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Following the successful first and second series of Unlocking the SDGs – A Blueprint for the Future, Professor Monica Lakhanpaul and Professor Priti Parikh are back with a deep dive into the UN SDGs. Over five episodes, the series considers issues including the role of AI and education in the SDGs and what other countries are doing to achieve the goals. Listen as academics from across UCL’s faculties and beyond bring new perspectives and understanding to this complex global issue.
00:00:11 Speaker 1
Welcome back to the third series of unlocking the SDK's a blueprint for the future. In this podcast, they explode the UN Sustainable Development Goals, or SDG's, and what they mean for society. I'm Professor Priti Parikh, professor of infrastructure engineering and International Development at Bartlett UCL School of Sustainable Construction.
00:00:33 Speaker 2
And I'm Professor Monica Lakhanpal, professor of integrated community child health in the UCL Great Ormond St Institute for Child Health. In this episode, we're discussing the role of mental well-being in relation to the goals. Last series we began to unpack some of those issues relating to mental health and well-being.
00:00:52 Speaker 2
With Doctor Nora Vera, San Juan and Doctor Keri Wong, and today we're taking a deeper dive into the issue.
00:01:02 Speaker 1
Our guests today are Professor Essi Viding from the UCL Department of Clinical, Educational and Health Psychology and Professor Argyris Stringaris from the UCL divisions of psychiatry and psychology and language sciences. In addition to their roles in research and education, they are the joint leaders of the new UCL Grand Challenge team.
00:01:23 Speaker 1
Of mental health and well-being, which aims to support cross disciplinary responses to this complex issue. Congratulations and a warm welcome to.
00:01:32 Speaker 3
Both of you thank.
00:01:33 Speaker 2
You, Professor Essi Viding, and Professor Argyris Stringaris
00:01:35 Speaker 2
Thank you so much for joining us today. We've talked a lot in the past here about how the issues contained within the goals across disciplinary. But you know, sometimes we don't really know what cross disciplinarity means and people get very confused about interdisciplinarity cross disciplinarity. So just wondering what does from your perspective cross disciplinarity?
00:01:55 Speaker 3
So from our perspective, we see cross Disciplinarity as something that is absolutely central for improving mental health and well-being. Humans are very complex. They're complex as individuals, and they also complex in terms of being embedded into close social relationship and larger societal structures.
00:02:15 Speaker 3
So in order for us to really understand what promotes well-being and what we can do to improve mental health, we really need to understand everything from DNA and molecules to psychological processes, social relationships, built environment and inequalities. Even climate change comes comes there in terms of thinking about.
00:02:36 Speaker 3
Things that influence our mental health, our well-being, and our Chris do want to say something about how we think about this in relation to the grand challenges.
00:02:43 Speaker 4
Yeah, no, absolutely. And I, I as as as said, so this is central to our goals as well for the grand challenges. But it was also reflecting coming here on my way to this podcast about.
00:02:54 Speaker 4
The SDG's themselves, the Sustainable Development Goals themselves, so there there are many themes in there right? But many of them are interconnected. So how can you think about poverty if you are not going to think about how someone lives in a city or climate emergencies? And how can you think about war without thinking about these other issues?
00:03:14 Speaker 4
And how can you think about all of that without thinking?
00:03:16 Speaker 4
About mental health because these.
00:03:18 Speaker 4
Can both have an effect on mental health, but can also be affected themselves by mental health, so they're clearly interrelated and therefore the subject matter itself calls for all cross disciplinarity.
00:03:30 Speaker 4
The university structure in general, but in particular UCLA's structure is quite uniquely placed to tackle some of these problems, and the reason is that we have quite broad expertise. We have lots of.
00:03:44 Speaker 4
Different faculties, divisions, departments, individual scientists who do an extraordinarily varied and diverse research, and we also go into.
00:03:52 Speaker 4
A.
00:03:52 Speaker 4
Lot of depth with that, which is the advantage of academia. We have the opportunity we're being paid to do exactly that, going to debt and to understanding these problems. So grand challenges are really trying to encourage people.
00:04:04 Speaker 4
LCL to do what we haven't been particularly good at doing, which is talk to each other and work together.
00:04:10 Speaker 4
And you know, look at goals like the SDG's and say, OK, what can we all do together to promote that? It's about incentivizing that, you know, and making it clear to everybody how important it is.
00:04:22 Speaker 2
So you've sort of addressed one of the things I was thinking about is that when we think of mental health in a global perspective and we're thinking about how does it affect people.
00:04:31 Speaker 2
Wherever you are in the world, mental health is something at the core of everybody's person. Personality, isn't it? Is it something that we think about, but actually we work in silos and just sort of elude.
00:04:35
If.
