 Hello and welcome to Pukipondas, the podcast where I explore big questions with brilliant people. Today's question is how can we create a world in which no one is held back by mental health problems and I'm in conversation with Miranda Wolpert. So I'm Miranda Wolpert and I'm Director of Mental Health at The Wellcome Trust and The Wellcome Trust is a big research funder, science research funder and mental health is an increasing part of what we fund and look to enhance. And the question that we've got as our kind of episode title today is how can we create a world in which no one is held back by mental health problems and I wondered if we could leap in by starting, why was that the question you are interested to answer? So that's the mission we've set ourselves at Wellcome to try and use our funding to try and create that world and it took some time when I first came into post, slightly different post as we were just discussing about a year and a half ago and to try and think about what was the impact the Wellcome could make in terms of science funding that would really make a difference for mental health. And one of the first things I did was did a blog around should we be trying to find a way to cure mental health problems? Should we be trying to find a way to help people manage with ongoing difficulties? And what emerged from that from discussions with the sort of wider communities that there's a real range that for some people they have a problem, it goes away, it never comes back again. For other people they are living with problems their whole life that they are managing and dealing with and they're actually trying to find a language that talks about the fact of that we don't yet know what's acute and what's chronic in terms of mental health problems that needs to be recognised. So we came up with this phrase no one held back by because we thought actually at heart what we're trying to do is make people what we want is science that helps people live their lives to their best and their fullest and to be able to flourish and flower whether they have an ongoing mental health problem or whether they don't. So that's the ambition and that's what we, so that's what I'm interested in sort of talking about and thinking about. Wow, so that's quite a big job, no? Yes, it is. And what are the things that kind of you know see when we come up with a mission that's because we think this isn't working right now what is not working there what are we getting wrong at the moment or what is holding people back? So I think our view at Welcome is that we don't yet have as good a handle as we need on what works for whom and why. And that the field of mental health science has been under resourced and that people have they've been passionate fantastic scientists and researchers who've done their work but they'd rather plow their own furrows and they haven't necessarily come together in an integrated group as yet. And one of the agendas is can we pull together the fantastic work that's been doing so it's a bit more integrated and we have a bit more of a concerted understanding. I think one of the things that's held us back as a scientific community is that that people have got caught in fights between for example, is mental health caused by a biological problem? Is it fundamentally a biological problem? Is it fundamentally a social problem? And that's been seen as if they those two are mutually exclusive and people have sort of gone to war with each other over that. And also people have been very focused on saying the only way to help people not be held back is to understand what causes mental health problems. And while that's a very understandable perspective, and it is obviously important to try and understand what causes problems. There's been this sort of working belief or core belief or assumption that we can only help people if we understand cause and then you get into this debate about what is it biological or is it social. Whereas actually what we're trying to say is why don't we put those debates about cause sort of to one side for the moment and think rather about what helps people. So whether it's caused by biological social factors, the solutions may be a mixture of biological or social or all sorts of other things. So it's trying to think from the solution and about what's what can really help people live their lives. So that sounds like a really like we're working at completely different levels, but with a similar approach I guess so when I'm talking to a room full of teaching assistants and I'm saying it doesn't matter if you're seeing this distress because the child is depressed or anxious or they've experienced trauma. What matters is that they're distressed and here's what we might need to help and you're kind of doing that on a big. I think that's exactly right and in a way I think we're where we have a shared agenda sources trying to help people find what works for them that what seems to be emerging from the science is that it's very individual. So there isn't going to be a one size fits all people we aren't going to find this wonderful evidence based X that if everyone does it, everyone's better. We might find something that a lot of people help or helps a lot of people. But even then it's going to it seems what seems to be emerging from what we're finding so far is that it may be about helping people navigate and find out what works for them which may be different at different times of their life, and maybe different in different contexts. That's, that's really interesting and a bit different than perhaps what we might have thought we were hoping to do a few years ago. So it's certainly it's been a change for me in terms of my thinking on this and that may change again we may then discover actually there is this wonderful evidence based thing and that that's all we need and we just need to roll it out. But it isn't clear to me that there are some that are like that so for example if you've got a child that is phobic of something there are very clear interventions. So around exposure and response pension about helping people face that fear in a very contained way that really work and that are quite straightforward. They need skill and expertise to do them but that can be done if we can roll those out