Helen Lavretsky, MD, MS

Serendipity has played a significant role in many scientific advancements in mental health throughout history, like the discovery of lithium as a treatment for bipolar disorder. Now more than ever, we are in desperate need of similarly impactful discoveries in mental health. Adopting a serendipity mindset—the ability to use uncertainty as a pathway to a more successful and purposeful life—to reverse engineer the systems needed for more breakthroughs, and to span and fuse disciplines, might be the way to achieve this.

The Leading Cause of Ill-Health and Disability

The world is in the throes of a global mental health crisis with severe physical, social, and economic ramifications. According to a recent World Health Organization (WHO) 

, around 450 million individuals currently suffer from mental health conditions, marking mental health disorders among the leading causes of ill-health and disability worldwide.

 Mental disorders account for 5 out of the top 10 causes of global disability. Although treatments are available, 

 of individuals with a known mental health disorder will never seek help from a health professional.

 Surveys in India and China, which represent a third of the global population, have suggested this number is even higher, with more than 80% of people with any mental health or substance use disorder not seeking treatment. In part, this is due to the pervasive stigma of mental illness that permeates societies and healthcare systems, resulting in systemic underinvestment in mental health.

When individuals do seek help, they may not be able to receive the care they need. According to a recent report from a team of 28 global experts assembled by Lancet, the world’s failure to respond to the mental health crisis has resulted in a “

monumental loss of human capabilities and avoidable suffering.

 The commission estimates more than 13 million lives could be saved every year if mental illness was treated properly—or at all. Alongside the profound costs of human lives and avoidable suffering, there are colossal financial ramifications. Indeed, epidemiological modelling suggests the rising cost of mental illness will hit $16 trillion USD by 2030.

 COVID-19 has amplified many of these issues, triggering social and physical distancing, economic hardship, and challenges in accessing care. 

The 21st century will be largely defined by our collective response to the global mental health crisis—and beacons of hope are beginning to emerge. Stigma is reducing, awareness is increasing, allowing people to slowly overcome back the barriers to seeking care. Meanwhile, venture capital funding for mental health start-ups has been growing rapidly and accelerated even more during COVID. 

 showed 146 deals ranked in nearly $1.6 billion in venture capital investments as of December 10th, 2020.

 A decade ago, there were only 3 deals, worth $6.6 million, whereas last year the total was $893 million from 111 deals. However, these advances on their own will not be able to solve the above stated global challenges. A paradigm shift is needed to solve the unprecedented complexities and challenges associated with the current global mental health crisis. This shift will require the education of governments and healthcare systems of the world, empowerment of consumers to take charge of their own mental health, and the use of technology both for prevention and treatment of mental disorders.

Convergence Mental Health as a Mechanism for Serendipity

Mental health is a prototypical wicked problem in that it embodies large numbers of diverse factors from biology, sociology, genetics, and psychology to economics and beyond.

 can counteract those influences and ease the anxiety that comes with the inherent unpredictability of the world. This outlook centers on being the agent of one’s own good luck. An individual can shift from a passive victim of circumstance to an active creator of opportunities by embracing the uncertainty that happens each day.

 Training the serendipity muscle in turn trains one’s ability to solve problems by identifying positive outcomes from situations and making accidents more meaningful. 

Interdisciplinary collaboration is the driver of serendipity. Those who operate with a serendipity mindset are not luckier than others, but rather cultivate luck and solutions by consistently seeking out new experiences and reaching across multiple industries. Convergence science is “an approach to problem solving that cuts across disciplinary boundaries. It integrates knowledge, tools, and thought strategies from various fields for tackling challenges that exist at the interfaces of multiple fields.”

 It can be a mechanism for serendipity through integration of knowledge, tools, and thought-strategies from various fields for tackling challenges that exist at the interface of multiple disciplines.

In the context of mental health, convergence science involves the integration of scientists, clinicians, bioinformaticists, global health experts, social scientists, health economists, engineers, technology entrepreneurs, medical educators, caregivers, and patients—we call this Convergence Mental Health.

