Optimizing personalized management of depression: the importance of real‐world contexts and the need for a new convergence paradigm in mental health

historical and economic drivers shape daily experience, there is promise in collective action. Without deliberate steps toward mental health equity through multiple routes, the global mental health project falters. One route to global mental health equity is through quality mental health research. The increased investment in mental health research in lowand middle-income countries has led to an expanded evidence base on effective interventions now being implemented in diverse sociocultural settings. Greater resources for research and research capacity-building provide opportunities for more diverse ethnic and cultural populations to contribute to the evidence base, to shape research questions and the approaches to answering them, thereby increasing the likelihood that research outcomes will be of relevance to all of us. Global diversity in mental health research participants will also permit more progress in the search for etiologies of mental illness. Our understanding of the genetic architecture of schizophrenia and bipolar disorder relies largely on Northern European data. Funding flows, partnerships, and opportunities to engage new populations and pursue locally relevant research are far from equitable and this must remain a goal of global mental health. Equity in improving population mental health outcomes will require a commitment to designing interventions to tackle social problems that limit the effectiveness of care oriented to the individual. Community leadership and empowerment, alongside engagement of service users to help transform service delivery, could be hallmarks of these interventions. Equity in the production and dissemination of global mental health knowledge requires prioritization of local cultural perspectives. Leveraging global relationships need not negate local experience. Rather, one strategy of the global mental health community should be to make known the innovation and ideas that come from communities which seldom find a global audience. In a recent initiative on suicide prevention among Arctic Indigenous people, a method was developed to build consensus across a diverse group of international stakeholders. Some members of the team called for a parallel process that would use culturally acceptable methods to relay the particular experiences of specific Indigenous communities. The group applied both methods and integrated the findings in the final report. Even widely experienced processes, such as deinstitutionalization, provide context-specific lessons about leveraging political opportunities into gains for mental health. In many settings, deinstitutionalization and innovations in community mental health coincided with the establishment of post-colonial governments, the end of military dictatorship, or the entry of democracy. For example, the expansion of community mental health services in Jamaica after its independence developed in alignment with local cultural values, distinct from the colonial era. These creative approaches to mental health care are valued, though not always widely disseminated. Nevertheless, the influence of innovative approaches to mental health from settings with scarce resources pervades global mental health. Integrating peers, lay health workers, primary care providers, as well as technology, into mental health care adds flexibility to mental health service delivery, breaks down traditional hierarchies, and makes care more accessible. Diverse ethnic and cultural groups in high-income countries that face challenges in access to and engagement in care can make use of such varied approaches. It is possible that the global reach of the social, emotional and economic shocks of 2020 will thrust communities around the world into innovation that benefits mental health. If so, the movements, resources and networks that represent people and projects engaged in global mental health may become increasingly widely accessible. The field offers a transnational community for diverse stakeholders with distinct perspectives who value its aims.