Professor Miranda Wolpert MBE, Head of The Mental Health Priority Area at The Wellcome Trust discusses the programme’s current work. The programme’s overall vision is of a world in which no one is held back by mental health problems.
The Wellcome Trust is injecting large amounts of funding into advancing mental health science to find the next generation of treatments and approaches for youth anxiety and depression worldwide.
They have recently launched a set of commissioned reviews on which aspects of mental health interventions are effective, they’re referring to this as ‘the active ingredients’ of prevention or intervention.
Working with policymakers they’re also taking an inclusive approach working with new voices and perspectives including lived experience to advance science.
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Professor Miranda Wolpert heads up the Mental Health Priority Area at the Wellcome Trust. This involves overseeing a ring-fenced fund of £200million to develop a new generation of treatments and approaches to help young people held back by anxiety and depression. The overall vision is a world where no one is held back by mental health problems.
Miranda is also Professor in Evidence Based Research and practice at UCL and founded the Evidence Based Practice Unit, which is dedicated to bridging research and practice in youth mental health. Between 2012-19, she was NHS England’s National Informatics Advisor for Children and Young People’s Mental Health.
Miranda has extensive experience as a clinical psychologist for NHS England and in schools. Her experiences working with young people and families led her to co-found the Child Outcomes Research Consortium, a learning collaboration focused on understanding the impact of mental health and wellbeing support through collecting and using outcome evidence.
In 2017, Miranda was awarded an MBE for her services to children and young people’s mental health. (Bio via Anna Freud)
Transcript
Interviewer: Hello. Welcome to the ‘In Conversation’ podcast series for the Association for Child and Adolescent Mental Health or ACAMH, for short. I’m Jo Carlow, a freelance journalist with a specialism in psychology. Today, I’m interviewing Miranda Wolpert, Head of the Mental Health Priority Area at the Wellcome Trust. She is also Professor of Evidence-Based Research and Practice at University College, London. In 2017 Miranda was made an MBE for her work on young people’s mental health. Miranda, welcome. Thank you for joining me. Can you say a little about yourself by way of an introduction?
Prof. Miranda Wolpert: Yes. Thanks for having me. I started off as a clinician working for many years in the health service and in school settings and then I moved into academia and policy and training. And last year I had the great privilege of taking up the post as Head of the Mental Health Priority Area at the Wellcome Trust. The Wellcome Trust, for those who don’t know it, is one of the world’s largest research funders. I think we’re second to Gates. And my particular role is to disperse 200 million pounds over the next five years, and potentially another 200 million pounds over the following five years, in order to advance science, to create a world in which no-one is held back by mental health problems.
Interviewer: Great. Thank you. Miranda, can you tell me a little about your journey into the field of child and adolescent mental health?
Prof. Miranda Wolpert: Sure. So I started off as a clinical psychologist, and I spent many years working as a clinician. And then I moved into policy advice and academia and training. And I guess I’ve worked for many years in the intersection between academia, policy and practice, always with a focus on using evidence to improve life chances for those with mental health problems, with a particular focus on children and young people. And perhaps it’s of interest to people listening that, actually, my original background was a degree in history. And for some years I was on my old university’s website as an example of what you did with a history degree. But I also think that that background of studying history as an undergraduate has left me, and still contributes to my thinking about how to piece together fragmented information to make theories.
Interviewer: Right. Yes, that makes sense. What, in your view, are the main challenges facing the mental health community when it comes to doing right by children and young people?
Prof. Miranda Wolpert: So, for me, one of the key challenges is that, whilst there have been many fantastic advances in terms of our understanding what helps who and why, we still don’t know enough about what treatments are effective, in what context, for which individuals, which may be harmful, which may be helpful, and why that’s the case. So, I guess we believe that it’s vital to find the next generation of treatments and approaches that will really change things for young people, to either prevent or address or manage ongoing anxiety and depression.
We know that anxiety and depression are holding millions of people back in life generally, and that they generally start in youth, but we still know very little about what works for whom, in what context and why, in terms of either prevention or intervention. And that’s the area that we’re focused on in Wellcome, trying to address. There are obviously many other sorts of mental health problems that are particularly difficult, but we’re starting with anxiety and depression as a way of focusing in on two of the largest issues that face us worldwide.
Interviewer: Right. Thank you. As you mentioned earlier, you’re head of mental health at the Wellcome Trust, which recently laid out its mental health programme strategy. Can you briefly summarise the Wellcome vision?
Prof. Miranda Wolpert: So just to clarify, I’m head of the mental health priority area at the Wellcome Trust, and I work with colleagues across the Trust where there’s a number of streams of funding, including through the humanities, through neuroscience, and through population, health and public engagement. And we’re all working together on a combined strategy, where we want to create a world in which no-one is held back by mental health problems. To do this, we want to advance science to create a next generation of treatments and approaches. We’re starting with a particular focus on anxiety and depression in young people, but moving to a wider range of difficulties and issues over time. And in fact, very excitingly for us, Wellcome is now refreshing its strategy such that mental health will be one of three key challenge areas that it will be focusing on over the next 30 years.
