Latest / New Thinking for a New World / The Global Mental Health Crisis

Transcript

The Global Mental Health Crisis · New Thinking for a New World

• 0:02
  Speaker 1: Welcome to New Thinking for a New World, A Tilburg Foundation podcast.
• 0:06
  Speaker 1: I am Alan Stoga your host.
• 0:09
  Speaker 1: Each week i bring you conversations with people who think differently about the great issues that are shaping our world Geopolitics Disruptive Tech Mass Migration The Changing Climate Culture Wars.
• 0:21
  Speaker 1: All of it is grist for our mill!
• 0:28
  Speaker 1: and that you join the conversation at telbergfoundation.org.
• 0:33
  Speaker 1: And now for today's episode of New Thinking
• 0:35
  Speaker 0: For A New
• 0:36
  Speaker 1: World.
• 1:01
  Speaker 1: live with a mental health disorder.
• 1:03
  Speaker 1: Lancet's twenty-twenty six global burden of disease study agreed that the number people living with mental health disorders, with mental disorders rather approaches one point two billion.
• 1:14
  Speaker 1: those are huge numbers and they obviously generate lots questions.
• 1:19
  Speaker 1: is this new?
• 1:21
  Speaker 1: if so why?
• 1:22
  Speaker 1: Is the incidence different in the Global North versus the Global South?
• 1:27
  Speaker 1: did COVID have anything to do with conditions today?
• 1:31
  Speaker 1: Could social media be a factor?
• 1:33
  Speaker 1: And perhaps most importantly, what can be done.
• 1:38
  Speaker 1: If anyone might have answers it is today's guest.
• 1:41
  Speaker 1: Vikram Patel is Professor and Chair of Global Health & Social Medicine at Harvard Medical School... ...and the founder of Sangath in India.
• 1:50
  Speaker 1: Welcome Dr.
• 1:51
  Speaker 1: Patel to New Thinking for A New World.
• 1:54
  Speaker 0: Thank you all!
• 1:55
  Speaker 1: As a Yaeli I'm tempted to skip The Harvard Part and go directly to Sangath But I'm not going to do that.
• 2:00
  Speaker 1: I think we need to start with the definition and dimensions of a problem, how should we understand the WHO and LACID?
• 2:07
  Speaker 1: And a raft of other reports about the pervasiveness of mental health issues today?
• 2:12
  Speaker 0: Well i think um That's a complex question because The most complex part of that question is what constitutes a mental health disorder.
• 2:22
  Speaker 0: and To be quite honest there isn't any kind of you know gold standard to define that an individual have a mental disorder or not.
• 2:30
  Speaker 0: For example, there isn't an equivalent of an x-ray.
• 2:33
  Speaker 0: There is an equivalent for blood test That you would traditionally use in any other branch of medicine To find who has the particular health condition.
• 2:41
  Speaker 0: on art You rely pretty much entirely On what and individuals shares with you about their experiences.
• 2:49
  Speaker 0: And then you use a set of algorithms, mental algorithms if you've been trained to actually do a diagnostic.
• 2:55
  Speaker 0: To actually define whether or not that constellation experiences the duration time when someone has had those experience and impact it's having on their daily lives where they all come together to find disorder.
• 3:08
  Speaker 0: what is really implication in this individual may potentially benefit from clinical intervention important for me to specify I say because there are no natural boundary between people who meet those criteria of a disorder.
• 3:24
  Speaker 0: And say, for example, those who are very distressed but don't meet one or more of those different criteria that I set up in the algorithms with their background and mind which may seem a little opaque to some of our listeners.
• 3:38
  Speaker 0: it's important just to give that caveat because like i said The numbers can shift if you just shift the algorithm.
• 3:45
  Speaker 0: With that caveat in mind, what I think it's safe to say is anywhere from one in ten-to-one and twenty individuals around the world will meet those relatively arbitrary criteria.
• 3:58
  Speaker 0: That they're living with a condition that is serious enough... ...that it merits some form of care or support for that individual.
