Jeremy Kane, PhD, MPH

Dr. Jeremy Kane is a psychiatric epidemiologist with research interests in global mental health, substance and alcohol use epidemiology, and adolescent health.

Why do you do this work?

I do this work because there is so much work to be done and the work is critically important. I tend to keep the figure 90% in my head all the time. 90% is the treatment gap for mental health outcomes in low and middle-income countries, 90% of people who need mental health services in low and middle-income countries do not receive adequate care, 75% receive no care at all. Those numbers haven’t moved very much since we started talking about global mental health as a field. The gap is substantial and wrong; the definition of inequity. So to me, all our work should be done with that number in mind and to reduce that gap.

What is your proudest moment from working within Global Mental Health?

A few years ago, we tested the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TFCBT), and we compared it to treatment as usual in addressing

PTSD symptoms and psychosocial functioning among children and adolescents in Lusaka, Zambia. Among this population, the rate of experienced traumas and the severity of types of traumas that these kids experienced was really high. When you run these trials, you don’t know what’s going to happen when you run the final analysis. I remember knowing in the back of my mind that in front of you, is just a few lines of computer code but the result of what this analysis is going to show could change a lot of peoples’ lives across the world if they find it to be effective. In the end we found that TFCBT was extremely clinically effective and was a game-changer for our work in Zambia.  We had found that this intervention that was delivered entirely by lay counselors but was based on evidence-based cognitive behavioral therapy principles can help people who have no treatment options at all.

So finding that result and just looking at how big that clinical effect size was, even though that was just a number, I was really proud. We presented the results in Zambia with the Ministry of Health and other researchers present, but of equal importance we were able to do it with community members. This included people who had served as lay counselors and when we presented the results, people just burst into applause. It was such an emotional reaction from people. That moment sticks in my mind a lot.

What are shifts you’re hoping to see occur in global mental health?

I think global mental health lacks really robust longitudinal data and longitudinal cohort studies in the field. When we run randomized control trials,or intervention studies, we often have very short-term follow-up periods, often only months after baseline. What happens to people who receive intervention 6 months later, 12 months later, 24 months later, and 5 years later? We have no idea, most of the time.

I think it’s important for us to understand, especially when you’re thinking about alcohol and substance use disorders, these are chronic conditions, where the recurrence can be pretty high. For a lot of substance use disorders, even with effective treatment, the rate of recurrence is around 50%.

So are we really thinking through the long term of this? Do we know what to do if someone has a substance use problem that recurs a year later after they’ve received one of the interventions that we’re testing? Should they receive the intervention again? Should they receive a booster session? Do we have a system in place to actually help address that? I don’t think we actually do. So to me, that’s one place the field needs to go. We need to think more about the systems of care as opposed to just individual interventions and trialing them.

Then the broader “where we need to go next” as a field is thinking through: “Who is going to be doing the work and how is the work going to be done?”. And that’s really about this idea of decolonizing global mental health. We can talk about different scientific areas of where the field needs to go, and they’re all important, but I think most important overarching thing is who is going to be doing global mental health research. An important facet of that is where the grant funding for global mental health is going to go. Can we switch that model where main recipient of research grants and funds go to the low and middle-income country with potentially a subcontract coming to Columbia to say, oh you know, Jeremy can help provide technical expertise on something? Ultimately, people working and living in low and middle-income countries need to be the ones driving the global mental health research agenda.

Milli Wijenaike-Bogle, an MPH Candidate in the Department of Sociomedical Sciences, interviewed Dr. Kane for this Q&A.