Jessica Carson

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

Jessica Carson brings up a reassuring point: after periods of illness or turmoil, comes a creative epoch. 

at a major mental health organization, Expert in Residence at Georgetown University, and author of Wired This Way. 

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After the bubonic plague came the Renaissance? What will follow the COVID-19 pandemic?

Quarantine Through the Lens of Creative History

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.

Jessica Carson

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