• 4:05
  Speaker 1: Do these criteria differ in different cultures?
• 4:08
  Speaker 0: You see its same criteria applied to all cultures, because the assumption of course is that mental health conditions just like any other health condition are universal human experiences and there's no reasonable grounds to say that uh...the criteria to define a mental disorder would differ.
• 4:24
  Speaker 0: Say in united states or amongst peoples in the United States.
• 4:27
  Speaker 0: Because remember In a country Like The US you also have very diverse groups Of people.
• 4:33
  Speaker 0: um..and so You could argue That if There Is A variation between Countries there's likely To be a variation within countries too And that just kind of opens a Pandora's box.
• 4:42
  Speaker 0: So the assumption is, these criteria work equally well in all cultures and all populations and all groups in every population because you can actually make comparisons between different groups and countries without having common standards.
• 5:00
  Speaker 0: it's impossible to make comparison.
• 5:02
  Speaker 0: In my own experience working with many different contexts I will say generally that these criteria work really well across different cultural groups, across different populations.
• 5:14
  Speaker 0: And so it is a reasonable benchmark for us to use to define how many people live with the mental health disorder?
• 5:22
  Speaker 0: What are the variations between different groups of people—for example by age, gender or ethnicity who lived with their mental disorders and therefore also begin to draw some conclusions about vulnerabilities protective factors and so on.
• 5:38
  Speaker 1: Would you agree with my friends at AI that the incidence of mental health disorders is increasing decade to decade?
• 5:47
  Speaker 0: Well, it's fair to say in those countries where we have longitudinal data... That has been collected over a period using the same criteria.
• 6:00
  Speaker 0: What I said earlier is extremely relevant.
• 6:02
  Speaker 0: If you shift the criteria between two thousand and twenty, then You don't know whether any differences you observe are because of the criteria have changed or Because there's a genuine change.
• 6:12
  Speaker 0: So if you look at that kind of consistent longitudinal data It has to be set.
• 6:17
  Speaker 0: very few countries in the world Have that kind Of information And most of them Are clustered In The high-income World That Is To Say North America And Western Europe.
• 6:28
  Speaker 0: The answer is yes.
• 6:32
  Speaker 0: There has been an uptick in the prevalence of mental health conditions, but to a large extent that uptake is observed in young adults adolescents and in young people In US and Western Europe.
• 6:46
  Speaker 0: And it's not just the prevalence Of mental health disorders That shown increase But also hard outcomes.
• 6:53
  Speaker 0: by heart I mean very clearly objective Outcomes like mortality.
• 6:58
  Speaker 0: And so if you think of suicide mortality as perhaps the best example for metric that is linked to mental health Yes, suicide rates have also gone up especially in young adults In high-income countries now.
• 7:13
  Speaker 0: That it's not to say that this may not be Also happening in South Africa or Asia?
• 7:17
  Speaker 0: It's just that we don't have comparable data that I can refer too.
• 7:21
  Speaker 1: Well that's exactly where I had wanted to go, so thank you for taking us there.
• 7:51
  Speaker 1: which says something about how I look at the world, but she's telling me that in the students.
• 7:56
  Speaker 1: She is dealing with this university.
• 7:59
  Speaker 1: they really do believe This Is an unstable World and hence That has some could have Something to Do With The Observation You Just Shared?
• 8:06
  Speaker 1: That Mental Health Issues Among
• 8:09
  Speaker 0: the
• 8:09
  Speaker 1: among Younger Generations Are a serious issue.
• 8:14
  Speaker 0: so you know it's A great Question is first of all objectively Is the world more unstable now than it was, say in the nineteen seventies and eighties?
• 8:23
  Speaker 0: I don't think there's any empirical way of comparing these two periods.
• 8:27
  Speaker 0: But i think my own lived experience is that... ...I don't see not really addresses why young people's mental health is worsening.. ..i think instability is part and parcel of human history especially in my lifetime.
• 8:40
  Speaker 0: uh you know It's easy to forget.