00:04:41 Speaker 2
To how do we actually get people to break those silos and realise that mental health is actually everybody's problem, everybody's issue and it's actually the core of every single discipline that we we worked with. We want to address these global challenges that we have.
00:04:56 Speaker 4
Yeah. So I think there.
00:04:57 Speaker 4
Are a few things. One is trust, fostering trust between between you for fostering trust requires fostering a common language so that people understand each other and realise, as they often do, that they talk about the same thing. But sometimes using different words, curiosity, which I think is kind of.
00:05:14 Speaker 4
Finding it. Oh.
00:05:14 Speaker 4
What? What exactly are you doing at architecture?
00:05:16 Speaker 4
Or in engineering, right. And let me let me show you what.
00:05:19 Speaker 4
We do and one thing, because we're all humans, you know, there is also the incentive structures. So you know, there is a lot of talk about inter or cross disciplinarity, but are the funds there to go to uh, you know funding body and say well here we are you know we are doing something cross disciplinary where you don't come up against the reviewing process.
00:05:39 Speaker 4
Just talk very practically. Where over it's very hard to find a reviewer who will do the engineering bit. One who will do.
00:05:45 Speaker 4
The architecture bit.
00:05:46 Speaker 4
Another one will do the medical bit, you know, or another and another.
00:05:48 Speaker 4
One will do the philosophy, so it's very, very.
00:05:50 Speaker 4
Hard from that point of view, so creating the culture change within our institution, but also within our funders is another very important component. I'm talking very practical here, but I hope it makes sense.
00:06:00 Speaker 2
Well, I hope you have two exemplars here. So which is, you know, her specialty environment and engineering and mine health. And we went off to India together looking at toilets together. And, you know, we were testing out the toilets actually each we actually walked into the toilets, opened the doors. I learned a huge amount about engineering. And I think pretty learned a lot about toilets and behaviour.
00:06:19 Speaker 1
Nutrition.
00:06:20 Speaker 2
And talk about what is it like to sit on a dirty toilet? How does that affect your mental health? How does it make you feel if you can't actually find a place to go to the toilet? So all of these things that maybe engineers want think of, but also for me, think about the structural side of the engineering side of things and how that might.
00:06:21 Speaker 3
Yes.
00:06:34 Speaker 3
And then how that might help help here.
00:06:36 Speaker 1
Help exactly. And it's really this cross fertilisation of concepts.
00:06:40 Speaker 1
Ideas and theories which leads to this interdisciplinary way of working to address current challenges. SC I was wondering if you wanted to come in on that.
00:06:51 Speaker 3
Yes. So I mean, we have thought about this as Argos already said much at the start of this. We've visited people across UCL. That's what we spent our first few.
00:07:00 Speaker 3
Doing and we've also organised networking events and and calls that specifically promote networking and pump priming calls that you can only apply for if. If you engage in work across different disciplines. So this is the the incentive structure in practise you know you can get money but you can only get money if you work across.
00:07:21 Speaker 3
These silos, and I think there is probably much that we can do within our institutional culture as well in terms of showing to people that we value.
00:07:30 Speaker 3
This sort of work, which sometimes doesn't fit into the departmental workloads or quotas, but some of this chains will probably some of it will come from no doubt university wide initiatives, but it will also be bottom up. Mostly we do our best work when it's something that we are really excited about and we find somebody who we have chemistry with and we really want to.
00:07:51 Speaker 3
Work with. So I think part of this is we sort of see ourselves as academic matchmakers a little bit with the, with the funds that are available from the grand challenge.
00:08:00 Speaker 3
And we are consistently in awe of the amazing work that is done at different parts of UCL, all the way from philosophy and law to neuroscience and population health, and we really want to see how this work can come together and go to your next level in doing something that really pushes the envelope, which I think you can only do.
00:08:20 Speaker 3
If you bring together these different strands of excellence, which individually and in their silos, are amazing at yourself, but how do we get them to come together so that they catalyse something that is more than a sum of its parts? That's the challenge and that.
00:08:33 Speaker 1
Absolutely. I mean, if we want to address some of those big challenges, grand challenges facing us with this, the climate crisis.
00:08:39 Speaker 1
Is whether it's mental health, whether it's conflict we need to really breakdown the silos to achieve impact, and in our last series we consider the importance of mental health as an indicator of equality and well-being in a society. And Doctor Kerry Wong, who joined us, highlighted the role of the social determinants of health and how addressing issues.
00:09:00 Speaker 1
Like poverty can in turn have knock on effects for people's mental well-being.
00:09:05 Speaker 1
Indirectly helping to achieve their stags how can academic research improve our understanding of those interconnected relationships that achieve alluded to previously?
