interRAI’s Contribution to Global Mental Health Research

by Dr. John Hirdes, Professor at the University of Waterloo and interRAI Treasurer

Why is mental health important?

Challenges related to mental health affect us all, and the COVID-19 pandemic has only heightened the intensity of those challenges around the world. Prior to the pandemic, over 20% of Canadians reported experiencing problems with mental health or addictions. Some studies estimate that about half the population will experience mental health problems by the age of 40. In fact, a New Zealand study suggests that only 17% of people will live their entire lives free from mental illness.

That means that mental health is personal. It affects us all either directly or indirectly.

Mental health is also complicated. It is reported that 70% of mental health problems begin in childhood or adolescence. For some of those individuals, difficulties related to mental health will endure for a lifetime. On the other hand, life experiences and age-related changes can cause mental health problems to appear in later stages of life. There are many other factors that can lead to adverse mental health outcomes including physical health and disability, unemployment, poverty, homelessness, and substance use. Our social relationships can be a source of comfort and protection from stress. Family and friends can play vital roles in recovery in mental health and addictions. On the other hand, dysfunctional or abusive relationships can be major causes of lifelong mental health problems and addictions.

Global impact

Mental health is also important in terms of its global impact. Every country of the world is affected. Mental illness and substance use disorders are the leading global cause of disability. Depression alone was the fourth leading cause of total global disease burden in 2000. Former US Surgeon General David Satcher stated, “There is no health without mental health”.

Need for a systems approach

For societies to deal with mental health and addictions issues, a systems approach that spans the life course is needed. Persons dealing with mental health and addictions issues are in contact with various health service providers, the education system, welfare services, and the criminal justice system. A sector-specific approach won’t be enough to provide an adequate response to these challenges. A coordinated, comprehensive strategy that spans the continuum of care is essential.

interRAI and mental health

interRAI ( is a not-for-profit charitable network of researchers, clinicians, and policy experts from over 35 countries focused on the development and application of comprehensive assessment, screening, and care planning systems that identify and respond to the needs of vulnerable persons of all ages across the continuum of care. With over three decades of research experience, interRAI developed systems that have been adopted on a large-scale basis internationally in multiple settings, including mental health services.

The interRAI suite of mental health assessments includes mental health measures for every care setting, and there is a series of specialized mental health instruments designed for emergency, community, and facility-based mental health services. These instruments cover all age groups ranging from infants and newborns to centenarians. They are designed to function as an integrated health information system that can be used to support measurement-based care over the person’s life course.

Special Issue of Frontiers in Psychiatry

interRAI recently partnered with Frontiers – a leading open-access publisher and open science forum – to launch a special issue of Frontiers in Psychiatry to highlight innovative applications of interRAI systems. This publication serves as a compendium of new research related to the interRAI family of instruments in psychiatric and non-mental health care settings. Priority was given to papers that illustrate novel uses of interRAI assessment data to address mental health problems through clinical care of persons living with mental illness or organizational level decision-making to deal with mental health of populations. This includes development and testing of new screening tools, as well as decision support applications for risk management, care planning, outcome monitoring, and performance measurement.

The Editorial Board for the Special Issue includes Jason Ferris PhD, University of Queensland, Australia; Gary Cheung, MD, University of Auckland; Jyrki Heikkilä MD, Turku University Central Hospital, Finland; and John P. Hirdes PhD, University of Waterloo, Canada. The papers published in the special issue include:

• Psychometric studies to evaluate performance of new instruments, scales or algorithms

• Comparisons of needs and outcomes of care for persons with mental illness across care settings or among different age groups

• International comparisons of mental health system performance

• Evaluation of innovative models of mental health service provision

• Novel clinical or management applications of interRAI mental health data

• Use of interRAI systems to monitor mental health outcomes over the life course

The papers appear sequentially after they have been evaluated and approved through a rigorous, independent peer review process. They will also be released as a compiled volume once all submitted papers are finalized. You can find the open-access published papers as they appear on-line at: In addition, interRAI is producing a series of video interviews with the papers’ co-authors who will discuss the key findings and implications arising from this work. The first video is available through the interRAI Youtube channel at:

If you’d like more information about interRAI’s mental health research, contact us at