• 8:42
  Speaker 0: back into the nineteen sixties and seventies You had a Vietnam war then You know, the Berlin Wall falling down.
• 8:48
  Speaker 0: There's been a lot of instability right through The last fifty years at just different epochs and different kinds Of consequences.
• 8:56
  Speaker 0: I think that more important question is why Is the feeling of Instability heightened in young people today for that?
• 9:03
  Speaker 0: And i think there's no doubt That the perception that the world has become More unstable or uncertain the future is more unpredictable.
• 9:16
  Speaker 0: Have that perception?
• 9:18
  Speaker 0: and the question.
• 9:19
  Speaker 1: And do you think?
• 9:19
  Speaker 1: That's a global phenomenon.
• 9:21
  Speaker 0: again, You know what I think it is true in many parts of the world but It's important not to think of Global as just the country.
• 9:29
  Speaker 0: i do Think there are variations within countries between different social classes Between individuals who've had Different life experiences and then i'm gonna say A little bit more about that.
• 9:39
  Speaker 0: so The question Of What Is driving this feeling of uncertainty This sense Some some dread dreadful thing that lies ahead is I think the key question of our times.
• 9:53
  Speaker 0: There's no doubt in my mind at one reason for that as social media because what Social Media does.
• 9:58
  Speaker 0: Is there an access a platform?
• 10:01
  Speaker 0: For it It's often an echo chamber.
• 10:03
  Speaker 0: with the moment you start having some uncertainty about a particular issue Its very quickly to be dragged into a rabbit hole.
• 10:11
  Speaker 0: Thanks, to the way these algorithms work because the moment You start looking for certain information The algorithm picks it up and amplifies them.
• 10:18
  Speaker 0: And so in a way, It actually can create kind of a cellar In which you're trapped.
• 10:25
  Speaker 0: These fearful ideas about the future or present Can only get more amplified.
• 10:33
  Speaker 0: Social media does play a role.
• 10:35
  Speaker 0: But I think there's another tantalizing possibility.
• 10:38
  Speaker 0: Is that young people today were children maybe fifteen or twenty years ago?
• 10:44
  Speaker 0: The question to also ask is that we know very well, our early childhood experiences profoundly influence the development of our brains.
• 10:52
  Speaker 0: This one of the most important findings in developmental neuroscience are that the earliest years of life are profoundly important.
• 11:00
  Speaker 0: and this why adversities in the earlier years of lives were the single-most important risk factor for mental health problems.
• 11:08
  Speaker 0: fifteen or twenty years later fundamental changes in the experience of childhood over the last two decades.
• 11:19
  Speaker 0: So, that the generation of young people today when they were growing up have there been any change is an inexperience with their child and some you know important observations.
• 11:28
  Speaker 0: but yes to happen children who are grown-up into young adults today experienced far more closeted costed childhoods than them then the young people off say twenty or thirty years ago.
• 11:41
  Speaker 0: And that opens the door to question, does overprotection from world actually ill-prepare for young people of today to deal with uncertainty compared their parents generation?
• 11:56
  Speaker 0: I don't know if i'm being clear here.
• 11:58
  Speaker 1: No you're really quite clear and it's terribly important.
• 12:01
  Speaker 1: this issue which is certainly case in United States but true northern Europe a lot places The way we parented was more protective because it could be.
• 12:16
  Speaker 1: We had the resources to protect our children from lots of things, famously in the United States kids get sick for things they didn't used to get sick because they weren't dirty.
• 12:27
  Speaker 1: when they were kids They didn't roll around in the mud and I say that facetiously but only partially facetiously.
• 12:33
  Speaker 1: It is part and parcel.
• 12:34
  Speaker 1: i think what you just described really quite eloquently.
• 12:38
  Speaker 0: Well, you know.
• 12:39
  Speaker 0: You can see signs of that everywhere Alan.
• 12:41
  Speaker 0: I mean consider for example when I look at the lived experience with my own childhood.
• 12:47
  Speaker 0: in My childhood?