00:09:16 Speaker 3
Well, we have lots of different methodologies that we can bring to bear on the problem. We can study the individual all the way from from their genes to their brain to their behaviour, but also we can try and understand how that individual embedded in a particular context may grow up. So we we have, for instance, animal models that can show us that even genetically identical.
00:09:37 Speaker 3
Animals.
00:09:37 Speaker 3
Will end up showing different phenotypes depending upon texts in which they are in and we are beginning to do that type of research in humans as well. Of course it's a lot more complex. We cannot, you know, randomised humans into different environments or get neat sort of genetically identical. Unless we look at twins humans, but.
00:09:57 Speaker 3
There are methods that we can use to study the complex interplay between the the individual's biological propensities and their environments, and I think we're making quite.
00:10:06 Speaker 3
Solid progress there, but we could always do more and the problem in the area of mental health has been traditionally lack of funding, so argue is often talks about, you know, Cancer Research in comparison to mental health research. His wife works in Cancer Research, which has been much better funded for decades. But the discoveries only came.
00:10:26 Speaker 3
When the funding got ramped up and I think what we have in mental health at the moment is traditionally quite small pots of funding, which people have sort of scrabbled scrapped over and we perhaps haven't collaborated and gone across silos as much as possible because the incentive structure hasn't quite been there. Do you want to add that?
00:10:44 Speaker 4
No, I think I think that covers really a lot and the landscape is fortunately changing. And indeed you see our grand challenges which perhaps we should say this for to your listeners, so that they they kind of know.
00:10:56 Speaker 4
The UCL has these grandchild has had these grand challenges programme for a while and what they are meant to do is to tackle big societal problems. There's four or five going on at the same time and now this is a new round of grand challenges, and indeed, it's the first time that mental health and well-being have come up as a great challenge.
00:11:15 Speaker 3
Together well-being has been there before, but this is not.
00:11:16 Speaker 4
And together, you know, kind of this is both together and it has funding. So it is a substantial investment.
00:11:25 Speaker 4
Not just in material terms, but also in terms of, you know, signalling to the outside world and to people within the university what matters. So that's a big shift for us I think and and quite quite a welcome.
00:11:35 Speaker 2
One can I?
00:11:36 Speaker 2
Ask you a bit of a controversial question. Now is that's something I've grappled with with. You know, when I've been thinking about mental health for many years in relation to global health children.
00:11:45 Speaker 2
Adults, whatever age you're talking about, mental health is something that affects all ages and the word mental health. The word mental I find sometimes when I go to other countries, particularly in the global S the word mental is a very negative terminology and that actually hinders.
00:12:00 Speaker 2
This policy changes. It actually hinders research it actually and hinders advocacy as well. Because of this word, mental health, when you translate it into other languages. And I've also had people going, I'm not mental, I'm not mental. I you know, why do you keep saying I'm mental? Do you not think that terminology that we've perpetuated?
00:12:20 Speaker 2
Actually hinders progress.
00:12:22 Speaker 3
I think it's it's probably debatable. So if you think about even in the in the global N, there was a huge stigma around mental health, which actually has reduced over the years and and actually young people now are quite happy to talk about their mental health and their mental health problems, which to me suggests that how the words are experienced can be shifted.
00:12:42 Speaker 3
I'm not necessarily hugely kind of ready to exact terminology myself, but what I am ready to.
00:12:50 Speaker 3
Is that there is a common framework so that when people do research and when they talk about something, they know what they're talking about as opposed to that being unclear. I also, possibly controversially, I'm not somebody who has a problem with something being sometimes called a problem or a difficulty because.
00:13:10 Speaker 3
In certain cases, much as you know for physical health, something's really disabled and make your life harder. I think that it it is true. And even people with lived experience would come forward and say for me this is disabling at times and I think we need to be able to talk about the fact that mental health difficulties can really be something.
00:13:30 Speaker 2
That hinders someone from achieving their full potential. We're not just talking about differences in mental health. We are in some cases really talking about genuine, disabling problems. I was wondering from a global perspective, the word mental, any thoughts about where that first came from? I was trying to work out where I did because if you convert it, for instance, when I get to India and we talk about mental health and you.
00:13:50 Speaker 2
Your translation.
00:13:52 Speaker 2
It comes across very differently in the language.
00:13:54 Speaker 4
Yeah, and it may.
00:13:55 Speaker 4
Be you know, it's a very interesting problem and you know, I I've worked in various contexts, including Greece, obviously, and and in Germany and terms even within the English speaking countries, terms can be experienced differently. So I think it is crucial that one also works with the local communities and one has a good grasp of the native language.
00:14:16 Speaker 4
To know what is best, because I agree there's no point in using terminology that will put off people. On the other hand.
00:14:22 Speaker 4
Sometimes simply changing the terminology you know invited chase of the terminology in its own right so you know the stigma catches up with the terminology rather than.