we can really change many people's lives. But there are other things that people experience, particularly for example depression where there's a range of ways through that people find, and there doesn't seem to be a one silver bullet that works for everyone. So I'm going to dig into that a little bit more in a moment but just before we go deeper. I think it's important to take a step outward and just just explain just a little bit more about what the welcome trust is and in terms of the national and international agenda there because maybe not everyone listening in will have come across. Yeah I wouldn't expect most of them to have so welcome is spelt, it is a very welcoming place but it is actually spelt with two L's, and it's named after this rather extraordinary pioneer called Sir Henry welcome, who made his fortune in pharmaceuticals, but also was an amazing figure around the world collecting anything to do with medicine and science. So when he died he left in his will his money in trust, and at that stage it would link to the pharmaceutical company. In more recent years we're completely separate we're an independent foundation we don't have a living founder, and our remit is to deal with the most urgent health challenges, and to really try and find ways forward using science. So the funding now comes from the money that he left has been invested we have an investment team that runs our investment portfolio so all the money that we get to use is based on those investments. We have about a billion pounds a year to give away so it's not a small endeavor this it's a big endeavor, and we're either second or the third biggest science funder in the world depending on how you look at it. Additionally, I think we were seen as very much biomedical and giving funding to fantastic science at the sort of biological level. We're increasingly seen as we do that and we continue to that we're very proud of that, but we also do. We have now encompassed science in a much wider view so anything, anything that's a rigorous addition to understanding what helps people and why in terms of the big health challenges that we've taken on. Right through from the sort of basic discovery science of sort of looking at anything in the world and trying to understand how the world works, right through to much more targeted funding about will this work for this group in this context. So it's quite unusual to be speaking to someone working within the field of mental health who says, I've got a decent budget. It's been a real shock to me. I'm working in academia and in the voluntary sector so it's new to me and I am. And what's even love is, is my budget is all to give away so my role is simply is to try and fund and fuel fantastic science is going to really make a difference in terms of people's lives. I would also say that the other part of the welcome foundation which is really exciting is again consistent with say Henry welcomes traditions. We have a museum. We have a cultural arm, and we have a policy on so we have we are also interested in how, not just in the pure science but how do we get that science out there how do we communicate it. How do we learn from the arts. How do we engage with people with lived experience mental health issues to really inform the agenda. So it's quite a sort of it is at its heart a very multidisciplinary agenda that we're trying to develop. And how do you choose what to do then with your time with your effort with your budget because you know that that mission that you've suggested is huge and very exciting but how do you prioritize within that. Yeah, that's a great question. We spend a lot of time agonizing about how to do that in a fair and transparent way. So when I came into role they'd already been about two years of work within the trust working with consulting with a whole range of colleagues around where were the big issues and that's where the idea came that the field was fragmented and needs to be brought together. The agreement was made at that stage to focus particularly on anxiety and depression and on young people as one sort of lens in, and to make sure that we were thinking globally not just beyond sort of what we're calling the weird countries the Western industrialized educated rich and developed, but actually moving beyond that to low middle income context to low resource context to really be thinking about what works for a whole range of global populations. So we have a process within the trust where we have external advisors we have internal advisors, we have a board that finally signed off in our strategic direction so my first six months in post were refining that strategy taken to the board agreeing it and then that's now being published on our website to anyone who wants to look at that strategy can see it can see how we've decided on where we will focus for the moment. As we move now into a broader challenge area in mental health we will move beyond anxiety and depression to encompass things like psychosis which we are already doing other parts of the trust we have psychosis flagships, looking at early intervention psychosis, but also looking at neurodevelopmental issues and more fundamental sort of neurology which is sits within our discovery funding streams. And have you had to radically revise any of your direction based on the current circumstances have certainly been hearing lots around sort of mental health linked to the pandemic. We had a very hard think about that, and I published a blog on it that people may be interested have a look at it's quite short, where we were really making the argument that many funders had sort of completely pivoted and said you know we're only going to focus on research related work. Welcome did do some very specific code code work and welcome to be very involved in vaccine development as part of our infectious diseases work so we've made one at that end and we had to make a decision about mental health of how much we meant stopping what we were doing and how much it meant continue what we're doing. And I think our fundamental so there were there were some cove of specific things we did which I can talk about, but our fundamental contention was that we could shine a spotlight on existing mental health crisis, it didn't create it didn't