• 12:48
  Speaker 0: You know i went to school and on public transport With everybody else And so it's stand-on-the-highway, you don't wait for the bus or get in the bus.
• 12:57
  Speaker 0: When I was like ten years old um And no one thought there was anything dangerous about When I would come home from school, my mum would immediately get me to get out of my school clothes and she'd say, Get out now.
• 13:13
  Speaker 0: And don't come back till supper
• 13:14
  Speaker 0: time.".
• 13:15
  Speaker 0: And I would disappear!
• 13:16
  Speaker 0: I would play with my neighbourhood friends... ...I would come back filthy dirty with cuts & bruises from playing sports on some makeshift parking lot where we would play soccer etc.
• 13:27
  Speaker 0: You don't see that experience all that often today, because children are being closeted and protected in every single step that they take out of school.
• 13:40
  Speaker 0: And I think it's a really important question has that kind of protection inadvertently led to their children growing up into young adults who are simply not fully prepared for the reality
• 14:01
  Speaker 1: unintended consequence of prosperity?
• 14:04
  Speaker 0: Also, if maybe prosperity but also wanting to make sure that your child doesn't fall into some kind of dangerous situation.
• 14:13
  Speaker 0: I feel we've over amplified the dangerous neighborhood idea.
• 14:19
  Speaker 0: there is a lot danger lurking and children need constantly protected by one's parents in certainly certain social and cultural contexts.
• 14:32
  Speaker 1: And, certainly in China we had the evidence of one children policy.
• 14:38
  Speaker 1: when child policies where you have four grandparents and two parents all focused on this one child must be different than it would've been twenty years ago or thirty years ago.
• 14:50
  Speaker 0: So that's an interesting point You just made.
• 14:51
  Speaker 0: I mean clearly these phenomena are also happening In real time alongside the reduction in size of their family.
• 15:01
  Speaker 0: In the nineteen thirties or forties, it was not uncommon to have four and five siblings And that formed a little community on its own.
• 15:10
  Speaker 0: Your parents were so completely unable make sure you could helicopter every single child.
• 15:15
  Speaker 0: Naturally You had A lot more engagement with The world outside And maybe it's true exactly as you describe, that families have reduced in size.
• 15:24
  Speaker 0: Also has they become disconnected from intergenerational family structures?
• 15:29
  Speaker 0: That the focus on one or two children you do have is naturally heightened and may be... ...that also plays a role in this kind of overprotected childhood which now becomes norm particularly for certain social groups at certain settings.
• 15:47
  Speaker 0: What do war lessons form Gaza rethinking education peace in Ukraine and visionary leadership have in common.
• 15:55
  Speaker 0: They are all themes from recent episodes of this podcast, check out more episodes on tellbergfoundation.org or on a platform over your
• 16:04
  Speaker 0: choice.".
• 16:08
  Speaker 1: So that's the demand side.
• 16:10
  Speaker 1: if you will let's shift to the supply side.
• 16:12
  Speaker 1: what do about it?
• 16:14
  Speaker 1: as with every aspect health care is undeniable.
• 16:17
  Speaker 1: there's shortage trained qualified mental health professionals everywhere.
• 16:23
  Speaker 1: that's true of health in general, it certainly drew up mental health in particular.
• 16:28
  Speaker 1: In other parts of the healthcare world this has led to sort of a pushing down and I don't mean down in a vertical sense with pushing responsibility into nurses, into other health professionals giving them better training perhaps more importantly empowering them act as healthcare professionals.
• 16:52
  Speaker 1: That's my simplistic understanding of what you have built with Sangrath in India, but You should probably tell us.
• 16:58
  Speaker 1: What actually is sangra?
• 17:00
  Speaker 0: Yeah before I tell you what song out there Is i just wanted to say a couple other things about young people.
• 17:05
  Speaker 0: The first thing To Say About Young People Is that the risk Of Developing A Mental Health Problem Is The Highest During The Years Between Puberty and Your mid-twenties.