Interviewer: Can you say what the other challenge areas are?
Prof. Miranda Wolpert: There’ll be climate change and infectious diseases.
Interviewer: Right. Great. Thank you. The Wellcome strategy describes how current research communities are siloed and fragmented and calls for a radical transformation. I’m wondering how might this transformation happen?
Prof. Miranda Wolpert: So we’re trying a number of things that we have hypothesised will make a difference. So, for a start, we’re seeking to create a more inclusive concept of what mental health science is. So to do this, we want to widen the concepts of science to include all rigorous exploration of evidence, whether that includes economic analysis or social and historical analysis, and to include new voices and perspectives, including those with lived experience and early career researchers from diverse communities worldwide. And we want this community to agree some common foundations, including core metrics, and a focus on what really makes a difference in terms of either prevention or intervention.
And as a first step on this journey, we’re absolutely delighted to announce this Monday, June the 8th, that we’re going to have our first set of commissioned reviews on what aspects of interventions make a difference. What we’re calling the active ingredients of either prevention or intervention. And each commission team will review the evidence for one active ingredient. And 30 teams worldwide will be looking at them. So some teams are looking at the same active ingredient. They’re very diverse. They cover the range of options from biological, such as changing gut microbiome function or changing levels of bodily information, right through to social, whether it’s changing people’s financial status or changing levels of neighbourhood cohesion.
And the idea is to really think about how we can understand those active ingredients, how they might work together, and in time to agree as a community which are the most important to focus on and fund, to really create the basis for the next generation of treatments and approaches, that are going to help people not be held back by mental health problems.
Interviewer: Right. And if people want more information on some of the findings, where will they go to get to that?
Prof. Miranda Wolpert: So all the information is available on our website. The report should be out in October and then we’ll be doing a dissemination strategy from there, trying to work with a diverse range of stakeholders to try and really work out what are the implications of what we found and where do we go next. So in time, Wellcome wants to work with the wider mental health science community to refine and review the active ingredients to a core foundational set that we know will work for most young people, in most contexts, globally.
And then it’s that step that we hope will underpin Wellcome’s work on advancing mental health science to find the next generation of treatments and approaches for anxiety and depression in young people, with a particular focus on 14 to 24 year olds. And that will be linked to our commitment of the 200 million over the next five years, to really try and galvanise the field to find improved and enhanced ways of helping young people, drawing on what we know already and building a new learning.
Interviewer: Right. Thank you. Working with policymakers is a component of the Wellcome strategy. Now, I often interview researchers who express frustration around the translation of evidence-based research into policy development. They feel it doesn’t happen as much as it should. How does one go about embedding an understanding of what science can contribute as central to the mental health policy agenda?
Prof. Miranda Wolpert: So I think there’s frustration on both sides of the equation here. And I’ve been in rooms with policymakers and scientists. And I think part of the difficulty is the issue of translation. So many policymakers are humanities graduates, and many researchers and scientists are not used to talking outside their own community. And so both of those groupings need help to understand each other’s perspectives. And both want the same things in terms of wanting to make use of science to really advance understanding and policy.
We’re very lucky in Wellcome that we work very closely with policymakers, and we have a strong policy and advocacy team who work closely with key organisations, such as the World Health Organisation, UNICEF, World Economic Forum, as well as members of civil society who are interested in mental health, such as leaders of big businesses or employers. And really we want to help policymakers understand the role of science and how important science is. And we also want to help them make better use of science.
So to do this we need movement on both sides. We need the policymakers to understand the role of science. But we also need scientists who are prepared to share their findings and insights in clear and actionable ways. We need them to, in some sense, recognise the caveats, but not expect the policymakers to get involved in that level of detail. And really give the policymakers some ideas around practical things they can do.
Interviewer: Right. And I’m just going to ask how you help policymakers and scientists, coming from different backgrounds, to speak the same language, in some way?
Prof. Miranda Wolpert: So I think it is an act of translation. So I think it involves helping the scientists be clear about what the current implications are, and be free to make inferences based on patchy data. So it’s not about not recognising the limitations of the science, but also saying the policymaker has to make a decision now, today. It’s no good you just saying endlessly more research is needed. You actually need to say, based on what research we have now, my best advice for today is this, with all the caveats that you need to add.
And then it’s for policymakers to help them understand, okay, this is the best advice you’ve got now, but it’s got all these uncertainties around it. So here are the things we can be more certain about, here are things that we can be less certain about. You then need to make your decision within that.
So I think it’s for both groups to slightly move their position. The policymaker always wants absolute, clear, black and white answers. This is the answer, this is how I’m going to address it. I now need you to do it. The scientist always wants to say more research needed, it’s all much more complicated than you think, and here’s the interesting, complex discussion I’m going to have on it. It needs translators between those two groups to bring them together and say, okay, I’m going to distill down what you scientists have said. Policymaker, I’m going to try and help you understand what the range of uncertainty is. And then it’s being very clear. The policymaker makes a decision. The scientist gives their best advice.
