Abstract
The global burden of disorders has shifted from infectious disease to non-communicable diseases, including neuropsychiatric disorders. Whereas infectious disease can sometimes be combated by targeting single causal mechanisms, such as prevention of contact-spread illness by handwashing, in the case of mental disorders multiple causal mechanisms are typically relevant. The emergent field of global mental health has emphasized the magnitude of the treatment gap, particularly in the low- and middle-income world and has paid particular attention to upstream causal factors, for example, poverty, inequality, and gender discrimination in the pathogenesis of mental disorders. However, this field has also been criticized for relying erroneously on Western paradigms of mental illness, which may not be relevant or appropriate to the low- and middle-income context. Here, it is important to steer a path between scientism and skepticism. Scientism regards mental disorders as essential categories, and takes a covering law approach to causality; skepticism regards mental disorders as merely social constructions and emphasizes the role of political power in causal relations. We propose an integrative model that emphasizes the contribution of a broad range of causal mechanisms operating at biological and societal levels to mental disorders and the consequent importance of broad spectrum and multipronged approaches to intervention.
Highlights
In recent decades, there has been a shift from infectious disease to non-communicable diseases throughout the world
Integrative Approach to Global Mental Health and are highly cost-efficient, but that neuropsychiatric disorders are often underdiagnosed and undertreated, with the treatment gap large in low- and middle-income countries. This treatment gap is a human rights issue; levels of stigmatization of people living with mental illness are too high, and levels of mental health literacy are too low in communities, clinicians, and policy makers [4, 5]
In considering some of these conceptual and ethical questions, we have argued that clinicians and researchers should steer a course between a scientism that regards mental disorders as natural kinds, and a skepticism that views all mental disorders as mere sociocultural constructions [7,8,9]
Summary
There has been a shift from infectious disease to non-communicable diseases throughout the world. Integrative Approach to Global Mental Health and are highly cost-efficient, but that neuropsychiatric disorders are often underdiagnosed and undertreated, with the treatment gap large in low- and middle-income countries. This treatment gap is a human rights issue; levels of stigmatization of people living with mental illness are too high, and levels of mental health literacy are too low in communities, clinicians, and policy makers [4, 5]. Integrative approaches are needed to address fully the complex reality of mental disorders In this commentary, we discuss this view in relation to global mental health, considering in turn issues of diagnosis, pathogenesis, and intervention (Table 1)
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