 Synergy between government, academia, and industry is also vital. Convergence science is the Ariadne thread necessary to navigate the intricate labyrinth of global mental health problems, bringing about urgently needed progress in science and society. Examples of Convergence Mental Health-associated advances are outlined in the 

Table. Convergence Mental Health-Associated Advances

Innovations at all different levels are urgently needed. Solutions will need sociologists, psychologists, philosophers, ethicists, scientists, media practitioners, crisis management experts, policy makers, senior civil servants, and more. 

 provides direction for these shifts in how teams work. As COVID-19 has demonstrated, distance does not stop the wheel of innovation, and in fact can propel it by lowering the perceived barriers to novel ways of working and collaborating. As we embark on building the new normal, Convergence Mental Health will play a key role in this rapidly unfolding change.

 provides a historic opportunity to lead to a new era of innovation and progress, leading to improved outcomes for all people and preparing psychiatry to meet the unprecedented mental health challenges of the 21st century. By adopting a serendipity mindset, we can learn to harness uncertainty to create unique solutions across industries.

is an associate with the PRODEO Institute and Thiel Fellow at Stanford University.

is Director of Innovation at a major mental health association and expert in residence at Georgetown University, and the author of

 is a masters candidate in Global Affairs from New York University. 

is Senior Advisor to the OECD Secretary General and Head of the New Approaches to Economic Challenges Unit at the OECD.

is a professor of psychiatry at University of California in Los Angeles (UCLA).

professor of psychiatry at the Institute for Mental and Physical Health and Clinical Translation (IMPACT) at Deakin University.

cofounder of the PRODEO Institute, adjunct associate professor with IMPACT at Deakin University, and co-lead of the OECD Neuroscience-inspired Policy Initiative.

The World Health Report 2001: Mental health: new understanding, new hope

2. Bosely S. World in mental health crisis of ‘monumental suffering’, say experts

https://www.theguardian.com/society/2018/oct/09/world-mental-health-crisis-monumental-suffering-say-experts

3. Patel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development.

4. Lee JL. Mental health tech startups fetch record investments with COVID-19. 

https://www.reuters.com/article/health-coronavirus-mental-health/mental-health-tech-startups-fetch-record-investments-with-covid-19-idUKKBN28P1SA

Convergence: Facilitating Transdisciplinary Integration of Life Sciences, Physical Sciences, Engineering, and Beyond

7. Eyre HA, Berk M, Lavretsky H, Reynolds C. 

8. Eyre HA, Lavretsky H, Forbes M, et al. Convergence science arrives: how does it relate to psychiatry? 

10. Richardson S, Sinha A, Vahia I, et al. Brain health living labs. 

Why mental health matters to global health.

12. Shah RN, Berry OO. The rise of venture capital investing in mental health. 

13. Chang DD, Storch EA, Black L, et al. Promoting tech transfer between space and global mental health. 

14. Ternes K, Iyengar V, Lavretsky H, et al. Brain health INnovation Diplomacy: a model binding diverse disciplines to manage the promise and perils of technological innovation. 

15. Smith E, Ali D, Wilkerson B, et al. A Brain Capital Grand Strategy: toward economic reimagination. Mol Psychiatry. 2021;26(1):3-22.

16. New Approaches to Economic Challenges, PRODEO Institute. Neuroscience-inspired Policy Initiative. Organisation for Economic Co-operation and Development. Accessed March 23, 2021. 

Articles

This mindset might be the key to mental health breakthroughs. 

Feeling Lucky? Convergence Mental Health as a Mechanism for Serendipitous Innovation

is Professor of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA.

Videos

Dr Lavretsky invites us to use the pandemic as a chance to build good habits, explore spiritual avenues, and start new routines. 

An Opportunity for Growth

Modern mental health problems are characterized by their complexity, multi-systemic nature, and broad societal impact, hence making them poorly suited to siloed approaches of thinking and innovation. The New England Journal of Medicine recently published an article that articulated the stark limitations of an increasingly siloed focus on biologic knowledge in psychiatry.

 The article describes how the biological revolution of the 1980s has failed to live up to its therapeutic or scientific promise, with a comprehensive biologic understanding of the causes or treatments of psychiatric disorders yet to be discovered. Further, the article argues that psychiatry faces a new set of challenges, such as a professional diagnosis being reduced to a “checklist-style amalgamations of symptoms,” and an alarming degree of “trial-and-error medication management” taking over practice.