00:14:31 Speaker 4
So it's a it's a difficult act. I think we have inherited some of the terminology from you know the some of the terminologies Cartesian is is comes from Jakarta, right. It is kind of mind body dualism which says the mental realm. Right. And then there is the physical realm.
00:14:42 Speaker 3
20 that's right.
00:14:47 Speaker 4
Now, it's obviously you know, a bit silly to to be thinking of those terms, given what we know about the body and the mind these days. But these terms have stayed, have stayed with maybe there will be better terms. I've been arguing for a long time that the term depression, for example, is problematic. But you know I can't, you know, I have as he was saying, you know, I have to kind of communicate with others.
00:15:08 Speaker 4
And therefore I'm still using it, but I.
00:15:09 Speaker 4
I wouldn't. I wouldn't feel terribly sorry if if I sort of sit down.
00:15:12 Speaker 2
It's from, I think it's quite an interesting thing from the SDG perspective. You know, terminology to win people for policy change and action.
00:15:12 Speaker 1
Yes.
00:15:20 Speaker 2
We don't really work with.
00:15:21 Speaker 2
Linguists a lot to really think. How is the narrative expressed?
00:15:24 Speaker 4
And can I add to?
00:15:25 Speaker 4
That there is this.
00:15:27 Speaker 4
Interesting assumption that people make that, for example, emotions are universal.
00:15:33 Speaker 4
Emotions are probably not universal, so there are emotions that are broadly experienced by many, many different people, but there are emotions that are unique to certain cultures that maybe even unique to certain people. So there's a lot of variety in heterogeneity in experienced emotions. If that's true of emotions, then that's true of mental states of other kinds as well, particularly those mental states that rely a lot on emotions.
00:15:55 Speaker 4
And their language and linguistics and understanding of how these things are expressed play obviously a very big, very.
00:16:00 Speaker 4
Big role but.
00:16:01 Speaker 4
There's always a danger to not slip into complete solecism, you know. You know, I mean, like, being able to talk to people, have a common understanding.
00:16:10 Speaker 4
Whilst also being aware of the connotations of the words.
00:16:12 Speaker 2
So coming.
00:16:13 Speaker 3
And acknowledging the difficulties, perhaps this is this sort of a key acknowledging the fact that, you know, language is an imperfect medium. We have to have some core agreements of what we call things if we want to transfer knowledge and know that we're talking about the same things.
00:16:30 Speaker 3
Using the same definitions, whilst the SARISSAS also being mindful to.
00:16:36 Speaker 3
Both cultural sensitivities, but also individual, you know sensitivities, we know that now two people may feel the same diagnostic criteria as we have it now, but may actually experience their presentation very, very differently. It may mean very different subjective things for them. We're talking about people who talk different languages.
00:16:56 Speaker 2
Children and adolescents, really. They talk a very different language than ours, especially with social media and other ways to.
00:17:02 Speaker 2
So I see your background. I understand this in child and adolescent mental health, which is an area of health provision in the UK that's probably struggled with demand. We have an increasing number of young people who are presenting with mental health problems or along the spectrum emotional challenges.
00:17:06 Speaker 3
So it's it's both of us, yeah.
00:17:21 Speaker 2
Sometimes and funding in recent years has increased, but probably still like.
00:17:26 Speaker 3
Nowhere near near in line with the demand.
00:17:29 Speaker 2
So thinking about what the issues are with policymakers, how do you think we need to be addressing?
00:17:36 Speaker 2
Policymakers, particularly to help young people more who might be experiencing mental health problems.
00:17:41 Speaker 3
So again it's it's not A1 silver bullet solution because the problem is complex and as you allude it yourself, people are at different places along the continuum. And also this is a developmental issue. People we know from longitudinal data.
00:17:56 Speaker 3
People sort of wax and rein out of experiencing high levels of symptoms, remitting maybe moving across what we currently perceive as different diagnostic categories across their development. So it's a really complex issue. We also know that most of the mental health problems start in adolescence and early adulthood.
00:18:17 Speaker 3
So I would say that the first thing that the policymakers ought to have as a priority, and I know in fact that this is in the in the labour mental health manifesto, an area that they are very keen on, is prevention and by prevention. I don't just mean universal prevention. Everyone gets some low level thing because you know, there are people who need more.
00:18:37 Speaker 3
But I mean early intervention, so you have perhaps elevated levels of symptoms. Could you get something that involves perhaps social prescribing, some individual attention early on before you develop a level of problems that mean that you're much, much risk of having a chronic detector? So if I had to name one priority?
00:18:56 Speaker 3
And it's a priority that even though we might target it in children and young people actually would have repercussions for adult mental healthcare and also for older adult mental healthcare that would be prevention.
00:19:07 Speaker 3
An early intervention?