• 17:17
  Speaker 0: Most listeners May Not Be Aware That About Two Thirds Of All mental health disorders have their onset before the age of twenty-four.
• 17:26
  Speaker 0: So this tells you something, first and foremost about the developmental nature of mental problems.
• 17:32
  Speaker 0: This is true even before modern times.
• 17:35
  Speaker 0: It's a characteristic property of mental conditions.
• 17:39
  Speaker 0: just in same way for example that cardiovascular disease or diabetes typically has its onset in middle years of life Mental Health Conditions had there on set in early years something very important about prevention, which is to say that obviously it's about the early years of life.
• 17:56
  Speaker 0: Something happening to you in your early years that shape your brains and make you either vulnerable or resilient to developing mental health
• 18:04
  Speaker 0: problems.".
• 18:05
  Speaker 0: So this is a universal phenomenon.
• 18:08
  Speaker 0: This is fundamental for mental health problem.
• 18:10
  Speaker 0: The second thing we understand why.
• 18:14
  Speaker 0: But that is the case because this is a period of life in which you make the most important social transitions, and there's no other ten-year phase when it comes to such a gigantic leap.
• 18:27
  Speaker 0: In young people who are making the leap from being completely dependent on adults... ...to becoming an autonomous independent adult yourself And actually having decisions for whoever depends upon them.
• 18:42
  Speaker 0: During these periods You attain sexual maturity, you have your sexual identity that consolidates.
• 18:47
  Speaker 0: You complete education and find work whereas in the parents or grandparents generation probably at this phase already had families of their own.
• 18:59
  Speaker 0: In modern times when they are still in education They're actually in a fairly secure environment So it's important to remember.
• 19:07
  Speaker 0: This is global phenomenon.
• 19:10
  Speaker 0: The final thing about young people That period of life is characterized by a sense of invincibility.
• 19:18
  Speaker 0: It's the most hopeful period in your life, and it is relevant to that question.
• 19:23
  Speaker 0: you asked me this way... ...it's the period when one doesn't want help from an adult.
• 19:29
  Speaker 0: Whether for mental health or physical health problems,... ...you don't think there will be any doctor who wants to see them.
• 19:37
  Speaker 0: You leave alone seeing psychiatrists or psychologists as usually the last person.
• 19:42
  Speaker 0: you want to see.
• 19:43
  Speaker 0: And so what Sangat has been doing in India, it's a not-for-profit organization... It's been designing interventions for the prevention and care of mental health problems across the life course but with a particular interest in young people.
• 19:57
  Speaker 0: that address both supply side barriers as you described Alan.
• 20:01
  Speaker 0: yes there are very few mental health professionals dedicated to their needs across the world um But also demand side barriers.
• 20:09
  Speaker 0: Let's not forget that even if you had mental health professionals in every little neighborhood, it stopped the case and young people are going to be trooping up their door saying I want to see who need help.
• 20:18
  Speaker 0: Because young people don't want just seeing mental health professions.
• 20:22
  Speaker 0: So we've developed models of providing care through providers Who Young People Find Acceptable which is typically young adults themselves who are trained To provide evidence-based psychosocial interventions And do that in settings where young people actually spend most of their time.
• 20:41
  Speaker 0: For example, in colleges and schools In community-based settings outside the hospital or clinic.
• 20:48
  Speaker 1: The term of art seems to be task sharing.
• 20:51
  Speaker 1: What is test sharing?
• 20:52
  Speaker 0: It's simply an idea that comes from global health more generally.
• 20:56
  Speaker 0: Um...the idea that certain healthcare tasks can be shared with individuals who do not necessarily have a high degree training And therefore cost that doctors might actually have.
• 21:09
  Speaker 0: In the mental health space, there are many such tasks.
• 21:11
  Speaker 0: for example Sangat has shown That delivery of specific psychological skills building techniques An example is problem solving.
• 21:20
  Speaker 0: Another one is behavioural activation Can be delivered very effectively even by lay people.
• 21:26
  Speaker 0: But key thing Is intervention must be manualised.