Psychiatry is characterized by multiple complex interacting, biological, social, medical, psychological, and related systems. Consequently, it is important to note that these challenges are not nostalgic arguments for a return to the insular, often unscientific psychodynamic practice of psychiatry that marked the 20th century. Instead, they indicate the need to forge a new path, one with an approach ready to meet the unprecedented and complex systemic mental health challenges of the 21st century.

Indeed, the 21st century will be largely defined by our collective response to the global mental health crisis. According to a recent World Health Organization (WHO) report, around 450 million people currently suffer from mental health conditions, making brain disorders among the leading causes of ill health and disability worldwide. The world’s failure to respond to the mental health crisis has resulted in a “

 of human capabilities and avoidable suffering.”

 Many of these issues will be magnified by COVID-19 that will result in social and physical distancing, economic hardship, and challenges in accessing care (

A paradigm shift is needed in order to solve the unprecedented complexities and challenges associated with the current global mental health crisis. Indeed, scientific progress may be seen as “a series of peaceful interludes punctuated by intellectually violent revolutions.”

 A convergence science approach is needed to address the global mental health crisis, bringing about an urgently needed revolution in science and society.

Convergence science integrates knowledge, tools, and thought strategies from various fields for tackling challenges that exist at the interfaces of multiple fields.

 In the context of mental health, convergence involves the integration of scientists, clinicians, bioinformaticists, global health experts, engineers, technology entrepreneurs, medical educators, caregivers, and patients. Synergy between government, academia, and industry is also vital. Convergence mental health is the approach used for mental health (

Innovation and entrepreneurship with convergence science

COVID-19 can provide a framework for a convergence science approach to tackling the global mental health crisis. Akin to 

 efforts, solutions to the global mental health crisis will require the traditional sciences of chemistry, biology and virology, and the new sciences of big data and artificial intelligence, computer science and statistical models, and -omics medicine. Subsequently, solutions will need sociologists, psychologists, philosophers, ethicists, scientists, media practitioners, crisis management experts, policy makers, and senior civil servants.

The demands of today’s global problems—especially the mental health crisis—also necessitate a fundamental shift in approaching education and workforce development. Individuals in a convergence science workforce must be equipped with deep expertise in their field, while also having literacy and understanding across a broad range of disciplines necessary for transdisciplinary collaborations.

We must be willing to rethink education and training for researchers, clinicians, and others within traditional health care fields. Education needs to shift toward skill sets adaptable to diverse problems. Unconventional skills and topics, such as design thinking, entrepreneurship, computer science, cryptography, and the like, could be incorporated into learning. Creative education opportunities such as mini-fellowships or exchanges may facilitate divergent thinking.

Traditional education pathways as the sole means of involvement in mental health research must also be reconsidered. To develop innovative solutions, a diverse array of solvers is needed. Collective intelligence—including citizen scientists—must be leveraged. Bansho, the Japanese method of collective problem-solving, teaches people to grasp connections and progressions of the thinking needed to develop solutions. It may provide a framework for education and training modules for convergence science researchers.

 was co-founded by Alph Bingham, PhD, and Aaron Schacht to crowdsource solutions to the most intractable solutions.

 As a space for dialogue between specialists and industry outsiders was created, fresh ideas to persistent questions were found. A chemist from Illinois, John Davies, was able to use an idea from his earlier career in construction to help solve the cleanup of the Exxon Valdez oil spill on Alaska’s coast.

 Other organizations have also utilized the InnoCentive model, including 

, which is dedicated to problems in machine learning.

 Both InnoCentive and Kaggle have methods that are currently being adapted to develop solutions for COVID-19 related issues and could be used to develop mental health solutions in the future.

In low- and middle-income settings, where there are few psychiatrists, greater deployment of community health workers is important to provide essential care. This requires transdisciplinary thinking. A recent clinical trial explored the role of lay counsellors in providing a “depression in later life” intervention in Goa, India.