00:19:08 Speaker 4
I completely agree with that. What as he's saying, I would make another, perhaps controversial point, which is we must take a step back and kind of think again about what mental illness is, because there's certainly it looks very likely rather that there is has there has been an increase in certain problems and.
00:19:27 Speaker 4
And obviously some of these.
00:19:28 Speaker 4
Problems are debilitating that they have deleterious effects on.
00:19:31 Speaker 4
People, but there is also a.
00:19:33 Speaker 4
Reasonable assumption that one can.
00:19:34 Speaker 4
Make that a rising levels of.
00:19:37 Speaker 4
Awareness and destigmatization of mental health might make people think that they have mental health problems when in fact they're experiencing, you know, what would come under normal adversity or alia, ephemeral.
00:19:48 Speaker 4
Problems and that can be particularly relevant to young people and labelling these problems as mental health problems as implications for them, so that striking the right balance is quite important, particularly because this affects the whole population.
00:20:00 Speaker 4
By extension, interventions that we introduce, particularly those that are at the population level, that are scalable, we have to make sure that they don't have unintended consequences and.
00:20:09 Speaker 4
These are very.
00:20:10 Speaker 4
Rarely examined, unfortunately, have been very early examined. So we've there's some work that Lucy folks and to an extent I have done recently and others trying to understand these problems.
00:20:20 Speaker 4
Precisely because they could compound an already existing an already.
00:20:24 Speaker 4
Existing issues and the third thing is healthcare systems globally face underfunding. In fact, if one looks in the Western world at the funding of healthcare system has been plateauing over the last, you know 5-6 years and there was a peak during COVID but then it flattened again. So this means that you know we'll be cash strapped so.
00:20:44 Speaker 4
Being efficient with what we have becomes an imperative. Being good at what we do, so we should ask for more money. But we should also make sure that what we do is efficacious is.
00:20:54 Speaker 4
Would really delivers what needs to be delivered.
00:20:57 Speaker 4
Particularly to those.
00:20:58 Speaker 4
Who need it the most? As a practitioner, which is part of my life, what I see is that often people who need care don't get it, and those who get care don't necessarily need it. And that's inefficient to say the least.
00:21:12 Speaker 2
And this also comes back to the cross disciplinarity approach as well of.
00:21:15 Speaker 2
What are the unintended consequences? What are the trade-offs? You do? Something we were talking about yesterday, weren't we about, you know, you think that you're moving somebody into better housing, which is so important? I mean, that's passion. And looking at people living in temporary accommodation and the impact on them, you think you're doing something good, which is moving them into better accommodation. Actually, those young people then lose their friends. They then disconnect from society. They then.
00:21:36 Speaker 2
Disconnect from feeling comfortable within the school that they're going, so there's on one hand you think you're improving something. On the other hand, you cause a negative consequence.
00:21:42 Speaker 3
That that really highlights the the multifaceted in the connected nature of, you know, what goes into making.
00:21:48 Speaker 3
Good mental health or not, I think what argues has just been saying about the sort of the importance of being more efficient is really, really critical. And part of that will come from better applying knowledge that we already have. But part of it will come from generating new cross disciplinary.
00:22:09 Speaker 3
Knowledge that allows us to make more accurate models, more multifactorial models of mental health. Quite often these days, many of us in our recess have been one or two trick.
00:22:20 Speaker 3
Is, so we look at, you know, a few aspects of what goes into good mental health. And I think your example you just gave is is a very good one. And when you start thinking holistically, suddenly the problem space gets quite complex.
00:22:33 Speaker 3
But you know we have new analytical solutions that are coming up all the time. We are improving measurement of things and again, you know when we hopefully get a bit more money coming into this area, we can do more complex research that will allow more persistent and more causal inference. So for allows us to move more.
00:22:53 Speaker 3
And correlational designs to understanding the causalities and something that argues and I have talked about a lot is how can we find the best ways of studying?
00:23:04 Speaker 3
What we call positive causal levers because by the time someone is on a risk trajectory, a lot of complex things have happened to them already and they're complex things that we have no control over. But what we can do is use interventions to study positive course or mechanisms and I think.
00:23:24 Speaker 3
Doing that well in a cross disciplinary framework could really produce some interesting results.
00:23:35 Speaker 1
As an engineer, I'm finding the conversation absolutely fantastic and I'm thinking about those links, those connections and complexities that I've not considered before, and the SDG's offers a framework with 17 goals, 169 targets where we can explore those connections. What is interesting is.
00:23:54 Speaker 1
That the SDGS don't explicitly reference mental health and well-being, and I was wondering whether you think there should be a dedicated goal to this topic.
00:24:02 Speaker 3
I'd argue yes. I mean, if you look at the economic cost.
