Addressing mental health challenges in clinical practice: a qualitative study to investigate perspectives of international mental health experts

Mental illnesses are not only associated with the highest level of subjective suffering compared to other chronic diseases but at the same time with a significantly increased morbidity. Especially in industrialized countries, a dramatically increasing proportion of sick leave and early retirement due to mental illness diagnoses is observed, pointing to increased social stress factors and a close association with societal changes and emphasizing challenges to the health care system. The following qualitative study was conducted as part of the establishment of the German Center for Mental Health, which unites excellence in psychiatric, psychological and neuroscientific research in Germany to facilitate translation of basic into clinical research and general health care. A 120-minute, guided, virtual focus group discussion was conducted with international experts in the field of mental health research from Chile, the USA, the UK, South Africa, and Australia to represent views from different continents. The participants discussed international trends, unrecognized needs and gaps in clinical practice and recognized many opportunities and challenges in the research of the different topics of the German Center for Mental Health. Furthermore, the focus areas of the German Center were presented, and participants were asked about the opportunities and challenges in researching these topics. The evaluation method was based on qualitative content analysis according to Mayring. The focus group discussion was transcribed and coded with MAXQDA 2022 software. The reliability of the coding was checked by using the intercoder reliability and Cohens Kappa. The experts emphasized the high mortality due to comorbidity of somatic and mental disorders including addiction and called for a mechanism-based approach to promote individualized treatment. Furthermore, the impact of poverty, social exclusion, stigma and discrimination was addressed as a key modifiable environmental risk factor. The experts highlighted digital tools, computational models and AI based approaches for precision psychiatry. To systematically evaluate real-world outcomes, the experts emphasized the need for interdisciplinary research including behavioral, computational, social, and neurobiological scientists and experts by experience. This study highlights the need for interdisciplinary and participatory approaches in mental health research. Key challenges include the high comorbidity of mental and physical disorders, the impact of social determinants, and gaps in translating research into practice. Experts emphasized the importance of digital tools, computational psychiatry, and community-based interventions to enhance prevention and treatment. The German Center for Mental Health (DZPG) is well-positioned to address these challenges by integrating diverse expertise and fostering innovation in mental health care.