 In this randomized clinical trial, lay counselors provided problem-solving therapy, brief behavioral treatment for insomnia, education in self-care of common medical disorders such as diabetes, and assistance in accessing medical and social programs. The intervention was effective for preventing episodes of major depression in older persons with subsyndromal symptoms. Furthering the reach of lay counsellors, promising trial data now show the value of internet- based behavioral activation with lay counsellor support for the treatment of depression.

A convergence workforce adept at navigating the adoption of new technological innovations is especially important. Technology will continue to fundamentally shift the way we conceptualize and treat mental health conditions. For example, Mindstrong aims to provide continuous digital biomarkers of mood and cognition to support diagnosis, prognosis, and treatment monitoring.

 Born from convergence science, Mindstrong originated from prior work of co-founder Paul Dagum, MD, PhD, in cybersecurity. Adopted for mental health conditions, it may make it possible to detect prodromal stages of mental health conditions, enabling objective measurements and the opportunity for early intervention and prevention.

The same technologies used for early detection and monitoring may also be used to deliver treatment and interventions. For example, 

 builds clinically validated cognitive therapeutics, assessments, and diagnostics that look and feel like video games and has submitted 

for people with attention-deficit/hyperactivity disorder for FDA approval.

 A recent review of the mental health technology field projected there will be 1000 mental health startups by the end of 2020.

 See the Examples of Convergence Mental Health in Action at the end of this article for more information.

The progress in technological advancements like the printing press and developments in science, art, philosophy, and trade that underpinned the Renaissance period was sparked by a convergence approach that merged science and humanities.

 A similar revolution will occur with convergence mental health solutions, ensuring greater integration of social sciences in care. Mental health is an inherently human undertaking. Indeed, convergence mental health should employ considerations from the new field of responsible innovation in mental health, which is “a collaborative endeavor wherein stakeholders commit to clarifying and meeting a set of ethical and social principles by designing solutions to sustainably address the needs and challenges of mental health systems.”

Convergence mental health must also address the social determinants of health and be mindful of the world’s immense cultural diversity. Addressing the social determinants and cultural components of mental health requires rethinking our concept of disease and integration among health systems, local community partners, and coordination at a national or international level. Ensuring that there is a place for social science is critical to achieve a convergence approach and provides an opportunity to prevent mental health disorders, improve mental health at a population level, and reduce social and health inequalities.

Psychiatry has a major opportunity to leverage convergence science that will lead to innovation and progress. Ultimately, convergence mental health will help usher in a new era of care marked by bridging the divergent fields of medical practice, integrating insights from the brain and mind. Convergence mental health holds the potential to integrate technological innovations, insights from other areas of medicine, paradigmatic research shifts that blur existing boundaries between academia and industry, social determinants of health, philanthropy, and unconventional funding mechanisms. These changes will result in better patient outcomes and ensure greater health justice for all people by preparing psychiatry to meet the unprecedented mental health challenges of the 21st century.

We hope to offer brainstorming opportunities and solutions in our forthcoming book, Convergence Mental Health: A Roadmap Towards Transdisciplinary Innovation and Entrepreneurship, scheduled for publication in late 2020. We only hope to keep up with the world that is rapidly changing in front of our eyes.

is Brain Health Venture Executive, Founder and CEO, FacePrint, and 

is Affiliate, Department of Computer Engineering Stanford University, Palo Alto, CA. 

is Distinguished and Emeritus Professor of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 

is Professor of Psychiatry, Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, ORYGEN Youth Health, The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Victoria, Australia. 

is Instructor in Entrepreneurship, Global Brain Health Institute (UCSF and Trinity College Dublin); Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Department of Psychiatry, University of Melbourne; Brainstorm Laboratory for Mental Health Innovation, Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA; and Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. 

 is Professor of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA. The authors report no conflicts of interest concerning the subject matter of this article.

—Dr Berk is supported by a NHMRC Senior Principal Research Fellowship (1059660 and 1156072).

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Convergence: Facilitating Transdisciplinary Integration of Life Sciences, Physical Sciences, Engineering, and Beyond. 

Washington, DC: National Academies Press; 2014.