00:24:06 Speaker 3
Of mental health problems, both those that are in the internalising spectrum, so anxiety and depression, for example, and externalising spectrum, sepsis, antisocial behaviour disorders for instance, the cost is enormous. The economic cost is enormous. The human cost is enormous. We have cost associated with ability to work so.
00:24:27 Speaker 3
Economic productivity, incarceration, hospitalisation and not to mention the sort of the human emotional and social prospects we can't really measure in pounds or dollars.
00:24:38 Speaker 3
So I I think.
00:24:39 Speaker 3
This is something that really touches the core of who we are as.
00:24:43 Speaker 3
Humans, and it should absolutely be at the front and centre of sustained development goals.
00:24:49 Speaker 1
So at the moment, sadly, we do not have a dedicated goal, but we do have targets or number of indicators which allude to or relate to mental health and well-being, including those which would address health, poverty, tackling substance abuse and those are universal problems across wealthy countries across less wealthy countries.
00:25:10 Speaker 1
What kind of interventions do you think we need to address this problems?
00:25:14 Speaker 4
Yeah. So I should say here that when we designed our proposal for the grand challenges, the word intervention was central to it. So achieving change and improvement is central. So we want to identify what we call mechanisms because that's our kind of background that causal ways, the ways in which.
00:25:35 Speaker 4
Something improves and if we identify how it improves and why it improves then.
00:25:40 Speaker 4
We can tune it up. We can pop, you know, make it even better. So that's kind of so much at the centre of the grand challenges and we want to incentivize cross disciplinary work in bringing about good change improvement. So that's what we consider as an intervention. Now there are lots of different interventions that can be done. The good thing about doing interventions in our field is.
00:26:01 Speaker 4
That one can do them as a causal probe. If you see what I mean. Because you use randomization.
00:26:06 Speaker 4
In their control? Not invariably, but very often. So that means that you can do certain things now. It is very hard to randomise people, of course, to poverty and non poverty would be completely unethical. But what people, as you know have done is to say, well, it doesn't matter whether poverty is causal or not, which it may be in the having, you know, poor mental health. But is it possible?
00:26:26 Speaker 4
That if we tackled poverty, say that if.
00:26:30 Speaker 4
I gave you.
00:26:30 Speaker 4
Money. That's something that's simple. Seemingly simple as that. If I give you cash that that would improve outcomes, including mental.
00:26:38 Speaker 4
So this can be done in the context of a randomised controlled trial, or one could exploit what is called natural experiments. There's a very famous one in child mental health that happened in reservations in the United States, where suddenly casino was opened randomly within a set of reservations, and this was a natural experiment.
00:26:58 Speaker 4
Because there was no particular reason why the people in that part of the reservation had the casino, not others. The thing was that the casino brought money to the community there. People had measured already mental health outcomes before.
00:27:10 Speaker 4
That unintended intervention when they went back after a few years, they found that those people who had benefited, who had got them money, so who were closest to that area, actually the outcomes of their children were better. They explained it through a mechanism that involved mothers having more time, parents having more time. But in their case, mothers having more time.
00:27:30 Speaker 4
To be with their children, supervise them. Whatever.
00:27:33 Speaker 4
So it was a very a.
00:27:34 Speaker 4
Very nice example of you know how you can exploit natural experiments or in other cases randomization to arrive at those causal inferences. So there's a multitude.
00:27:46 Speaker 4
Of ways of tackling both substance abuse and poverty. None of them is perfect, obviously far from it, but there's there's so many things that could be tried and should be tried. Some have been tried, having worked. That's very interesting to know, despite best intentions, right. Some may even cause harm, but some will work and they are worth doing. And there are designs in which to do it.
00:28:07 Speaker 4
And I think that this is absolutely the thing to do.
00:28:11 Speaker 4
One of my favourite kind of examples, just to understand the complexity of issues in oncology and Cancer Research, which has seen dramatic developments in the last 20 years is the Philadelphia chromosome. So there's a blood cancer called chronic myeloid leukaemia. Someone discovered a very simple genetic mutation, I'll call it like that it's translated.
00:28:30 Speaker 4
Actually, in the 1960s it took 40 years to develop a drug based on that simple genetic defect that was such a simple disorder. It's like, I don't know, in engineering terms, it's like, you know, I don't know, building a pencil, mental health issues like build building an iPhone, it is going to take you longer, right. It is more complex.
00:28:51 Speaker 3
We know from genetics that that mental health problems are influenced by hundreds, if not thousands of genes each of.
00:28:59 Speaker 3
Increases the risk for developing disorder probabilistically a teeny tiny bit.
00:29:04 Speaker 3
So you know, then trying to figure out how that genetic risk translates into mental health problems and under what environmental conditions, it's a really it's formidable challenge. But there have already been some really interesting advances and, you know, as more concentrated cross disciplinary effort comes to bear on this research.