create new mental health problems than we've ever heard of. It actually shine a spotlight on something that we already knew so actually progressing we're trying to find next generation treatments for anxiety and depression for young people was a spot on, and we need to do that faster and harder we didn't need to sort of change. We did commission two bits of specific work around COVID. One was that we funded Daisy Fancourt at UCL, who was convening work around surveys around the impact of COVID, and we're convening that at a global scale something called the cove of minds network. And that's worked brilliantly in that she's now producing reports about what we're learning from across the world. One of our worries was that there are lots of these surveys set up and that we're going to end up with a million different surveys of variable quality. People were basically saying oh look, people are anxious and depressed which we sort of, some of which we knew. But so some of these surveys, but what's brilliant is now by bringing it together and really learning who's it's affecting in what ways how it interacts with loneliness how it interacts what people can actually do how to interact with self care, that's really helpful to us. The second piece of work we did was a sort of cultural engagement of trying to understand how people manage during lockdown and how people were coping and trying to think about what we could learn from this crisis that we could take forward in the new world. So we developed something called COVID living and something called collective resilience where we commissioned cultural groups to look at those issues and again that's on our website and people can see what we've done in relation to that. What that's led to then is engagement with some some big global organizations the wealth health organization, the World Economic Forum and UNICEF, and we've committed with them to work with a group of young people with lived experience mental health problems to say how we're embedding three key principles and our work going forward. One is how we embed lived experience and everything we do and make sure that those who have the most deep experience really inform what we're doing. The seconds we look at local innovation to really understand what works in a particular locality. And the third is that we always look larger than health care that we recognize that mental health is really an issue that has implications for all sorts of policy and not just health care. I'm particularly interested to pick up as I would be personal bias but why that you know number one priority you named there was about lived experience kind of working through all of your work. What's the kind of thinking behind that. It's, you wouldn't build or design anything without building without bringing in experts who really understand who you're building it for. So part of this is about that we just need the expertise of people who this who were doing this for you don't have the expertise you can go completely right I think you're getting something really right is completely wrong. The second I think thing is that that up till now, where we haven't had those voices. There have been all sorts of assumptions and ideas around what lived experience looks like and what the variety of it is and that I think made made us rather more limited and what we understand by what it is to feel to have depression to have anxiety to have drama. We need a variety of experience to really inform us so that we can, we can make the best science as possible, and that those that people lived experience bring particular expertise that when brought together with other areas of expertise can can lead to new insights. And I think, yeah, I suppose that's it. Yeah, on a personal level, obviously I think that's really important and it's something I've always worked hard to bring to my work but I think it is always important to think about at what point does lived and living experience. You know what at what point do we need to then hand over to the people who've got the academic expertise and so on and so forth but I think that's a really important point so I think it's really important that no one expertise trumps another. So it isn't that, you know, oh well you're the academic so I defer to you on everything. You defer I defer to you on the things that you are expert on. But on other things so that the end it is about a given to doesn't require a lot of give and take from people and it requires everyone who's involved to be open minded and respectful of other people's expertise. Yes, because I could think there can be. You can go the other way and end up then not really recognizing the academic expertise of the research expertise which is also complex and there are different perspectives on that as well. So even within the academic field, it's important that expertise from different domains is also seen as having equivalent status and people defer when when when they're working someone else's domain. It's always been one of my personal frustrations when people wait my living experience of mental health issues as more credible than the many many years of research and training that I have and actually I think both both are important and and certainly you know a kind of big personal thank you to you really for supporting me in my personal journey there because I do remember you know when I was very very ill feeling very ashamed actually and thinking how can I possibly purport to be an expert and how can I remain credible when I'm in hospital and my life is in the balance. And I'm not able to to manage and I remember you saying you know that will make you more credible, but you've got to get through and you know, yeah, so thank you. Yeah, just takes me back to a very difficult time and yes, so I mean I wanted just to say thank you to you because I think you do. You have done so much to change those perceptions and to hold in balance both being a professional expert and bringing lived experience and being clear that those are different. Expertises that but they're both informed by each other so I think, you know, I think you've taught all of us a lot around that so thank you. Oh no thank you, no thank you and it's that's the thing and it is it is hard and it's one of the