Interviewer: That’s really helpful. You earlier mentioned the importance of including new voices and perspectives. A component of the Wellcome strategy, I understand, is to involve young people with lived experience of anxiety and and depression. Why is this so necessary?
Prof. Miranda Wolpert: So we believe this is one of the pillars of advancing the field in new ways. And this comes from a belief that those with lived experience of a particular issue bring a different perspective than those without that experience. And as with any other field of knowledge, direct experience gives you different insights. This doesn’t mean that everyone with the experience will have the same views or the same insights, but we want to ensure that a range of perspectives is at the heart of all we do.
All too often, insights from young people, particularly those with experience of mental health problems, are somehow downgraded or left out or disregarded from discussions. And it’s really important they’re included. Not to trump other views, but as part of a wider range of wanting diversity of perspective. Because we want the best brains and the best experience and the best detail to really help us understand how we can go forward. Otherwise, we’re basing our science on limited insights and reducing our potential for creative thinking and taking things forward.
Interviewer: Thank you. Great. Miranda, as we speak, we are impacted by the Covid-19 pandemic. What do you envisage will be the long-term impact of the pandemic on child and adolescent mental health? And is there anything that practitioners, service providers and commissioners should be thinking about now in preparation?
Prof. Miranda Wolpert: I think it’s actually quite hard to know what the long-term effect will be. And whilst one’s in the middle of a crisis, there can be a tendency to want to assume that we know we can be able to see long-term. I suspect, if I were to guess, that it will amplify existing problems, including particularly inequalities, rather than necessarily creating particularly new things. Although there may be some specific neurological effects of Covid itself, but yet to be explored in detail.
I think we all need to think now about how we can best prevent and address the problems at scale which already existed and are going to be even more amplified by the current experiences. And particularly be mindful of the inequalities that already exist and how these can be addressed at their roots.
I guess, at Wellcome, we’ll also have the opportunity to think about what positive learning we might be able to take from this incredibly challenging and difficult time, including potentially thinking about how, under crisis, we’ve been perhaps able to develop more cohesive communities or be more open about mental health or be more open about inequalities or systemic racism, for example, that have come up as discussions that have galvanised communities.
And whether we can hold onto those and really take them forward into the science going forward so that we make sure they’re embedded in everything we do. And we’re currently exploring a piece of work around how we can best capture these aspects and hold them into the future.
Interviewer: And Miranda, what else is in the pipeline that you’re working on?
Prof. Miranda Wolpert: Well, one thing that we’re particularly excited about is we have a call out currently for a software supplier to work with us as a learning partner to develop an innovative databank that will allow us to really focus on rich data about a whole range of things in people’s lives that may relate to either preventing or intervening or stopping relapse or managing ongoing anxiety and depression.
I’m really interested in trying, not just to capture what people do, but actually why they do it, using the lens of the active ingredients we discussed earlier. So we’re really trying to understand what works for whom and why by gathering that data from the individuals, using things ranging from self-report to wearables to other indicators.
And as part of this, we’re seeking to create this in a way that really gives as much control as possible to the people who are choosing to bank their data and share their data in this way. So that they, as citizen scientists, control as much of the process as possible. And that’s something that we have expressions of interest out for at the moment.
The deadline for that is Monday. So we’re really excited to see who will be applying for that and who we might be working on that with going forward. And that’s something we’re looking to do both in the UK, but also internationally, to make it something that could be a global initiative.
Interviewer: Miranda, can you say something about how the data bank will be used at the user end?
Prof. Miranda Wolpert: So our hope is that this data bank will allow multiple uses of data and will be genuinely modelling open science in new ways. So we want it to be accessible to a wide range of scientists, this general data, with obviously appropriate data security in place. But we also want to create it in such a way that those banking their data can both join in that broader scientific endeavour, but also view their own data to help them manage and monitor their own mental health.
So, in an ideal world, as we learn more about which active ingredients help which people, individuals may choose to monitor particular active ingredients that are relevant for them and to check in and use that information to help them manage and monitor their own mental health.
Interviewer: That sounds really exciting. Miranda, before I ask you for your takeaways, is there anything that I haven’t asked that you would like to add?
Prof. Miranda Wolpert: I think the only thing that I would like to add to people that may be hearing this is that I know that Wellcome can feel like somewhere that is only for a certain sort of people. And we really want to be clear that we want the best science done from that wider community, including those with lived experience of mental health problems, to access the funding and riches of Wellcome to advance the science.
So don’t think Wellcome is not for you. Wellcome is open to anyone who has great ideas that might make health thrive. So please consider us. We’re a very open organisation. If you’ve got a great idea, look to see if there are opportunities.
Interviewer: And finally, Miranda, what is your takeaway message for those listening to our conversation?
Prof. Miranda Wolpert: So my message would be, please join us on this journey to create a new inclusive mental health science. We want, together, to develop the next generation of treatments and approaches. And together, we’re going to try and create a world where no-one is held back by mental health problems. Look at our website and do remember that Wellcome is for everyone.
Interviewer: Brilliant. Miranda, thank you ever so much for your time. For more details on Professor Miranda Wolpert, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt ‘ACAMH’.
