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Table 2 Summary of scenarios

From: Possibilities for the future of global mental health: a scenario planning approach

 Universal standards for careWorldwide coordination of researchMaking use of diversityFocus on social factorsGlobalised care through technologyMental health as a currency in global politics
Main featuresUniversal standards for the treatment of patients with mental health disordersAll research activity is coordinated on a global levelMental health care and research is focused on embracing diversity rather than striving for similarity or universalityGlobal consensus on social determinants of mental healthRemote and virtual delivery of mental health careSituations traditionally requiring political action are understood in terms of mental health
HealthcareAdaptation of local procedures to new set of worldwide standards;
Regular audits
Increasingly evidence-based care meeting local needsBoth the organisation and content of care is developed out of or adapted to the local contextPublic mental health services providing social interventions; Worldwide community tackling underlying social factors on a global and local levelAll treatment can be delivered remotely or virtually, leading to redundancy of servicesIncreased funding and availability of public mental health services; Clinicians act as consultants for policy-making and government decision-making
ResearchResearch procedures also adapt to new standards, e.g. informed consent proceduresCentralised 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 methodsFocused on exploring associations between wider social and economic factors and mental health on a global and local scaleResearch focuses on developing new technology-assisted diagnostic tools and interventionsPublic health and prevention focus
GovernanceGlobal intergovernmental organisations e.g. United NationsGlobal governance through centralised research organisationLocal leadership driven by mental health professionalsGreater role of social services and local communities; National and regional governmentsMulti-national organisations;
Private health firms;
Technology companies
National governments and international organisations
Key driversIncreasing 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 countriesRapid 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 implicationsReliant on one concept of human rights and consensus on standards being accepted universallyDependent 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 prioritiesPotentially 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