things I have to hold myself to account for often because actually you know exactly as you talked about right from the beginning this is about learning to live well in spite of of ongoing challenges. And I find that sometimes I have to be careful because we're all telling a story all the time. And sometimes I work really hard to be positive and proactive and productive. And people don't always see the days when it's really hard and I have to check in sometimes and share that honestly because I think that one of the issues I find sometimes and this is why I find things like eating disorders awareness week particularly hard. It's people who seem to be managing perfectly. And I think it's important that we know that you know what there are hard days to and perhaps these are the way that we get through those. Yeah, it's probably worth mentioning in relation to that there are two things I want to sort of plug while I was on your podcast. One is that we have a welcome photography prize, which is open each year to anyone you don't have to be a professional photographer at all. The second date is if I remember it right, the 18th of January. And that really is about people finding more nuanced ways of representing what it is to have a mental health problem and what it is to recover from the problem. So just really remind me when you were talking just now, yeah, anyone that's got a vision of how they'd like to present that either about themselves or other people, please put in an application it's quite a simple way of doing it and certainly last year we had some amazing ways of people representing that that trajectory which is for most people is up and down for many people it's fluctuating so that was one. And then the second one was that I have the privilege of being a judge on the All in the Mind Mental Health Awards. And that closes at the end of January and their people have a chance to nominate someone that's really helped them with their mental health journey. So we can put both those details on your show notes but just be really good to encourage people to make use of these these two prizes. Absolutely, can you tell us a little bit more about them so first of all maybe why welcome sponsors the photography prize and what you kind of hope to get from it and maybe what you've seen in the past that's inspiring there. So I think it's part of this, this mission from welcome to to bring together cultural engagement with policy with hard science with lived experience. So, the photography prize really is a way of trying to bring a different language and and open new debates and discussions around some of these health challenges. And it really brings a different, it allows you to have a different sort of conversation and to present things different ways so you know when you write something, or even talk about it. You are limited by those sort of structures where when you present it visually, it can lead to all sorts of different emotions so exactly as you're saying one of the things last year's photography prize, and I'm going to forget at this moment the name of the photography prize was a mental health series of mental photos, and it was fantastic photos of this, the photographer's journey through his own mental health issues, and they were both witty, but deeply sad but also deeply strong, all at the same time. So you can post that exactly what you're saying that that can be conveyed in a way that I've posted on Twitter that says I'm great now, or I'm sad that doesn't quite get. So the sort of nuance of all that complexity can be got so I would encourage people to look at it and again we can put links on your show notes to people. So you know there's a picture of him for example, with a sort of a dead Christmas tree in his parents basement. And just, you know, and he's reflecting on both the sadness and the hope for the year to come. So I think there's some very, it's very powerful and then another prize winner was a photographer who's Russian photographer who'd photographed friends and colleagues and they're sort of two kits of what got them through their mental health issues, which range from poetry to pills. So and what they had is they had sort of images of themselves and then images of these things that were there sort of lifeline. So I think one person was a cold water swimmer, which always resonates with me. But there was also, you know, therapy poetry friends games. And I think again, it helped and I think seeing it visually again bring makes it feel much more real and and allows you to relate to it more emotionally than having a list of those things in a sort of written format. Yeah, absolutely. And yeah, and as you say there is something just really powerful about the different arts as you know I'm a big fan of using poetry and the thing I found with poetry is, it doesn't need to be good to provoke a thought of feeling a conversation and can be quite cathartic as well and somehow it's a lot more freeing than yeah other forms of writing. That's right. And I think for mental health in particular where we're still really feeling our way to try and understand what is this, what is this, what is it, and trying to convey to each other, very personal things, trying to get that mix. And I guess that's, that's another reason why I think having lived experience of part of the scientific community is so important because otherwise there can be this sort of othering. Like, you know, and I suppose, those of us who've worked with mental health feel there is no them and us, you know, everyone has mental health. Different people have different different times just everyone has physical health. So the fact you've got a cold today or not tomorrow doesn't make you a better or worse person or a different sort of being. And in a way the more we can sort of build that in and know that you know people researchers might talk about their own personal experiences and not identify someone with lived experience mental health problems. Someone with mental health problems may not choose to talk about their lived experience at all but they draw on that and thinking about how they want things shaped so that people I suppose I feel very passionate no one should feel any pressure to tell a personal story they don't want to. But we should