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11. Arjadi R, Nauta MH, Scholte, WF, et al. Internet-based behavioural activation with lay counsellor support versus online minimal psychoeducation without support for treatment of depression: a randomised controlled trial in Indonesia. 

12. Carey B. California tests a digital “fire alarm” for mental distress. 

14. Kollins SH, DeLoss DJ, Canadas, E, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. 

15. Hays S. Approaching 1000 Mental Health Startups in 2020. 

https://medium.com/what-if-ventures/approaching-1-000-mental-health-startups-in-2020-d344c822f757

16. Szaley J. The Renaissance: The Rebirth of Science and Culture. Live Science. 2016. 

https://www.livescience.com/55230-renaissance.html

17. Eyre HA, Ellsworth W, Fu E, et al. Responsible innovation in mental health. 

18. Fernandes BS, Williams LM, Steiner J, et al. The new field of precision psychiatry. 

19. Brady L, Hotopf M, Broekmans A, et al. Remote assessment of disease and relapse in major depressive disorder (RADAR-MDD). 

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21. Jain FA, Walsh RN, Eisendrath SJ, et al., Critical analysis of the efficacy of meditation therapies for acute and subacute phase treatment of depressive disorders: a systematic review. 

22. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: a systematic review and meta-analysis. 

23. Laird K, Jain F, Lavretsky H. Convergence neuroscience of meditative mind-body therapies for mental health. Eyre HA, Lavretsky H, Reynolds III C2020, Eds. 

Convergence Mental Health: A Roadmap Towards Transdisciplinary Innovation.

 New York City: Oxford University Press; 2020.

24. Eyre HA, Robb A, Abbott R, Hopwood M. Mental health innovation diplomacy: an under-recognised soft power. 

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https://onemind.org/healthy-brains-financing-initiative

27. Smith E, Au R, Mosse M, et al. Rebooting late-life mental health innovation and entrepreneurship with convergence science. 

A paradigm shift is needed in order to solve the unprecedented complexities and challenges associated with the current global mental health crisis.

Convergence Mental Health: A New Pathway for Transdisciplinary Innovation and Entrepreneurship

Society’s psychological reactions to a crisis can be predicted according to disaster response frameworks. Mental health innovators can use these frameworks to understand what to build during the evolving 

 crisis, and when those innovations will prove most vital.


	While the occurrence of disasters is largely unpredictable, the human emotional response to disasters is relatively predictable. Researchers have mapped the phases of emotional 

 based on patterns that have been consistently witnessed in times of crisis, from hurricanes to terrorism to disease.

 Although plot details differ, the same storyline can be applied to crises worldwide: the impact occurs, heroism abounds, social cohesion surges, and then, once the news crews have resided, another sentiment takes its place-disillusionment, apathy, grief, and psychological distress.

Crisis, however, does not have to be an inhibitor of innovation, but can be an invitation for innovation. Historically speaking, crisis is often followed by a creative resurgence of the human spirit that guides changes in technological and social innovation, like the 

 (1347-1350), which was soon followed by the Italian Renaissance; new societal concepts and financial institutions can bring about global restructuring that facilitates psychological adaptation and growth (similar to the concept of post-traumatic growth). We witnessed this in the last global crisis, World War II, that resulted in the complete remake of the world’s social matrix with the emergence of the US as the global leader, and significant innovations on every level of human functioning.

While facing the reality of the COVID-19 pandemic, we can anticipate far-reaching consequences that will affect our financial system in the immediate future and bring about massive changes to the way our world functions on every level. This global pause-the “quarantine”- as a self-imposed reset button has the opportunity to usher in a heightened awareness of our individual priorities, and a burst of alternative technological solutions that are likely to persist beyond the viral pandemic, such as how schools and education function, or how health care is administered.

In light of the COVID-19 crisis, we can use this historical precedent-now conveniently captured by emotional response disaster frameworks-to guide our path forward. Not only can these frameworks be used to understand how and when our world will be psychologically affected by this disaster, but they can help inform what is needed during each phase to best support mental, emotional, and spiritual well-being. Mental health innovators must come to view their work through a public health lens, not only considering what is immediately needed, but what needs will arise once the “honeymoon” phase of this crisis is over.