• 21:30
  Speaker 0: It needs to be protocolised and defined So you know exactly what it's supposed do And there has to be attention on the training, supervision and quality of showing process.
• 21:41
  Speaker 0: So these frontline providers are delivering these interventions with a high degree of fidelity.
• 21:47
  Speaker 1: Obviously There's it that is the possibility Of doing great good but also potentially great harm Would seem to me That as you've described The range of mental health challenges You mentioned earlier the increasing incidence of suicide among young people.
• 22:04
  Speaker 1: Obviously, that's the extreme case.
• 22:09
  Speaker 1: How do you train lay people to know when it is time... ...to help this person find more professional support?
• 22:19
  Speaker 0: The first thing I would say is that identification of a high-risk individual or red flags as they were should signal the need for a specialized individual provider is integral to the training.
• 22:35
  Speaker 0: It's always part of everything we do, exactly the kind of safety issue that you refer to.
• 22:41
  Speaker 0: The second thing to say is that supervision Is critical to this process.
• 22:46
  Speaker 0: so training is one thing knowing when to refer.
• 22:48
  Speaker 0: but the other aspect is supervision.
• 22:50
  Speaker 0: and supervision Of course ensures if there are any red flags that a supervisor notices That can also trigger referral.
• 22:57
  Speaker 0: And third thing To Say Star-sharing has to be seen as part of a comprehensive mental health care system response, to population and mental health needs.
• 23:11
  Speaker 0: It's not just frontline workers working on their own.
• 23:13
  Speaker 0: they're working as an outreach To the established mental healthcare system.
• 23:17
  Speaker 0: And in this way what the Mental Healthcare System is doing?
• 23:20
  Speaker 0: Is that it's reaching The last mile its ensuring That those who either for historical reasons or For other reasons do Not want to come and seek care directly from the mental health service are actually still receiving the support they need to enable recovery.
• 23:35
  Speaker 1: You work both in the global south and the global north, you work with it... The ranges of different quality healthcare systems, Ranges of different aspects of the problem specifically Sengeth In India.
• 23:51
  Speaker 1: what has your experience been?
• 23:53
  Speaker 1: that translates for example To the United States or two northern Europe?
• 23:59
  Speaker 1: or two more broadly, the global north.
• 24:02
  Speaker 0: So I had a real privilege of actually translating uh... The models that we've developed in India to the United States through partners in Puxes and then California and in Massachusetts.
• 24:12
  Speaker 0: And it's been a terrific learning experience because what it showed me is That mental health inequities unmet needs for care existent.
• 24:21
  Speaker 0: all parts Of the world including the united states which has more mental health professionals per capita than any other country in the world.
• 24:28
  Speaker 0: And it tells you something very important, just simply having more mental health professionals doesn't guarantee that the needs for mental healthcare will be eliminated.
• 24:38
  Speaker 0: To give me one example The city of New York has more mental-health professionals In absolute numbers than the whole continent Of Africa and yet a former mayor of the City of New york launched A program called Thrive New York City.
• 24:55
  Speaker 0: On the front page of that document, The title is star sharing.
• 24:59
  Speaker 0: Bringing mental health care to all New Yorkers.
• 25:01
  Speaker 0: and this tells you there are demand side barriers That are extremely important And that Star Sharing isn't only a way To address the lack Of Mental Health Professionals It's also A Way To Provide Equitable Mental Healthcare That Reaches Everyone In The Community.
• 25:20
  Speaker 0: Our work in Texas I'll Tell You Alan Has Been Really Inspirational Because one of the great strengths in the United States is that it's a nation with people of faith.
• 25:30
  Speaker 0: And we have found that the interest that faith-based communities have to leverage their faith, to leverage congregations and reach out and support those struggling with mental health has been one of our most remarkable potential.
• 25:45
  Speaker 0: partnerships established at Harvard Medical School And that's currently what we're doing is one example of a partnership.
