Kathryn Lovero, PhD

Dr. Kate Lovero aims to improve the prevention and treatment of adolescent mental health problems in low-resource settings, using multilevel stakeholder engagement and implementation science methods to generate health care delivery models that address the complex drivers of health inequity.

Why do you do this work?

To abbreviate a long and winding training journey, my postdoctoral research fellowship focused on the treatment of infectious diseases and maternal child health services in Brazil. My aim was to

understand the ways the health system could better deliver services to reduce health inequities. In this case, our findings showed that the health system was doing a great job delivering services but there was very low engagement in care, independent of sociodemographic factors. From my experience working in clinics, there seemed to be a big divide in engagement between those people who were feeling mentally well and those who weren't. This got me really interested in the research that was being done to improve mental health care globally and in low resource settings, where my work focused. I saw mental health as a growing field I could dive into and apply what I had learned studying physical health systems.

From a non-academic perspective, I just feel very strongly that everyone deserves to be mentally well and not enough attention is paid to this need. If you ask people what they want out of life, they say to be healthy and happy. For so long, and in global health especially, we went really hard on “healthy” and keeping people alive without thinking as much about the quality of life and their well-being.

What is your proudest moment so far, working within global mental health?

I think the best part of this job is there's a new proudest moment all the time and there's always a new challenge that you have to figure out. And a lot of times, you have to fail a lot to finally find the right thing to do—that's the world of research. But when it does get figured out, it's so gratifying.

Since 2017, I’ve been working in Mozambique, in collaboration with the Ministry of Health, to grow adolescent mental health services. Recently, I was in Mozambique launching a pilot study we have been preparing for 4 years, to deliver Interpersonal Therapy for Depressed Adolescents in primary care. It's just so awesome to get to this point and see the providers who are now fully trained to deliver this intervention and hear about the kids that they've helped and worked with. Also, our team there at the Ministry of Health is comprised of all psychologists and the idea has been that we work in tandem so that they'd be able to gain research skills in addition to their role as policymakers and clinicians. Each time I visit, it’s so great to see them in action and witness the importance of research capacity building.

What surprises you about this work?

I guess, looking back, I’m surprised by how the little moments feel so big, and the big moments end up feeling so little. As someone who has worked over 15 years in research, you spend all this time on

long grants and papers, and in the end those don't feel anywhere near as important as when you hear the story of one kid that went through treatment and is feeling better. Also, thinking of mental health specifically, there are issues of human existence where the details of the who, what, and where change across cultures and contexts, but the emotional core is the same. Adolescents from New York City and adolescents from Maputo, for example, often describe their problems pretty similarly, even if they may have a different source and impact.

What shift do you hope to see in the future of global mental health?

Often when I talk about low resource settings, people think I mean low-income countries. I mean low resource settings in all types of economic contexts, and I think we can learn more and make change faster if we recognize similarities, and even differences, across them.

Also, many challenges to mental health are fixed problems that can be helped in the way that people cope with them, but the problem itself will still exist. It's a chronic disease, in that you will go in and out of having mental health challenges that you need help with. But if you can't afford the bus ticket or the time off of work to come to therapy, these interventions can only go so far. Unless we address people’s basic needs, I don't know that mental health can ever quite get the focus that it needs because people just don't have those resources to engage.

I hope that there is continued growing interest and recognition of mental health as an integral part of every area of a person's life, and the need to think about it in the home, in school, in the community, in the health clinic, and woven through everything. I hope that trend continues.

Can you share something you're working on right now that you're particularly excited about?

We are pursuing a next phase of funding to grow the work we've been doing in Mozambique the past few years, and that's really exciting because one thing we want to avoid is sort of having this little initiative for a few years, and then disappearing. And so this will give us a chance to continue growing as a team there and developing the services that we've been working on testing out for the past few years, aiming for a more sustainable improvement in mental health care.

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