also feel comfortable that anyone can tell a personal story without feeling they're going to be judged for it in any way if it feels apricite or useful for other people. I think that's that's so important and it is one of the things that people often ask me about because I've been fortunate in that because I've always worked kind of relatively independently. I've been able to share my own story and carve my own way but many people don't have that privilege do they many people do feel that they will be judged by colleagues or employers and that that is a much harder thing to be open and honest about. And I guess we would hope for a future where that wasn't the case. Absolutely. And then tell me about the all in the mind. So all in the mind is a radio for program run by Claudia Hammond which does fantastic work in mental health and really raises the profile and looks at latest research findings. And she's been a sort of amazing advocate for mental health, generally, and they run these awards and not sure how many years they've won them, they've run them but I certainly know it's been a number. And they're really trying to celebrate to individuals and organizations that have made a real difference in people's lives so what you get to do is nominate someone it can be an individual coming organization. I'm hoping there might be a few scientists in there who knows who have really made a difference for some for you when you were struggling or were in distress, and it's a chance to celebrate those those people in groups. The truth of those prizes they relatively easy to enter just wondering about in terms of people listening. Incredibly easy they so again before put the links on it's literally you go on the website and you just plug in your entry. Amazing. Okay, we'll make sure to include those so diving a little bit more deeply in some of the work that you're doing at the moment I'm really keen to talk to you about the active ingredients work that you're doing a I just love all the visuals around it but maybe you can tell us a bit about that and where it's going and why why you're doing it. So I'm really pleased to hear that because we are really trying to think hard about the visual so I guess one of the, one of the things we thought about when we think about what we're trying to address here with this with our strategy was the fact that there are hundreds of different interventions for anxiety and depression, literally hundreds and with new ones being invented each day. And people then become very passionate about about the thing they've invented and then people start sort of competing between their inventions, and they're coming from a good place everyone wants to help these are really passionate carrying their advocates, but it becomes then quite hard to find a sort of neutral science within that. So, and also they're that these interventions are often quite complex and multi dimensional. So it's often like you do lots of this and then lots of that and you've got to be trained for 10 years to have done that. And so it's quite hard to know what are the core components what are the things that really make a difference within sort of intervention X or intervention So we start out with this ambition to say well can we tease them apart we know that it's all going to be very complicated there isn't going to be one magic building block that you know you just take this pill it's all going to be okay. But can we try and pull apart these things like try and get them down to building blocks so we can then test and do science on the different building blocks before we build them up again so that we can try and find out what's the most sort of what's the simplest thing that we could do what's the cheapest thing we could do what's the easiest thing we can do that will really help the most people. So, to do that we launched a commission where we said okay scientists out there and anyone. Tell us what your best bets are for what you think is the one core component the one had to be agreed and if you had to make a bet you would say this is the thing I would really study and work on. And we had loads of people bring in their ideas and from those we chose 30 teams around the world to look at 26 active ingredients. Not a comprehensive list we recognize that we could have probably done another 100 and in fact we will have a second call out coming out later this early well early this year but in a month or so time to fill it plug in some of the gaps. But the idea was to try and look at a range of things really as examples of how we might look at active ingredients, looking at the evidence already existed not doing fresh research just looking at what does the evidence already say. And we wanted them to range the full span from the cellular to the societal. So we ended up with looking at active ingredients that range from things like changing brain chemistry to the microbiome of the gut to sleep patterns, right through to. What about if you just give people money cash transfers. What about neighborhood social cohesion and in between all this sort of behavioral and cognitive things like changing how people think about themselves. What about levels of self compassion. What about levels of physical activity. What about how people do pleasurable things each day to try and stimulate themselves. What about engagement with the art so full range of things all of that's on our website anyone can have a look at it and we ended up with these fantastic reports again we've got a little summary of each one on the website that talk about which ones work for which people and and try to understand in what ways and as you say we've now tried to sort of create a sort of visual metaphor for that which we which we develop with people with lived experience so we have youth advisors from around the world who work with us to help us think these things through. And they came up with this you know is it a bit like cooking is it a bit like finding the right ingredients that work for me. What can be in my store cupboard and one of the things we want to do is say that store cupboard might include things that only professional can prescribe. So they might include sort of antidepressants but it might also include things that you can prescribe yourself like