	Over the course of March 2020, our world traversed the heroic phase of the disaster response. This phase is characterized by high levels of activity, low levels of productivity, and a surge in altruistic, adrenaline-induced rescue behavior (think: health care providers valiantly working without personal protective equipment).

 During this phase, the mental health innovation trend was that of open-access innovations. A multitude of companies, from meditation apps to teleconferencing technologies, offered free or discounted access to their platforms in this time of limited resources and millions out of work. Examples of this include therapy app Talkspace, which now offers free therapy for health care workers and discounted subscriptions for the public, and the meditation app Headspace, which now offers free meditation recordings for all.
	• Phase: Heroic - March 2020
	• Characteristics: High activity, high altruism, low productivity
	• Innovation trend: Open-access

Throughout April 2020, we entered the honeymoon phase (

). In this phase, disaster assistance became available, community bonding was more prevalent than ever (albeit virtual), and there was a sense of collective optimism.

 This honeymoon phase seems to be characterized by the mental health innovation trend of platform innovations-the use of existing technologies (apps, websites, etc) upon which new products and services can be offered. Examples of this include the teleconferencing platform Zoom, which has created specialized resources, tools, and capabilities to meet the heightened demand and unique needs of this time; Facebook helping local governments and emergency health organizations reach people via Facebook and Messenger.
	• Phase: Honeymoon - April 2020
	• Characteristics: High assistance, high bonding, high optimism
	• Innovation trend: Platform


	However, as we move deeper into May 2020 we seem to be nearing a less hospitable phase-the disillusionment phase (

). In this phase, the public has recognized the limits of the governments in being able to control viral spread, develop vaccines, or provide disaster assistance. We are feeling a heightened sense of discouragement and distress as we see more clinical manifestations of reactions to stress including affective and emotional symptoms (anxiety, phobias, depression, irritability, apathy, withdrawal); physiological disorders, sleep disorders and dreaming disturbances, memory disorders; behaviors that reinforce and maintain the trauma in the conscience; and 

 Experts have been referring to this phase as the “mental health tsunami”-if the virus outbreak was the earthquake, then mental illness will be the storm surge that comes in its wake. In the disillusionment phase, realities like unemployment, debt, and death begin to sink in, and individuals may rely more heavily on alcohol, opioids, and the like to cope.

Disillusionment is the longest of the phases-the depth of which will largely dictate how quickly and easily we will recover-which is why it will need to be characterized by a mental health innovation trend of prevention innovation. These technologies must focus on the prevention or mitigation of mental health issues like depression, 

, and addiction, as it is through prevention that we will lessen the depth of the post-crisis crash. An example of an existing prevention technology is affective computing that can detect depression relapse or emergent suicidal ideations through the wearable devices or iPhone use, and connect individuals to mental health providers.

 can assist in detecting high-risk populations among health care workers who might be experiencing burn out, stressed caregivers, or students with high levels of pre-existing anxiety. Technologies oriented toward rebalancing of stress response (eg, meditation and breathing apps, music and art therapy, promoting sleep, proper nutrition, and facilitating immune response) could be developed to guide those in distress.
	• Phase: Disillusionment (including post-crisis crash) - May 2020 - ?
	• Characteristics: Low optimism, high distress, high illness
	• Innovation trend: Prevention


	Although we cannot say for certain how long the disillusionment phase will last-the range is from months to years, especially with the looming financial crisis-we will eventually emerge into the calmer waters of the reconstruction phase.

 During this phase, individuals feel a sense of recovery, responsibility, and capacity for rebuilding-there is a greater acceptance of and adjustment to the new normal. With the new normal must come novel solutions, which is why mental health innovation will need to be characterized by frontier innovations, novel technologies based on significant scientific advances, and engineering innovation. Examples of frontier technologies include innovations like AI, sensors, -omics, imaging, synthetic biology, smart devices, digital therapeutics, and the like. While this is not to suggest that frontier technologies should not be built throughout the crisis, it’s also useful for mental health innovators to consider what tools are most crucial and when they are most needed. For instance, frontier technologies may not be readily adopted during the disillusionment phase if they are too costly or complex to use during a time of great uncertainty.
	• Phase: Reconstruction - timing unknown
	• Characteristics: Return to recovery and responsibility
	• Innovation trend: Frontier

Although these stages of response to disasters are true for the population at large, patients with serious mental illness are more vulnerable to profound levels of depression, anxiety, and distress, and may not reach recovery without additional help from practitioners.


