1Scientific REPORtS | (2018) 8:3794 | DOI:10.1038/s41598-018-21900-1

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Quantitative account of social
interactions in a mental health care
ecosystem: cooperation, trust and
collective action
Anna Cigarini1,2, Julián Vicens 1,2,3, Jordi Duch 3,4, Angel Sánchez5,6,7,8 & Josep Perelló 1,2

Mental disorders have an enormous impact in our society, both in personal terms and in the economic
costs associated with their treatment. In order to scale up services and bring down costs, administrations
are starting to promote social interactions as key to care provision. We analyze quantitatively the
importance of communities for effective mental health care, considering all community members
involved. By means of citizen science practices, we have designed a suite of games that allow to probe
into different behavioral traits of the role groups of the ecosystem. The evidence reinforces the idea
of community social capital, with caregivers and professionals playing a leading role. Yet, the cost
of collective action is mainly supported by individuals with a mental condition – which unveils their
vulnerability. The results are in general agreement with previous findings but, since we broaden the
perspective of previous studies, we are also able to find marked differences in the social behavior of certain
groups of mental disorders. We finally point to the conditions under which cooperation among members
of the ecosystem is better sustained, suggesting how virtuous cycles of inclusion and participation can be
promoted in a ‘care in the community’ framework.

Approximately one fifth of the world population will suffer some mental disorder (MD) at some point in their
lives, such as anxiety or depression1. The direct economic costs of MD, including care and indirect effects, is esti-
mated to reach $6 trillion in 2030, which is more than cancer, diabetes, and respiratory diseases combined2. As
part of a global effort to scale up services and bring down costs, reliance is increasingly made upon informal social
networks3. A holistic approach to mental health promotion and care provision is then necessary, and emphasis
is placed on the idea of individuals-in-community: individuals with MD are defined not just alone but in rela-
tionship to others4. Such a paradigm shift implies superseding the traditional physician-patient dyad to include
caregivers, relatives, social workers, and the community as a whole, recognizing their crucial role in the recovery
process.

A key aspect in the definition and aetiology of MD has to do with social behavior5: behavioral symptoms, or
consequences at the behavioral level, characterize most MD. For instance, autism, social phobia, or personality
disorders are determined by the presence of impairments in social interaction. Other disorders result in signif-
icant difficulties in the social domain, s