In their inaugural Editorial for this Journal, Profs. Harry Minas and Alex Cohen developed a compelling case for why a scientific journal of the highest standards and the broadest possible circulation was sorely needed. Their detailed description of the scope of this Journal’s focus and the daunting gap in knowledge remains as valid today as it was back then, with the exception of the solid body of work that researchers and practitioners from all regions of the world have published in the now well-established International Journal of Mental Health Systems [1].

My first act as Editor-in-Chief is to thank Professor Harry Minas and the Editorial Board for their unique and lasting contribution to science and to the wellbeing of people with mental health-related problems and disorders. And my second act is a call to action to my fellow researchers and practitioners globally: our work has only but started, the impact of our collective efforts as reflected in this Journal has only recently begun to be properly acknowledged. We are at the gates of an unfamiliar world, where mental health has captured the attention of anyone who has been listening to the public conversation about societal priorities. Grass-roots advocates, people with lived experience, their families, public figures in all walks of life—from artists to sports people—have come out through traditional and new media platforms to publicly acknowledge their own mental health struggles and demand adequate funding for mental health research and services. During the past decade, leaders of private and public organizations, jurisdictions, nations, and multilaterals have pledged their commitments to universal health coverage inclusive of mental health, and there is a growing recognition that, in order to achieve this, all levels of research need to advance in lockstep, including basic, clinical, and health systems research. In order to bridge the “knowledge to action” gap (also labeled “bench to bedside” when it comes to health), translational research and implementation science have emerged as a key final step in bringing the advances of our field to the populations in need. It has been found that only 15% of proven innovations ever make it to day-to-day practice, and only after 20 years. This is no surprise when the third crucial step of the translational process (from basic, to clinical, to health systems research) is frequently neglected.

Fourteen years after the IJMHS was created to contribute with evidence to the tide of mental health systems research and practice, where do we stand? I submit that we are at a tipping point: three convergent forces have dramatically changed the landscape and the opportunities at the policy and systems level. First, the global push for universal health coverage inclusive of mental health—driven by the United Nation’s Sustainable Development Goals—has thrust the field into the limelight and significantly expanded the potential sources of funding for mental health systems research. Second, the exponential growth of digital innovation (including data science and online platforms) offers concrete opportunities to effectively deliver services at any scale, highlighting the need for a comprehensive health system strategy capable of integrating e-mental health with in-person services locally, nationally, and globally. And third, the COVID-19 pandemic has painfully demonstrated that even efficacious interventions will only go so far without rational, strategic, system-wide planning capable of delivering them at scale.

The Sustainable Development Goal number 3 (specifically targets 3.4, 3.5, and 3.8) embodies an explicit pledge by all Governments to implement the required changes at the national level to meet its targets. In addition to committing national research funds to mental health research, this pledge gives multilateral organizations the mandate to facilitate these changes by developing innovative financing mechanisms to support scaleup and evaluation. Indeed, the United Nations and its agencies (most notably the World Health Organization (WHO), but also all others) now have legitimacy to prioritize mental health as one of the central health and development challenges of our time, as they have successfully done in the past with HIV and maternal and child health. The World Bank and other agencies are incentivized to include mental health components in development assistance for health packages, as well as mental health impact assessments in general development packages (analogous to environmental impact assessments for infrastructure projects). Also, debt-for-mental-health swaps can now be considered by high-income creditors for debt-distressed countries, swapping payments for capital and/or interest for local mental health investments. When it comes to global development priorities, mental health is poised to take the central stage previously occupied by the fight against AIDS and the push to improve maternal and child health outcomes.