today's a TV watching day and that's what's going to help me. So it's trying to find the range of ingredients and then trying to think how can we put those ingredients together in a water order and which ones are core for whom and now any of those ingredients harmful. You know we must make sure that we're not prescribing harmful ingredients for people and then our idea is then to do research about those ingredients so we can really understand them and how they work and for whom and in what context. I'm interested about that idea they're avoiding harm just because one of the things that kind of comes to mind is is running you know it's it's January at the moment and lots of people are doing run every day and I love running but I can't do it because I can't do it safely so part of my kind of eating disorder history means that I used to literally run until I would collapse and I can't run without competing against myself and I've tried really hard but for me it's like a drug and so I do other things instead I climb because you can't over climb in the same way that you can overrun, but it does make me wonder because something like running say would for most people be I think a really positive and easy to access you can even do it during full lockdown. But for some harmful so how do you differentiate that because what might be good for some maybe harmful for others and I think this links to the personalization point that I think with mental health in particular, what may be fantastically help exactly as you say what fantastically help for someone may be completely harmful for someone else. And so, what I think is increasingly comes to the fore as a researcher gender is how do we help people make those choices. So how do we help people learn that for them running is not going to work, or that is going to work or find a way to have a way it isn't going to be about just saying to everyone run that works. I think it is about, how do we help people find the right door for them, and know that particularly will for where we are currently with current evidence mental health, it may mean trying a few doors before you find the one that's right for you and it may be right for you one stage in your life, and then not right for you to another stage in your life. Yeah. So I think it is exactly that it's about knowing that this might have to be individual experiments of one for some people. I know some things are overall harmful and some things are overall helpful, but I think it is it isn't it is an area where personalization and what's right for an individual is crucial. So one of the things we have commissioned is we're looking at creating a global data bank, which is where where we want large numbers of individuals to kindly share their daily activities and their experiences to try and track what works for them over time for exactly these sorts of reasons so that we can try and see for these sorts of people for this sort of group this might work for this sort of group this might not work and that that gets shared as a sort of community so that people learn. And one of the things we're trying to experiment with that is can we set that up in such a way that the people who are banking their data have maximum control and input into the science. So it isn't again in them and after they become citizen scientists in their own lives. So we're working with a fantastic company called sage bio networks in the state. They've convened a collaboration across the UK, India and South Africa, and we're just testing out to prove a concept to see if we can get this to work. Wow, that sounds really exciting and that would presumably that also speaks to this idea of trying to kind of close the gap between research and practice because it would be very much kind of living data. Wow. And as you have done this piece of work which it sounds like is very much ongoing but has there been anything that's really surprised you. I think the individuality of it has, I think I went in still thinking maybe there'll be some real front runs that will come up maybe they'll be, you know from these 30 maybe three will come up that are like these are absolutely, you know, hitting the spot. There are some there are definitely some so you know physical activity, behavioral activation when you get people to be sort of positively orientated sort of exposure for anxiety. There are some there are some areas where we really know stuff and we can really say to most people this is going to be really helpful. But I suppose I've been surprised by how individual it seems to it seems to be from the science so far. And also the other thing that surprised me is particularly for the 14 to 24 year olds, how little research has focused particularly on that age group that we've got lots on the sort of younger age group and lots on sort of working age at well not lots but more. But that age group in particular we, it is often isn't designated in the literature in that way so it's quite hard to find things that specific to that age group. That's because that's been interesting. Because that's such a crucial moment as well when we're kind of you know growing into adults and it's a really difficult time and we know that obviously in the current context right now that's a particularly vulnerable group they've lost a lot of their sense of purpose and belonging and yeah the world is hard for them and their prospects are perhaps a little poorer and compared to other age groups. Yeah, that's really interesting. So will that be a kind of particular area of focus for you then that age report. It is at the moment so within the mental health priority of the 14 24 years as our absolute focus, not that we are interested in other ages but that's our focus I think as we move into wider mental health challenge, we'll be looking at wider age groups but at the moment 14 24 years is a key area of focus. And it's interesting that idea that yes it's there aren't any kind of your very few sort of golden bullets I find this that in my teaching I always want to tell people you know the one thing you should do although the one thing I do always say I think I'm a bit of a broken record on is sleep. And you know that if you want to do one thing to make people feel better actually good and regular sleep I think