The XXXX files: MQ swears in

Abstract

In January this year, travellers on London's underground system were greeted by an unusual set of advertisements: celebrities, including The X-Files' Gillian Anderson, photographed in stark black-and-white, apparently turning the air blue: “Mental illness in young people: thinking nothing can be done is utter XXXX”. This was the launch of MQ's We Swear campaign, aimed at funding research on mental illness in children and young people. MQ is a charity, created in 2013, with the aim of transforming mental health through research. With initial funding from the Wellcome Trust and the Institute of Social Psychiatry, it is now looking for public funding to continue its work, with the message “Research has the power to transform young people's lives. We swear to take it on if you swear to help.” In a crowded arena for charities, MQ's advertisements certainly stand out. But after this eye-catching launch, can it achieve—and sustain—success? The challenges are formidable: differences in donations for research in mental illness compared with other common illnesses are stark. MQ states that overall, only £8 is spent on research per person affected by mental illness in the UK, which is 22 times less than per person for cancer (£178) and 14 times less than dementia spend (£110). Although other common conditions such as cancer, diabetes, or Alzheimer's disease have well-supported charities solely dedicated to funding research, mental health has lagged behind in this. It is not simply a matter of raising awareness. Not only is there still public stigma towards some mental health conditions, but mental health professionals themselves are divided on everything from diagnostic criteria to the politics of using the term “mental illness”. Professional splits are likely to promote scepticism among the public, who might well feel that research into mental health conditions is not worth funding, if there is not even consensus on their existence. Furthermore, psychiatry does not have a well known history of game-changing wonder drugs. There has not been an equivalent of insulin for diabetes or antiretrovirals for HIV. Without palpable advances in research, the public might be less willing to give. So it might be wise for MQ to choose a mixed funding portfolio of quick wins and longer term projects. Failure is not a problem as long as projects are carefully monitored to ensure any blind alleys are identified quickly, and lessons learned. It is also important that when success is achieved—as we hope it will be—this is communicated rapidly and clearly to the public with measured optimism rather than hype. The indignation harnessed by MQ's advertisements might be effective fuel for take-off, but a more nuanced approach will be necessary to sustain the journey. Collaboration with people with lived experience of mental health problems will be essential to navigate the practical and moral difficulties ahead: for example, in identifying priority research questions and appropriate outcome measures for clinical trials, and in thinking through the ethical implications of cutting-edge scientific areas such as genetics. It is also the case that mental health research, however technically advanced, cannot ultimately avoid the issue of social inequality, whether as a risk factor for mental illness or as a barrier to service delivery. MQ will need to be politically as well as scientifically savvy. Can a major mental health charity with funding research as its aim overcome these challenges and succeed? With the right timing, carefully chosen projects and good media communications to show the public where their donations are going and how they make a difference, the answer is a cautious yes. The time is right: MQ's campaign was launched just a week after the UK Prime Minister Theresa May pledged new mental health initiatives; and anti-stigma work by organisations such as Time to Change and individuals such as Stephen Fry have made the general public increasingly receptive to discussion about mental illness. The answer to controversies over the diagnostic system or theoretical model of mental health problems is best met not through debate, which has long since become entrenched to the point of caricature, but through tangible results: improved treatments, faster access to care, and, most important of all, better lives. MQ occupies a unique niche in the medical research funding landscape; it will have a choice of high quality research proposals to fund, some of which might produce practice-changing results. It's about XXXXing time.