Until recently, calls to scale up mental health services—justified as they may be in light of the unparalleled mental health burdens and the cost–benefit evidence—lacked a feasible, credible plan. The shortage and high cost of human resources for mental health has been the hill where most policy battles ended, certainly in low-income, but also in high-income countries. Two critical innovations, one low-tech and one high-tech, have transformed the landscape: the solid evidence supporting task-shifting (also referred to as task-sharing or right-skilling, depending on the conceptual framework), combined with the infinitely scalable nature of digital tools, offer a concrete program of global scale-up with minimal marginal cost. This combination allows for a rapid expansion of coverage leveraging the ubiquitous distribution of smartphones in middle- and high-income settings. For low-income settings, additional efforts are required to distribute devices, create digital hubs, and expand network coverage to deliver self-guided and peer-supported tools, as well as clinical training, supervision, and services. Task shifting and leveraging digital tools represent quintessential health systems innovations: they offer platforms to deliver interventions that have already been found to be clinically effective, from psychotropics to cognitive behavioural therapy (CBT), peer-support and self-care, but were until now largely undeliverable due to the prohibitive cost of the specialized brick-and-mortar and personnel required.

The first wave of the Covid-19 pandemic has driven home the message of how costly it is to have unprepared, fragmented systems. Having well-functioning, integrated systems able to gather data about population needs and to respond in a coordinated manner helps explain why some countries withstood the first wave relatively unscathed with respect to health outcomes, and why vaccination rollout efforts met with different degrees of success, even in similar country-income levels. For our field, the implications loom as large, if less noticeable: the evidence showing that online psychotherapy, peer-supports, and self-guided care work is already out there; what is lacking are the pragmatic, real-world implementation and translational studies assessing the impact of integrating these innovations into existing health systems. These types of program evaluations, most of them grounded on mixed-methods and/or multi-level analyses considering not only individual effectiveness but also the organizational or system level impacts are what the mental health field needs at this point to quantify and qualify what is gained—and what may be at risk of being lost—by this unprecedented democratization of mental health services.

In summary, the IJMHS seeks to foster the critical research programs that will inform the decision-making process required to democratize mental health services, by bringing together the multiple effective interventions we already know to exist and the platforms that will deliver them at scale in real-world health systems. In order to achieve these goals, we are adding four Editorial Priority Areas to the general focus of our journal, each with a new responsible Associate Editor. Digital Heath and Mental Health Systems will seek to incentivize and disseminate research focusing on the integration of digital tools (from virtual care and telemedicine to fully automated AI-powered interventions) into existing systems and services. The Substance Use and Mental Health Systems area will highlight the need to consider mental health and substance use together when developing services and systems, in a world where the patterns of substance use are rapidly shifting (from the opioid crisis in its multiple forms to the various decriminalization, legalization, and normalization efforts). The Mental Health Systems Planning Editorial Priority Area will encourage research and submissions that stem from collaborations between mental health researchers and decision-makers geared towards informing prioritization and resource allocation by rigorously assessing what the population needs are and what the services to meet those needs should be, both from a qualitative and a quantitative perspective. And finally, Mental Health Systems for Populations in Need: this Editorial Priority Area will focus on population groups that are particularly underserved from a mental health systems perspective. These groups may be underserved due to different reasons: they may constitute a group historically neglected by our field, as is the case with older adults; or a group whose needs are prioritized but poorly understood, such as children, adolescents, and transitional age youth; or a historically marginalized group, such as indigenous peoples everywhere.

This is an ambitious program of editorial work that seeks to build on the achievements made possible by Harry Minas, the Editorial team, and mental health systems researchers everywhere. Of note, IJMHS will continue to be a reliable source not only for studies from high-income settings, but also for knowledge and innovations from low- and middle-income countries. The two examples of health systems innovation highlighted above demonstrate how scientific advances are indeed bidirectional: computer science and digital tools emerged in the wealthiest countries, as innovators sought to maximize our ability to gather, store, access, curate, analyze, and deliver data; conversely, task-shifting emerged in low-income settings, as innovators strove to meet people’s needs despite lacking the amount and types of resources (both material and human) that were traditionally considered necessary. One limitation of most international journals is their insufficient focus on knowledge emerging from low- and middle-income countries (LAMICS). This is sometimes due to the dominance of the English language, the rigidity of editorial expectations, or the chronic underfunding of research in LAMICS. It may also be the result of less explicit but more deeply rooted biases stemming from the colonial history of our discipline and science in general. With this in mind, and building on the track record of our journal, we will create a new section, Field Experiences, inspired by the World Health Organization Bulletin’s Lessons from the Field, with the goal of facilitating the publication of unique health systems experiences that for different reasons may lend themselves more to a “case study” format than to traditional research papers. We will also seek to strengthen our collaboration with regional research networks to create a pipeline that increases the visibility of the vast mental health systems knowledge currently being produced in LAMICS.