• 25:52
  Speaker 0: We are leveraging two different things, the science The Science Of These Brief Protocolized Interventions and the Science Of How You Train & Supervise Frontline Workers... ...and this moral commitment That members of these congregations have to serve others in their own communities In the name of their faith.
• 26:12
  Speaker 1: I'd like to shift To technology..we talked about social media.
• 26:16
  Speaker 1: you talked About Social Media as as a problem in terms of compounding fear and anxiety, there's a frightening amount at least anecdotal evidence that people are turning to AI for mental health counseling.
• 26:31
  Speaker 1: And an extremist for advice on literally life-and death issues?
• 26:35
  Speaker 0: That
• 26:36
  Speaker 1: raises several interesting questions.
• 26:39
  Speaker 1: one is obviously why our people willing to rely for counsel about such deeply personal issues as their mental health, is there anxieties?
• 26:52
  Speaker 1: Is the issue in second if that phenomenon is as widespread.
• 26:58
  Speaker 1: As the media suggests it is what can be done above to avoid the obvious downside risks?
• 27:05
  Speaker 0: So I think to answer your first question The evidence suggest the reason because you have instant advice and no one even a mental healthcare system that has fabulous coverage, will ever be able to provide the kind of instantaneous support or advice that AI bot can give you.
• 27:25
  Speaker 0: And I think we have to learn to live with
• 27:27
  Speaker 0: AI.".
• 27:28
  Speaker 0: You know?
• 27:29
  Speaker 0: A more important question for us is how do we ensure that the AI agents are not providing incorrect advice and not amplifying or worsening mental health
• 27:41
  Speaker 0: crisis?".
• 27:42
  Speaker 0: This actually an engineering that there are safety parameters built into those AI agents.
• 27:50
  Speaker 0: And I believe many of the AI agents out there already being engineered to do so, for example... I don't think any AI agent would ever give advice on how they should end their life as a person who is suicidal.
• 28:07
  Speaker 0: Those are obvious safeguards you'd have to engineer in your agency and it's an effort that we need is a partnership between AI companies, mental health professionals and very importantly young people themselves to ensure uh...that the kind of responses that AI is generating are always tailored for the individual.
• 28:30
  Speaker 0: And they're guided by what helps recovery rather than making things worse.
• 28:36
  Speaker 1: Tragically unfortunately there are some documented examples points someone in the direction of suicide, but helps execute the process.
• 28:51
  Speaker 1: Which leads to a larger question which is beyond the scope of this conversation about control safeguards fail firewalls etc.
• 29:01
  Speaker 1: It isn't engineering problem But it may also be intrinsic to the technology that Control Is a problem.
• 29:10
  Speaker 0: Yeah, you're right.
• 29:11
  Speaker 0: I mean if the technology is like a social media algorithm of technology which has intended to suck a person and have them hooked into your AI bot then yes!
• 29:22
  Speaker 0: You are absolutely right because then the AI is no longer working towards more science-based response but more trying keep people... And when try to keep someone hooked than sometimes amplify or very mental health concerns that experiencing as a way to keep them hooked.
• 29:42
  Speaker 0: You're absolutely right, I know these concerns you mentioned also apply the social media algorithms and in the United States.
• 29:50
  Speaker 0: there have been some very high-profile litigations that many states of the US has taken Metta for example to court And infact there's been a giant out-of-court settlement.
• 30:00
  Speaker 0: That tells something.
• 30:02
  Speaker 0: when a company of the size of Metta does an Out Of Court Settlement it tell us about their sense.
• 30:10
  Speaker 0: the litigation would have gone if it had gone the full distance.
• 30:14
  Speaker 0: In a sense, you know that they feel something did potentially was damaging to mental health of young people.
• 30:20
  Speaker 1: Absolutely.
• 30:21
  Speaker 1: but I'm skeptical.
• 30:22
  Speaker 1: i have confess those settlements or indeed kind regulation kids under sixteen not allowed social media for example.
• 30:32
  Speaker 1: Australia is leader in others as well.
• 30:34
  Speaker 1: prohibition almost never works.