regardless of what the issues are generally that makes a big difference quite quickly. It is interesting sleep was one of the actual ingredients we looked at. And in Hickey and his team did a fantastic review looking at that and there's some very interesting evidence about the links between sleep and mental health problems, exactly as you say and a really interesting emerging field. I think what we are lacking so far yet is the research that shows how best to intervene to help with that. Yes, and I guess that that's that's the bit that we still need to really crack. Yeah, and I think that yeah there's a couple of different things there aren't there and certainly I started engaging more with sleep. And I'm thinking about it actually I think it was you that gave me Ariana Huffington's thrive, and she talked about sleep and how it made a big difference in her life and I think it was one of those were you thought well if she can make it a priority I ought to at least give it a try and for me kind of sleep deprivation had been, I think a form of self harm perhaps in the past but I found it made a big difference. And I think when you really believe in something personally and you've seen the impact then you are more likely to advocate it. But one of the issues I come across is that largely people get it and they have seen that in their own life and they can see it would make a difference and they're happy to give it a try. And that's the part for some people where there is some sort of disorder or difficulty around sleep, being told, do you know what getting a bit more regular good sleep will really help you. Sometimes that can actually make things worse because it makes them worry then, well I'm not getting enough sleep and I can't get to sleep and yeah that can make it hard. I think that's right and I think it goes back to what we're doing about the personalization is it is about trying to find what's right for the individual, and also for the state so there's some interesting research about people with a very severe and enduring depression that actually had a sleeping less can be helpful and having sort of, so there are all sorts of interventions about sleeping less so they're there. I think, I think helping people find what works for them at that stage, and sort of opening that as an issue and then seeing if there are ways into it. One of the things I suppose that's that's really given me pause for thought about the active ingredients is, we don't know what it's it may be. Each person has to work out an individual chain of how things will affect them. So it may be that for someone that the way of addressing their sleep may be by addressing something else will help them sleep. Whereas for someone else by helping them sleep it will address something else. And it's quite hard that there's a lot of of trying to work out which think which way to go in, in I think in the active ingredients feel that we need to sort of try and find a way to disentangle. And within your work or within the wider work of welcome do you look at the kind of the links between physical and mental health because that picture feels like it's getting more and more blurry all the time. Everything I thought I once knew about these interactions I feel I don't really anymore. I think that's a really important area and a really growing area and I think there will be all sorts of opportunities for learning, learning going forward. And why are you doing this like what you know I've known you for years and you've been such an important advocate and voice within the field of mental health and you've had such an impact but why did you start within that field and what you know what inspires you to continue. So something I've always been interested in, and I'm sure one could dig into my family history to try and work out why, but certainly from childhood I've always been interested in trying to understand how what motivates people and how to help people with mental health difficulties. I guess to such an extent I can't really understand why everyone else isn't completely fascinated by it too I don't really understand why you don't really don't really believe that everyone else isn't secretly fascinated to. And I guess what sort of fuel me throughout my career and I suppose having started as a clinician and then moved into more research and policy and now into funding. I have a sense that it is such a mystery, and one that it's so if you don't, if you can get the right voices involved we can find some creative solutions. But that if you end up sort of trying to sort of battle it out by yourself or sort of think there's one easy solution. I end up with so many dead ends are really unhelpful and potentially harmful to people. So I suppose I feel a bit of mission to try and bring those brilliantly rich voices together to find creative solutions and I suppose going back to those 1424 year olds we were talking about earlier one of the things that's really struck me working with some of the youth advocates. There are some really exciting new ideas emerging, both from older, you know, even over 50 research. But also from those youth advocates and if we can bring those energies together. We're at, you know, mental health sciences at the cusp of actually being unbelievably exciting. I listened to a program on rage I'm a bit of a radio for addict and there was a program with Adam rather rather for looking at the, all the best findings of science of the last 10 years. My self didn't come on the radar and my mission is in 10 years time 2030 I want that to be such fantastic finds in mental health science that we are in such a different place for understanding some of these things. Wow. And how important is it that you do you think that we are learning from our mistakes because I feel this is as you say it's really a relatively young and emerging science and we've got some stuff quite wrong in the past haven't we. I don't mean like necessarily always in a big way I think there are little things we're learning all the time where the new evidence says oh gosh we should be doing this differently so classic example would be for me when working with young people who self harm we used to tell them to snap an elastic band on their wrist and the latest evidence says