00:29:23 Speaker 3
Problem I think we're going to see advances in the coming years, but I would also say in this context that in some cases we may also want to.
00:29:33 Speaker 3
Think about how we can help people with mental health difficulties lead better lives. It's as Argo says, it's not realistic that everybody will be in quite secured and not everybody might even want to be.
00:29:47 Speaker 3
So there is also, you know, in addition to this idea of how can we shift the distribution, how can we get more people to be well, we may also want to invest effort and should invest effort. I think it would be morally appropriate to do so thinking about how can people with chronic mental health conditions lead a good life?
00:30:05 Speaker 4
Yes. And for young people in particular, I don't know.
00:30:08 Speaker 4
If they would agree with this.
00:30:11 Speaker 4
It is also about what the expectation is of a good life versus, you know, constant happiness and what constitutes a good life. And it's it's a very difficult it's it's not a scientific question as such, it's a societal question. It's about it's a value based question, but a very important one, right. And it shapes your expectation about how you would be and there's nothing worse than negative violations of your expectations. So adjustment of expectations.
00:30:33 Speaker 4
About what it means to live you.
00:30:35 Speaker 4
Know in society.
00:30:37 Speaker 4
Is actually quite an important.
00:30:38 Speaker 3
It's very much resonates with me. I'm from Finland and Finland regularly tops the world happiness pulse, which all the Finns find absolutely amusing because they're not particularly Jolly nation. But I think actually what those the service matter is general contentment. And I think we are a nation that is.
00:30:58 Speaker 3
Quite good and not expecting very much and being happy with their nice cup of coffee in the middle of the day. So I think that really speaks to about your access about you know, what are your expectations and how does your life matter up in relation to those expectations?
00:31:11 Speaker 2
So when you're talking about expectations, I'm a paediatrician, you know, the early years are very important to me.
00:31:17 Speaker 2
And when you're bringing a child into the world, you know, there are expectations for that child. Do you think that actually, you know, we put a lot of funding on, like you said, treatment or later on in life, do you think by shifting that to the early years, more and thinking about mental Wellness and creating children with more happiness?
00:31:37 Speaker 2
Or mental Wellness supporting the.
00:31:40 Speaker 2
Lots of engagement with the world that these young children need to have would shift some of the balance in the the mental health discipline.
00:31:48 Speaker 3
So I would like to see both money devoted to the earliest, but also maintained at the other bits of the distribution. So I I often think of particularly very vulnerable.
00:32:00 Speaker 3
Children and families as something that need the early vaccination. That is the early intervention, but that will also need booster shots. Adolescents is are not the sensitive developmental period. So absolutely I I think everyone would argue about the importance of investing in the early years into childhood in the ADA.
00:32:19 Speaker 3
Medicines, but not at the expense of of taking the investments away from the, you know, other periods of the of the lifespan and you know we only starting to, for instance, understand Women's Health and and its impact on mental health. And there are number of sort of shifts in terms of both hormones and big life events and you know pregnancy, menopause for instance.
00:32:39 Speaker 3
Which we now have impact on mental health. We are only starting to research.
00:32:43 Speaker 3
You know, it's it's a lifelong journey. So I I wouldn't advocate putting money to the earliest at the expense of the other bits of the development of spend. But I would absolutely advocate the importance of adequately investing to to children and young people. And then I think there is the question of what do we mean by promoting Wellness. Would we assume that everyone should be happy?
00:33:03 Speaker 3
All the time, which I don't think is probably a realistic proposition. Or would we be better off doing what Sir Mike Futter argued some probably 40 years ago now, which is inoculating the children sort of stealing the children?
00:33:18 Speaker 3
Against the inevitable stresses of life, and doesn't mean that we go out of our way to kind of cause disappointment to our children, but in a way, helping the child to negotiate the inevitable disappointments that come along the way. And in fact something that agrees. And I talk about regularly is we're a little bit concerned about actually, at least in the.
00:33:38 Speaker 3
Sort of middle class parents. What we see is this huge concern and anxiety about whether the child is happy all the time and and actually difficult to in tolerate.
00:33:47 Speaker 3
Negative feelings in the children and actually life sometimes has stresses and disappointments. And actually I I view my job as a parent, as someone who scuffles my children so that they can write truth. Those inevitable periods of difficulty without it becoming an all crushing thing. Obviously I'd rather they'd be happy most of the time, but I think that there is. There is something to be sort of.
00:34:08 Speaker 3
Is that also about what? What is it that constitutes promoting Wellness and what is Wellness? Is it being happy all the time or is it being content most of the time and being able to ride the difficult periods?
00:34:20 Speaker 1
And since we're talking about expectations, I was thinking about social.