We hope you find this Editorial proposition engaging, and that you are inspired to submit your research to our journal and even to develop projects or programs targeting the areas mentioned above. This is the right time to focus your research funding proposals on mental health systems.

1. 1.

   Minas H, Cohen A. Why focus on mental health systems? Int J Ment Health Syst. 2007;1(1):1. https://doi.org/10.1186/1752-4458-1-1.

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1. Mental Health Systems and Services Laboratory, Department of Psychiatry and School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada

   Daniel Vigo

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This article was conceived and written by DV. The author wants to thank Prof. Harry Minas for reviewing this manuscript and providing feedback. The author read and approved the final manuscript.

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Correspondence to Daniel Vigo.

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The author declare that they have no competing interests.

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Vigo, D. Dawn of a new day for mental health systems. Int J Ment Health Syst 15, 49 (2021). https://doi.org/10.1186/s13033-021-00475-x

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• Received: 04 May 2021

• Accepted: 17 May 2021

• Published: 26 May 2021

• DOI: https://doi.org/10.1186/s13033-021-00475-x

中文翻译：

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精神卫生系统新的一天的黎明

在本期刊的首期社论中，Professor。哈里·米纳斯（Harry Minas）和亚历克斯·科恩（Alex Cohen）提出了一个令人信服的案例，说明了为什么迫切需要一本标准最高，发行范围最广的科学期刊。他们对本《杂志》关注范围的详细描述和巨大的知识鸿沟至今仍然有效，但世界各地的研究人员和从业人员目前已发表了扎实的著作。完善的《国际精神卫生系统杂志》 [1]。

我作为总编辑的第一个行为是感谢哈里·米纳斯教授和编辑委员会对科学以及与精神健康相关的问题和障碍者的福祉所作的独特而持久的贡献。我的第二个举动是呼吁全球各地的研究人员和从业人员采取行动：我们的工作才刚刚开始，但直到最近才开始适当认识到本刊所反映的集体努力的影响。我们正处于一个陌生世界的大门，在这里，心理健康吸引了任何听过关于社会优先事项的公众讨论的人的注意力。基层拥护者，有经验的人，他们的家庭，从艺术家到体育人士，各行各业的公众人物都通过传统和新媒体平台出现，以公开承认他们自己的心理健康斗争，并要求为心理健康研究和服务提供足够的资金。在过去的十年中，私人和公共组织，司法管辖区，国家和多边组织的领导人承诺对包括精神卫生在内的全民健康覆盖做出承诺，并且人们日益认识到，为了实现这一目标，需要进行所有层次的研究与时俱进，包括基础，临床和卫生系统研究。为了弥合“知识到行动”之间的差距（在健康方面也被标记为“从床到床”），翻译研究和实施科学已成为将我们领域的进步带给需要的人群的关键的最后一步。已经发现，只有15％的经过验证的创新能够在20年后用于日常实践。当转换过程的第三个关键步骤（从基础到临床，再到卫生系统研究）经常被忽略时，这不足为奇。