actually that does more harm than good. But I'm not sure how good we are always at learning from those mistakes or publishing when we find out that oh we did this thing and it didn't work or it caused harm. I completely agree and I think. I think it's partly a function of having been a small and beleaguered field. People felt they had to advocate for what we did know and sort of to give themselves to give themselves understandably status with other disciplines to say well you know this is the way we do it and also the field got very early defined by different schools. We were trained as a clinical psychologist we were trained in sort of CBT or psychodynamic therapy and you always have to pick your horse was actually we should be. We should just be interested in what works doesn't really matter what it's called, and it doesn't and we should be able to pick and choose from wherever it's out there. And then, and then when we find it doesn't work we should stop doing it and do something. I think part of it is creating a new identity where we see ourselves as mental health scientists and mental health practitioners, and that we're not a CBT person or a psychodynamic person or a, you know, an elastic band slapping person. And, and, and I think that's partly the trajectory we've got to go on. So collaboration is going to be really, really important. It is and I think, and I think remaining curious just remain like we are reminding oneself that once here in order to try and understand what works for whom and why and then to help. So in order to do that we need to learn from the latest findings and pull together and synthesize from across the sort of diverse fields that are currently a bit sort of an almost island that we need to sort of find bridges between those islands and then bring a build a sort of meta community. And I will stop talking to you soon I promise I could talk to you for days, but one one kind of final question before we maybe go into a closing thought. You talked about, you know, by 2030 you would love us to be able to look back and see that some of the most exciting things that have happened in science that are happening within mental health. What are you personally like really excited about when you look at that next decade in your career if you were looking back what do you hope will be different, and that you might have played a part in there. Yes, there are three things at the moment that sort of linked to my strategy. The first is that I would hope we would have a thriving mental health science community where people saw themselves as mental health scientists. And then neurologist, psychologist, psychiatrist, second, in a sense, and that they and that from that would have emerged some really exciting new occasions, whether it's can add up the doils and psychosis or whether it's deep brain stimulation for OCD, or whether it's a personalized route through for anxiety and depression, or whether it's, you know, do we just need to give money to communities and that makes all the difference mental health. So those are all seen as scientific findings that we can share and talk about and celebrate. So that would be one thing. The second thing is that we have managed to harness big data in new ways. So this sort of population data, these data banks, and that we've managed to somehow square the circle between privacy and open science and and control ownership by the people whose data it is. And then the third is that we have a sort of new narrative around mental health, which is around how around this next generation of treatments and approaches that allows us to learn from our mistakes and allows us to learn new things. And doesn't mean that we are stuck in having to sort of defend everything we've done. Or and that that stigma has become such a thing in the past it's become a sort of non issue in a sense. So those will be my hopes and wishes for the next 10 years. Wow. That's quite that's quite a wish list. But it feels possible you know you're in. Yeah, you've got such an incredible opportunity, I think, and you are so amazing at making things happen. So, yeah, I have Well, I think my closing thought will be that we need collaborators that that I can't do this alone welcome can't do this alone. None of us can decide that we need collaborators, both in the UK and globally. Anyone that's excited by this join us join us on this journey we're trying to be as open as we can I'm following your lead on trying to be on Twitter, trying to be on LinkedIn blogging. So you're really trying to we're open to engagement with people. We also have within welcome a whole open funding schemes for researchers who come with your great ideas, share them with us. We're trying to simplify our schemes that should be easier and simpler but mental health is actually front and center so please look at us don't think we're for someone else with everyone. Come and look and see if there is a way that we can have funds can help you create a world in which no one is held back. And I'm going to ask you to make one more more closing thought just normally I leave people to do whatever they they want but I'm particularly interested in just hearing a few thoughts for you from you on what it is like to be a female leader within mental health, and how you know there are lots of really promising young women out there who might like to one day you know have the chance to change the world, like you're doing and what advice would you give to people like that. As I've gone on in my career my eyes have got more and more open to the challenges and exclusions, not just a gender but of race and ethnicity. And I would say there are many intersectionalities that that limit people's opportunities and I feel deeply committed to try and make sure that we can take this forward in a positive way. So what I would say to people who feel that they are are not in the entitled group, whether by virtue of gender or race or other characteristics. Find, find mentors and supporters who can guide you through some of the norms and ways that power is is held. Think carefully about those issues and find peers and mentors who you can talk to about that so that you can be mindful yourself about how to negotiate the very real power dynamics that exist in our structures.