	The COVID-19 pandemic is forcing us to face the reality that our world has shifted-climate change, natural disasters, and pandemics are part of our new normal. What seemed stable is now uncertain, our hope in the government’s ability to manage all disasters is diminishing, and we are turning to each other and to our neighbors for solutions. The phrase “we are in this together” rings true for us and has left us to ask: What can each of us do to contribute to the solution and solvency of our society and the planet 

? How can we innovate to continue to enjoy our planet, and leave it to our children to enjoy and develop further? What should be guiding the development of technologies during crises of global proportions such as COVID-19?

To guide innovation at every level, we should anticipate the spiritual and psychological needs of the population at large, as well as those of the most vulnerable patients. Maintaining hope, focusing on well-being, and rebalancing the stress response, as well as improving infrastructure for mental health care can help reduce burnout in the health care workforce and improve the lives of all individuals. We encourage you to consider the following questions with us:
	1. How can we inspire, encourage, and retrain those who have been cast aside as “non-essential” in this time? If retraining 20 million people can be quickly achieved, what scalable technological or vocational training can be offered immediately?
	2. In an increasingly non-religious world, what scalable spiritual alternatives can be offered to provide individuals with answers to existential questions like meaning, purpose, destiny, control, and role of the self at this time?
	3. How can we cultivate resilience to ensure society of its capacity to rebuild and redesign our collective new normal?


	4. How can we train individuals to live simpler lives with enhanced self-reliance, and how can technological innovation help?

Armed with the knowledge of the human emotional response to disaster, we can anticipate and potentially bypass psychological lows by preparing humanity to be more flexible, proactively deal with disasters, and honor their own strength and ability to fight adversity. Mental health innovators will represent a group of humble, perhaps unsung heroes in this crisis, and it’s through collaboration, urgency, optimism, and trust that we will get through this together.

 It’s time for us to get to work-to help, heal, and harness the innovative potential inherent in crisis.

, Expert in Residence at Georgetown University, and author of Wired This Way; 

 is Brain Health Venture Executive and Innovation Diplomat, Instructor in Entrepreneurship at the Global Brain Health Institute (UCSF and Trinity College Dublin), Advisor to Brainstorm Lab for Mental Health Innovation, Stanford University, Honorary Fellow with IMPACT, Deakin University, Australia; 

 is Professor of Psychiatry, Department of Psychiatry, University of California Los Angeles. We’d like to hear from you, you can email Jessica Carson (jessica@jessicacarson.co), Harris Eyre (harris.eyre@gmail.com), or Helen Lavretsky (hlavrets@ucla.edu) with questions, comments, or if you’d like more information on mental health innovation ideas. The authors report no conflicts on interest concerning the subject matter of this article.

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Dealing with Stress, Anxiety, and Grief during COVID-19

Society’s psychological reactions to a crisis can be predicted according to disaster response frameworks, which can be used to understand what to build during the evolving COVID-19 crisis, and when those innovations will prove most vital.

Dear Mental Health Innovators: The COVID-19 Honeymoon Is Almost Over

Dr. Lavretsky is Professor of Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles.

This Special Report on Geriatric Psychiatry addresses a variety of clinical issues in the rapidly growing diverse population of older adults. With the increase in the population of adults over age 65 years expected to reach 22% of the general population by 2040, neuropsychiatric disorders of aging will become a challenge for many practicing health care providers. This demographic trend has led to an intensive search for effective strategies to diagnose, treat, and prevent mental, cognitive, and physical disorders of aging.

The stigma of mental illness still overshadows proper diagnosis and management of neuropsychiatric symptoms and disorders in the elderly. The boundaries between neuropsychiatric and physical illnesses are often blurred, especially in the acute medical and in long-term care settings, because of frequently comorbid mood, anxiety, cognitive, and physical disorders in older adults. Aging-related physiological changes lead to the increased risk of adverse events such as falls and drug toxicity with pharmacological management.