IJMHS创建十四年来，为精神卫生系统研究和实践的潮流做出了贡献，我们站在哪里？我认为，我们正处于一个转折点：三个趋同的力量极大地改变了格局，并在政策和系统层面带来了机遇。首先，在联合国的可持续发展目标的推动下，全球对包括精神卫生在内的全民健康覆盖的推动使该领域成为众人瞩目的焦点，并大大扩展了精神卫生系统研究的潜在资金来源。其次，数字创新（包括数据科学和在线平台）的指数增长为有效地提供各种规模的服务提供了具体的机会，强调需要全面的卫生系统战略，以将电子精神卫生与本地，国家和全球的现场服务相结合。第三，COVID-19大流行令人痛苦地证明，只有有效的干预措施才能有效实施，而没有能够大规模实施的合理，战略，全系统的计划。

可持续发展目标3（特别是目标3.4、3.5和3.8）体现了所有政府的明确承诺，即在国家一级实施所需的更改以实现其目标。除了将国家研究资金投入精神健康研究之外，这项承诺还赋予多边组织授权，通过发展创新的筹资机制来支持规模扩大和评估，从而促进这些变化。确实，联合国及其机构（最著名的是世界卫生组织（WHO），但也包括所有其他机构）现在已经具有合法性，将精神卫生列为当今时代的主要卫生和发展挑战之一，正如他们在联合国的成功所做的那样。过去的艾滋病毒与母婴健康。鼓励世界银行和其他机构将精神卫生组成部分纳入对卫生一揽子计划的发展援助，并将精神卫生影响评估纳入一般发展一揽子计划（类似于基础设施项目的环境影响评估）。此外，高收入债权人现在可以考虑将债务换为精神卫生债务，用于陷入债务困扰的国家，将付款交换为资本和/或将利息交换为当地精神卫生投资。当谈到全球发展优先事项时，精神卫生将处于先前与艾滋病作斗争以及改善母婴健康成果的努力所占据的中心地位。以及一般开发包中的精神健康影响评估（类似于基础设施项目的环境影响评估）。此外，高收入债权人现在可以考虑将债务换为精神卫生债务，用于陷入债务困扰的国家，将付款交换为资本和/或将利息交换为当地精神卫生投资。当谈到全球发展优先事项时，精神卫生将处于先前与艾滋病作斗争以及改善母婴健康成果的努力所占据的中心地位。以及一般开发包中的精神健康影响评估（类似于基础设施项目的环境影响评估）。此外，高收入债权人现在可以考虑将债务换为精神卫生债务，用于陷入债务困扰的国家，将付款交换为资本和/或将利息交换为当地精神卫生投资。当谈到全球发展优先事项时，精神卫生将处于先前与艾滋病作斗争以及改善母婴健康成果的努力所占据的中心地位。

直到最近，有关扩大精神卫生服务的呼吁（由于考虑到无与伦比的精神卫生负担和成本效益证据而合理）仍缺乏可行，可靠的计划。精神卫生人力资源的短缺和高昂的成本一直是大多数政策战结束的地方，当然在低收入国家，在高收入国家也是如此。两项关键的创新（一种低技术和一种高科技）已经改变了格局：支持任务转移（根据概念框架而定，也称为任务共享或正确技能）的坚实证据与无穷无尽的结合数字工具的可扩展性，以最小的边际成本提供了全球规模扩展的具体计划。这种结合可以利用中等收入和高收入环境中智能手机的无处不在的分布来迅速扩展覆盖范围。对于低收入环境，需要付出更多的努力来分发设备，创建数字集线器并扩展网络覆盖范围，以提供自我指导和同伴支持的工具以及临床培训，监督和服务。任务转移和利用数字工具代表了典型的卫生系统创新：它们提供了平台，可以提供从精神药物到认知行为疗法（CBT），同伴支持和自我保健等已经被临床证明有效的干预措施，但是直到现在由于所需的专门实体和人员的费用过高，因此在很大程度上无法交付。需要付出更多的努力来分发设备，创建数字集线器并扩大网络覆盖范围，以提供自我指导和同伴支持的工具以及临床培训，监督和服务。任务转移和利用数字工具代表了典型的卫生系统创新：它们提供了平台，可以提供从精神药物到认知行为疗法（CBT），同伴支持和自我保健等已经被临床证明有效的干预措施，但是直到现在由于所需的专门实体和人员的费用过高，因此在很大程度上无法交付。需要付出更多的努力来分发设备，创建数字集线器并扩大网络覆盖范围，以提供自我指导和同伴支持的工具以及临床培训，监督和服务。任务转移和利用数字工具代表了典型的卫生系统创新：它们提供了平台，可以提供从精神药物到认知行为疗法（CBT），同伴支持和自我保健等已经被临床证明有效的干预措施，但是直到现在由于所需的专门实体和人员的费用过高，因此在很大程度上无法交付。