00:34:24 Speaker 1
Media but the social media would have an impact on what we expect or societal expectations, and whether that has links with mental health and well-being.
00:34:34 Speaker 3
I might say something and I'll pass on to you as well, but I think it's a complex area of research. We don't have a lot of good data that would allow us to really understand what's going on, what we have out there at the moment suggest that it's not as simple as it's universally bad.
00:34:53 Speaker 3
For some children, it can actually be good aspects of it can be positive aspects of it can be negative. The children who seem to benefit are the ones who can engage with it with some level of agency and take the good bits that they like and not the bits that might be distressing. So my view would be that.
00:35:13 Speaker 3
It would be a mistake to write it off wholesale and that we need a lot more research into who might benefit from what and how we might adequately support children in using it in positive rather than negative ways.
00:35:27 Speaker 4
I completely agree.
00:35:29 Speaker 4
The just for those listeners of the podcast who may not be familiar with terms like confounding one of the issues is in in, in reverse causality is are the children who are unhappy to start with. To put it very simply, the ones who are also more likely to use social media excessively.
00:35:46 Speaker 4
In which case you know the chicken and egg problem, right? So that's one of the fundamental issues that we have. We don't it's it's very hard to find, to disentangle those things. And people are trying to do that. And you know there is some reasonable data suggesting results that suggest that as you've heard some of the children are probably affected by it. What exactly is affected?
00:35:49 Speaker 2
Let's check my e-mail.
00:36:06 Speaker 4
I mean, there are some very obvious things. Obviously, exposure to inappropriate material, which can happen through social media is a very bad thing. And unlike how it was, you know, 30-40 years ago now, it can happen at a grand scale. So there are things that.
00:36:18 Speaker 4
There are negative opportunities.
00:36:20 Speaker 4
As it were, that are afforded by social media, which we didn't have before at that scale and.
00:36:24 Speaker 4
Those are clearly bad.
00:36:26 Speaker 4
But then similarly, you know you can be in a very remote part of the world and you can, I don't know, watch Khan Academy. You know, it's amazing, right. So that's so that's kind of social media and then you can also connect with your friends and your family. You know, I was abroad. I was away from my.
00:36:40 Speaker 4
Family at the.
00:36:40 Speaker 4
Time when it was very expensive to talk on.
00:36:42 Speaker 4
The phone you know now I could see the, you know, I can see the.
00:36:46 Speaker 4
Picture in front of me and they just Chuck to them live. So those are amazing things and changes. So it's a question of of, of balance.
00:36:54 Speaker 4
And of doing really.
00:36:55 Speaker 4
Good research to arrive at the right at the conclusions that we need as a society.
00:36:59 Speaker 1
I agree it's a question of balance and also kind of good sign.
00:37:03 Speaker 1
And it feels that today there's been a really strong call for action, whether it's additional resources, but whether it's the right type of interventions at the right kind of stages of life for all groups and early interventions as well.
00:37:18 Speaker 2
Yeah, 1 intervention that people said to me was keep smiling every time you feel sad. Smile. Seriously, I I was a a Wellness resort and talk about Wellness as a Wellness result.
00:37:28 Speaker 2
And actually, they said if somebody looks at you and makes you feel low, just smile and you'll realise things get better. And I do that now. So a an easy intervention to tell everybody that, you know, just keep smiling every time you feel a little bit sad and it.
00:37:42 Speaker 2
Makes a difference.
00:37:43 Speaker 2
So on that note, thank you very much.
00:37:45 Speaker 1
On that happy note, keep smiling and thank you for joining us today. Where can listeners find you online?
00:37:47 Speaker 4
Thank you.
00:37:49
Yeah.
00:37:52 Speaker 4
By UCLA, yeah.
00:37:53 Speaker 3
Or use at.
00:37:53 Speaker 3
Google we both have very peculiar names. If you spell them right, you will find us.
00:37:54
Yeah.
00:37:57 Speaker 4
Exactly. Yeah. It's very hard to go wrong.
00:38:00 Speaker 2
Wonderful. Thank you very much. Thank you. You've been listening to unlocking the SDG's. This episode was presented by me, Professor Monica Lakhanpal.
00:38:01 Speaker 4
Thank you.
00:38:09 Speaker 1
And me Professor Peter Paric.
00:38:11 Speaker 2
And produced by the UCL SDG's initiative and edited by Frontier, our guest today were Professor SVD and Professor.
00:38:20 Speaker 2
Darius.
00:38:21 Speaker 1
If you'd like to hear more podcast from ECL, subscribe to UCL Mines wherever you download your podcasts or visit https://www.ucl.ac.uk/sustainable-development-goals/
00:38:32 Speaker 1
Join us next time on unlocking the SDGs.