The growing population of aging baby boomers brings to light new challenges characteristic of this cohort, such as increasing rates of drug abuse and higher rates of depression and anxiety, sleep disorders, and PTSD compared with previous generations. The issue of gender identity and the aging LGBTQ community is coming to the forefront of public and professional awareness of the unique health care needs of its members. It is also becoming more obvious that multiple diseases of aging share common risk factors and may benefit from shared treatment and preventive strategies, such as heart disease, diabetes, and Alzheimer disease.

The 7 articles in this section highlight common clinical dilemmas and outline the nuances of diagnosis, management, and outcomes-and provide helpful practical tips for clinicians. We hope that readers will find the information in this Special Report clinically relevant and helpful in the diagnosis and treatment of neuropsychiatric conditions in older adults.

Dr. Lavretsky reports that she has received research grants from Forest/Allergan.

This work was supported by the NIH grants MH97892, AT009198, and AT008383.

This Special Report on Geriatric Psychiatry addresses a variety of clinical issues in the rapidly growing diverse population of older adults.

Introduction: Neuropsychiatric Disorders of Aging

Meet Helen Lavretsky, Professor of Psychiatry at UCLA, who speaks about a 

 in older adults with subjective memory complaints and mild cognitive impairment.

Patients assigned to yoga practice for 12 weeks with daily meditation for 12 minutes in weekly one hour classes did better than those who participated in memory training classes in verbal and visual memory, executive function, mood resilience, anxiety, and connectivity of the brain.

Results suggest that yoga can be a cognitive enhancement or brain fitness exercise that can confer similar or even more extensive cognitive resilience than memory training-the gold standard-in older adults.

Meditation in this study was practiced with music recorded on the 

 album, which received a Grammy award this year.

Dr Lavretsky is Professor of Psychiatry at UCLA. She also directs the Late Life Mood, Stress, and Wellness Research Program at the Semel Institute at UCLA. She is a member of the Editorial Board of 


	
	1.Eyre HA1, Siddarth P1, Acevedo B1, et al. A randomized controlled trial of Kundalini yoga in mild cognitive impairment. 

https://www.cambridge.org/core/journals/international-psychogeriatrics/article/randomized-controlled-trial-of-kundalini-yoga-in-mild-cognitive-impairment/138A3EB97520CE72B01D17059B7AA286

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	2. Yang H, Leaver AM, Siddarth P, et al. Neurochemical and Neuroanatomical Plasticity Following Memory Training and Yoga Interventions in Older Adults with Mild Cognitive Impairment. 

 http://journal.frontiersin.org/article/10.3389/fnagi.2016.00277/full

In this pilot study, older adults who practiced yoga did better on measures of verbal and visual memory and executive function than those in memory training classes.

Cognitive Enhancement-With Yoga

Dementia, also referred to as major neurocognitive disorder (including Alzheimer disease [AD]), is a growing problem because of increased lifespan. There is no known cure. Several drugs are FDA-approved for the treatment of dementia, including acetylcholinesterase inhibitors (eg, donepezil, rivastigmine, galantamine) and an 

-methyl-D-aspartate (NMDA) receptor antagonist, but these have limited efficacy, adverse effects, and significant cost-all of which contribute to the search for alternative therapies to improve cognition.

In this article, we look at several natural products used to improve cognitive impairment or cognitive symptoms of dementia (

A popular supplement for cognition is ginkgo biloba, which is extracted from the leaf of the Maidenhair tree. Although it has been used as a supplement in the US, in many European countries it is part of mainstream medical care and requires a prescription. A standardized extract called EGb 761 is prescribed in many countries outside of the US.

Here: a look at several natural products used to improve cognitive impairment or cognitive symptoms of dementia.

Helen Lavretsky, MD, MS

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Introduction: Neuropsychiatric Disorders of Aging

Cognitive Enhancement-With Yoga

Natural Supplements and Vitamins for Treatment and Prevention of Dementia and Cognitive Decline

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Treatment Options in Late-Life Treatment-Resistant Depression

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