Covid-19大流行的第一波浪潮已经传达出这样的信息，即没有准备的，零散的系统将是多么昂贵。拥有运行良好的集成系统，能够收集有关人口需求的数据并以协调的方式做出响应，这有助于解释为什么某些国家在健康结果方面毫不动摇地抵御了第一波冲击，以及为什么疫苗接种工作取得了不同程度的成功，即使在类似的国家/地区收入水平中也是如此。对于我们的领域来说，影响似乎更大，甚至不那么明显：证据表明，在线心理治疗，同伴支持和自我指导的护理工作已经存在；缺乏实用的，现实世界中的实施和转化研究，这些研究评估了将这些创新纳入现有卫生系统的影响。

总而言之，IJMHS致力于通过整合我们已经知道的多种有效干预措施以及将实际大规模提供这些干预措施的平台，来促进关键研究计划，这些计划将为使精神卫生服务民主化所需的决策过程提供信息世界卫生系统。为了实现这些目标，我们在期刊的总体重点上增加了四个编辑优先领域，每个领域都有一名新的负责任的副编辑。Digital Heath and心理健康系统将寻求激励和传播研究，重点是将数字工具（从虚拟护理和远程医疗到全自动的AI驱动的干预手段）集成到现有系统和服务中。该物质使用和精神卫生系统该领域将强调在当今毒品使用方式正在迅速转变的世界（从多种形式的阿片类药物危机向各种非刑事化，合法化和正常化努力）的情况下，在开发服务和系统时需要同时考虑心理健康和毒品使用情况）。在精神卫生系统规划编辑优先领域将鼓励研究和意见，从对通过严格评估哪些人群的需求是什么服务，以满足这些需求应该是通知的优先次序和资源分配面向心理健康研究人员和决策者之间的合作干从定性和定量的角度来看。最后，针对有需要人群的精神卫生系统：这个社论重点领域将集中于从精神卫生系统的角度来看服务不足的人群。这些群体可能由于不同的原因而服务不足：它们可能构成了我们的领域在历史上被忽视的群体，例如老年人。或需要优先考虑但了解程度不高的人群，例如儿童，青少年和过渡年龄的青年；或历史上处于边缘地位的群体，例如世界各地的土著人民。

