I'm June Gruber, an associate professor of psychology at the University of Colorado Boulder and Director of this Mental Health Experts Series. I'm delighted to be here today and talk to Lauren Ng, an assistant professor of psychology UCLA, about her ground-breaking work on developing culturally, adapting, and implementing evidence-based interventions for under-served minority communities. Thank you so much for being with us today. Thank you for having me. I was wondering, Lauren, if we could start by hearing a little bit more about the mental health research you do. I focus on developing treatments that are sustainable, and different types of low-resource mental health services. For example, here in the United States, that might be communities that people are more likely to experience poverty, more likely to experience community violence, less likelihood of access to mental health services either in their community or that are accessible for various reasons. I try to develop treatments like developing treatments and primary care, where people, in general, are more likely to attend. If you have a cold or you need immunizations done, the primary care physician or nurse is more likely to see you than a mental health provider. Those services are more accessible to diverse and under-served communities. Similarly, I do work in low-income countries that are far less likely to have access to any type of mental health services at all. In fact, in a lot of rural areas in low-income countries, there are absolutely no mental health service providers, so we need to think outside the box of different types of ways to deliver mental health treatment. A lot of that is also in the primary care system, although there a lot of the primary care providers actually see mental health service delivery as part of their mission of health in general, whereas here in the US it's often still seen as a separate system. How could you first go back getting started in this just incredibly important work? Thank you. I started, I guess my work in global mental health in graduate school. I had always been interested in thinking about how do we get more services for people who don't have services. My initial thinking was actually here in the US. But I also always had this interest in human rights and what does it mean for people to be persecuted based on identity. I had an interest, particularly in communities that had experienced things like genocides. In grad school I joined a lab initially, that looked at delivering evidence-based mental health treatments to ethnic and racial minority communities in the US and learned a lot there. Then for my dissertation, I actually had the opportunity to work with a professor who had a project on survivors that were in a genocide. That was a collaboration with an organization of orphan heads of households in Rwanda, youth who'd been orphaned during the genocide and were raising their siblings. The organization had a hypothesis that mental health problems are interfering with their beneficiaries' ability to access things like education, food services, economic income-generating activities. Even though they were trying to provide these, a large proportion of their beneficiaries just were not participating. We became involved to do an assessment of that and figure out, was this in fact true, was it really mental health symptoms that were interfering? If so, how, and what could be potentially done to ameliorate some of those effects. That was my initial foray into global mental health. As you've progressed through your career starting in graduate school or even earlier up till present, what happened to you, some notable frustrations or failures as well as successes that you've been able to savor along the way? It's a good question. One of the things that I've noticed, there has been an ongoing frustration of mine is that a lot of research has been done on a lot of different treatments and different innovative models around the world but it's really hard to actually get those implemented in real-life care. There's a lot of reasons for that but one of the things that I found a bit difficult, is that the money that goes into research is often not actually available at the service-delivery level. This is seen here in the US, but it's particularly stuck in low-income countries. For example, when I first started working on some of the interventions in Rwanda, I worked on a project that had funding around $250,000. For US research that may not seem like very much for an intervention-based study, but at the time, the entire mental health budget for Rwanda was around $750,000 for the whole country. You see this huge disparity in resources used to do research compared to resources available to actually provide care. We can do all of these amazing studies, then come up with all kinds of things, but if they're not actually something that can be implemented, then what's the point anyway? That experience transformed some of my thinking about research and about interventions, to really focus on things that actually are feasible, even if they may not be "optimal" from a mechanistic or research perspective. Because I want to actually ensure that the research leads to actual change on the ground for people's lives. That's a really inspirational and admirable goal too, to really have your work have real-world change for the people who need it most. Along these lines, I wonder, what do you see has been the most important next steps in the field, the steps we need to take to really move this forward to achieve these goals? I would love to see more funding available, and more opportunities available for research capacity building in low and middle-income countries. While there are, obviously, researchers in those countries, we know are working very hard to advocate for the services needed, the types of interventions needed, they're really underfunded and really under-supported, and they're few and far between. People often feel like they're working with a very small team with very small supports. There's not very much of a pipeline for graduate students, for postdoctoral fellows, etc. If some of the research funding that's pulled from high-income countries can be really re-transformed into research capacity building on the ground by people from those countries, for me that seems like the appropriate next step. It's hard to find funding for those types of initiatives, unfortunately. With those challenges and funding initiatives, as you're saying, being sometimes challenging to surmount, what advice would you have for others who may be watching this interview today, whether they're students or scholars, or just the public at large who are interested in this field, maybe who want to get engaged too? I think part of it is really having a long-term commitment to the collaborators you're working with, to the projects that you're interested in because research in general takes a very long time. Then research in lower-resource settings takes even longer amount of time and requires a real commitment to ethical approaches, to bilateral and bidirectional capacity-building in respect, and a willingness to step back from demanding that things move at a particular pace or in a particular way. That's hard to do for a number of reasons, but I would say that for people looking at this and thinking about potentially working in different low-resource settings, for example, as their career, that is critical. I think also because of that maybe being strategic in how you approach your career as we need to have different metrics moving forward, some of those things you need to be able to get out in a year or two and that may not be reasonable in different types of settings and so just being realistic about that approach. Wonderful. Well, thank you so much. These are really powerful and inspirational answers than just hearing about the field and your work. I just want to say thank you for your time speaking today. Thank you.
