There is a need for high-quality studies to test the effectiveness of interventions.

The research described in this article was prepared for the Royal Society and the Wellcome Trust and conducted by RAND Europe.

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