这是一项雄心勃勃的编辑工作计划，旨在利用哈里·米纳斯（Harry Minas），编辑团队和各地精神卫生系统研究人员所取得的成就为基础。值得注意的是，IJMHS不仅将继续成为高收入环境研究的可靠来源，而且还将成为低收入和中等收入国家的知识和创新的可靠来源。上面强调的两个卫生系统创新的例子说明了科学的进步确实是双向的：计算机科学和数字工具出现在最富裕的国家，这是创新者寻求最大限度地提高我们收集，存储，访问，管理，分析和传递数据的能力。相反，在低收入环境中出现了任务转移，尽管缺乏传统上认为必要的资源和数量（物质和人力），但创新者仍在努力满足人们的需求。大多数国际期刊的局限性之一是它们对中低收入国家（LAMICS）新兴知识的关注不足。有时这是由于英语的优势，编辑期望的僵化或LAMICS研究的长期资金不足所致。这也可能是由于我们学科和科学的殖民历史普遍产生的不那么明确但根深蒂固的偏见的结果。考虑到这一点，并在日记记录的基础上，我们将创建一个新部分，大多数国际期刊的局限性之一是它们对中低收入国家（LAMICS）新兴知识的关注不足。有时这是由于英语的优势，编辑期望的僵化或LAMICS研究的长期资金不足所致。这也可能是由于我们学科和科学的殖民历史普遍产生的不那么明确但根深蒂固的偏见的结果。考虑到这一点，并在日记记录的基础上，我们将创建一个新部分，大多数国际期刊的局限性之一是它们对中低收入国家（LAMICS）新兴知识的关注不足。有时这是由于英语的优势，编辑期望的僵化或LAMICS研究的长期资金不足所致。这也可能是由于我们学科和科学的殖民历史普遍产生的不那么明确但根深蒂固的偏见的结果。考虑到这一点，并在日记记录的基础上，我们将创建一个新部分，这也可能是由于我们学科和科学的殖民历史普遍产生的不那么明确但根深蒂固的偏见的结果。考虑到这一点，并在日记记录的基础上，我们将创建一个新部分，这也可能是由于我们学科和科学的殖民历史普遍产生的不那么明确但根深蒂固的偏见的结果。考虑到这一点，并在日记记录的基础上，我们将创建一个新部分，现场经验受到世界卫生组织《现场经验教训》的启发，目的是促进独特卫生系统经验的出版，这些经验由于各种原因可能更适合于“案例研究”形式，而不是传统的研究论文。我们还将寻求加强与区域研究网络的合作，以创建一条管道，以提高LAMICS当前正在产生的大量精神卫生系统知识的知名度。

我们希望您能发现此社论主张引人入胜，并希望您能将您的研究提交至我们的期刊，甚至开发针对上述领域的项目或计划。现在是将您的研究经费提案重点放在精神卫生系统上的合适时机。

1. 1。

   Minas H，CohenA。为什么关注精神卫生系统？国际精神卫生系统。2007; 1（1）：1。https://doi.org/10.1186/1752-4458-1-1。

   文章PubMed PubMed Central Google学术搜索

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隶属关系

1. 不列颠哥伦比亚大学医学院精神病学系以及人口与公共卫生学院精神卫生系统和服务实验室，加拿大温哥华

   丹尼尔·维哥（Daniel Vigo）

作者

1. Daniel Vigo查看作者出版物

   您也可以在PubMed Google学术搜索中搜索该作者 

会费

本文是由DV构思和撰写的。作者要感谢Harry Minas教授审阅此手稿并提供反馈。作者阅读并批准了最终手稿。

通讯作者

对应于Daniel Vigo。

利益争夺

作者宣称他们没有竞争利益。

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对于已发布地图和机构隶属关系中的管辖权主张，Springer Nature保持中立。

开放存取本文是根据知识共享署名4.0国际许可许可的，该许可允许以任何媒介或格式使用，共享，改编，分发和复制，只要您对原始作者和出处提供适当的信誉，即可提供链接到知识共享许可，并指出是否进行了更改。本文的图像或其他第三方材料包含在该文章的知识共享许可中，除非在该材料的信用额度中另有说明。如果该材料未包含在该文章的创用CC许可中，并且您的预期使用未得到法律法规的许可或超出了许可的使用范围，则您将需要直接从版权所有者那里获得许可。要查看此许可证的副本，请访问http://creativecommons.org/licenses/by/4.0/。

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引用本文

Vigo，D.精神卫生系统新的曙光。诠释J精神疾病健康SYST 15， 49（2021）。https://doi.org/10.1186/s13033-021-00475-x

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• 收到：2021年5月4日

• 已接受：2021年5月17日

• 发表时间：2021年5月26日

• DOI ：https ：//doi.org/10.1186/s13033-021-00475-x