• 30:38
  Speaker 1: any drug and whether it be the social media drug or alcohol, you name it.
• 30:43
  Speaker 1: But let's push that in a positive direction.
• 30:45
  Speaker 1: You are leader of global mental health arena.
• 30:51
  Speaker 1: How is it possible to start conversation with people who lead AI tech sector?
• 31:01
  Speaker 1: And others in your space To think differently about how these tools Can be shaped.
• 31:09
  Speaker 0: Yeah, well I mean you know?
• 31:10
  Speaker 0: I would personally have no direct engagement with the social media industry on these very important You know their structural questions is really good.
• 31:19
  Speaker 0: it goes to the heart of what an algorithm Is.
• 31:21
  Speaker 0: uh-you Know how you actually engineer those algorithms.
• 31:24
  Speaker 0: is the algorithm there to keep you your eyeballs hooked On?
• 31:28
  Speaker 0: do y'all particular platform or isn't that actually generate information That is going to Be grounded in science and It's Going To be you know, practical even if it's boring and the person may then disconnect from the platform.
• 31:41
  Speaker 0: And I think...I'm hoping very much that these social media companies have been chastened by growing public discontent with way their algorithms work and they've engaged experts in my field to make sure kind of outputs are producing are actually science-based and not based purely from the perspective of the marketplace.
• 32:08
  Speaker 1: I was hoping we could end on a positive note, because too many these kinds of conversations ends somewhere else...
• 32:14
  Speaker 0: What I'd say is that we now have global agreement across countries and across sectors that AI and social media need to be regulated in way it doesn't harm people's mental health.
• 32:29
  Speaker 0: That wasn't there even five years ago.
• 32:32
  Speaker 1: Oh, five minutes ago.
• 32:33
  Speaker 1: Five minutes ago!
• 32:34
  Speaker 0: No but I mean it's important to recognize that it took more than fifty years for us to reach this stage with tobacco and i think our listeners should be aware of the commercial influences on our health and well-being didn't start in AI.
• 32:45
  Speaker 0: they started you know more then a hundred years ago.
• 32:48
  Speaker 0: so tobacco being an exemplar we can... It is easy to forget that it takes fifty years roughly before first science linking tobacco and lung cancer emerged, and finally the fact that the UN in all countries of the world agreed that tobacco was a deadly substance.
• 33:06
  Speaker 0: And it needed to be heavily regulated.
• 33:08
  Speaker 0: so we've done much better with social media.
• 33:11
  Speaker 0: It's only happened in.
• 33:12
  Speaker 0: you know Social Media Only came into our pockets In twenty twelve.
• 33:14
  Speaker 0: So I think first of All We need To Be Pleased With How Quickly The World Has Responded Uh uh to the threats Of Social Media.
• 33:22
  Speaker 0: but i'll tell You the other positive message and That is that we have such a robust science about what creates risks and resilience for young people to experience poor mental health, but this is a robust Science That Should Directly Inform Public Policy.
• 33:41
  Speaker 0: And part of that science Is also the demonstration Of The World That Organizations Like Sangat Have Been Doing Which Demonstrates That Carefully Designed Brief Interventions That Can Be Delivered By A Range Of Frontline Providers can Help The Majority Not everyone, but the majority of young people struggling with their mental health recover.
• 34:00
  Speaker 0: This is a really important piece of science and I think it's time for public policy or health systems to embrace that science by investing in these approaches.
• 34:10
  Speaker 1: What sweet at there?
• 34:11
  Speaker 1: Thank you both for that summary on this conversation Dr.
• 34:15
  Speaker 1: Patel And we all have a lot of work to do.
• 34:18
  Speaker 0: thank you so much Alan.
• 34:19
  Speaker 0: i've enjoyed this conversation.
• 34:26
  Speaker 1: I'm Alan Stoga, podcast host and i look forward to your joining our next conversation.
• 34:32
  Speaker 1: Remember tell us what you think at telbergfoundation dot.
• 34:36
  Speaker 1: org.