Table 2 Summary of scenarios

Main features

Universal standards for the treatment of patients with mental health disorders

All research activity is coordinated on a global level

Mental health care and research is focused on embracing diversity rather than striving for similarity or universality

Global consensus on social determinants of mental health

Remote and virtual delivery of mental health care

Situations traditionally requiring political action are understood in terms of mental health

Healthcare

Adaptation of local procedures to new set of worldwide standards;

Regular audits

Increasingly evidence-based care meeting local needs

Both the organisation and content of care is developed out of or adapted to the local context

Public mental health services providing social interventions; Worldwide community tackling underlying social factors on a global and local level

All treatment can be delivered remotely or virtually, leading to redundancy of services

Increased funding and availability of public mental health services; Clinicians act as consultants for policy-making and government decision-making

Research

Research procedures also adapt to new standards, e.g. informed consent procedures

Centralised management of all research funding and activity;

More innovative research;

No duplication

Localised research that aims to explore specific and unique aspects rather than striving to produce generalisable evidence; Qualitative methods

Focused on exploring associations between wider social and economic factors and mental health on a global and local scale

Research focuses on developing new technology-assisted diagnostic tools and interventions

Public health and prevention focus

Governance

Global intergovernmental organisations e.g. United Nations

Global governance through centralised research organisation

Local leadership driven by mental health professionals

Greater role of social services and local communities; National and regional governments

Multi-national organisations;

Private health firms;

Technology companies

National governments and international organisations

Key drivers

Increasing human rights movement; Increasing funding for mental health services;

Increasing universal access to information (e.g. through information technology)

More efficient use of funding for mental health research;

Increasing research accessibility in LMICs;

Advances in technology; Rising role of big data

Increasing national economic growth;

Increasing funding for mental health service development

Rapid social and economic change;Increasing urbanisation; Increasing migration; Widening inequalities within countries

Rapid increase in global development; Advances in technology;

Stronger role of virtual relationships

Political instability;

Climate change; Increasing war and conflict; Increasing prioritisation of mental health issues

Potential concerns and implications

Reliant on one concept of human rights and consensus on standards being accepted universally

Dependent on the views of the central committee members, Potentially strengthening mainstream approach rather than overcoming it;

Management of all research worldwide may be difficult to manage in practice

Differences may be so great that there is no scope for learning across contexts (i.e. highly unique healthcare in different settings)

Requires government support and working across different organisations and agencies that may be difficult to bridge in practice; May clash with other political priorities

Potentially less creative, innovative and personalised approaches in mental health care (i.e. replaced by algorithmic software);

Potential to drive people further apart through reduced need for face-to-face interactions

Potential neglect of more severe mental disorders;

Potential trivialisation of mental health distress