Abstract
We are in an important moment for mental health treatment around the world, as many Low and Middle Income Countries (LMICs) – representing an increasing majority of the world’s population – are currently developing and scaling up services for the first time. Yet, research on Global Mental Health (GMH) best practices remains scattered and difficult to synthesize. This review aims to simplify existing GMH research on effective biomedical and psychosocial treatment approaches from both high-income countries and LMICs to enable a more comprehensive understanding of the benefits and drawbacks of existing interventions, based on the highest quality, up-to-date research. By understanding which treatments are most effective and why, we can begin to not only implement more effective practices, but guide the future of GMH research in the right directions. The purpose of this review is therefore to understand mental illness, what it is, how it was treated in the past, how it manifests differently around the globe, and how to best treat it. Ultimately, while psychosocial approaches are advised for patients with more mild to moderate disorders, medications and other biomedical approaches are recommended increasingly only for more severe cases. While significant evidence exists to justify the use of psychotropic medications for mental illness, their adverse effects indicate that psychosocial approaches should be prioritized as first line treatments, particularly for mild to moderate disorders. As one of the first to analyze this research, this review is useful not only for GMH scholars, but for practitioners and public health workers globally, as well.
Highlights
Brief history of mental illnessIn 2018, The Lancet Commission on Global Mental Health and Sustainable Development led by Dr Vikram Patel, and other leaders in the field, characterized mental and substance use disorders as emotional, cognitive, or behavioral disturbances that reach a threshold which causes substantial functional impairment, so that an individual struggles to fulfill desired social roles in the community (Patel et al, 2018)
According to the Commission, the focus on functional impairment is an essential criterion to identify the point at which a person might be considered to have a disorder or require a diagnosis; the measurement of functional impairment in diverse cultural contexts remains hotly debated in global mental health research (Patel et al, 2018)
The future of mental health treatment is one of openness to adaptation and experimentation based on a wide range of cultural factors, to ensure that treatments are in sync with patient understanding itself
Summary
In 2018, The Lancet Commission on Global Mental Health and Sustainable Development led by Dr Vikram Patel, and other leaders in the field, characterized mental and substance use disorders as emotional, cognitive, or behavioral disturbances that reach a threshold which causes substantial functional impairment, so that an individual struggles to fulfill desired social roles in the community (Patel et al, 2018). While in the late 1800s, substances such as bromides and barbiturates were used to sedate the mentally ill, it wasn’t until 1949 when an Australian psychiatrist experimented with the element Lithium and found it to be effective in treating some mental disorders, such as depression (Foerschner, 2010) Since this period, medications from Valium (diazepam) in the 1960s to Prozac (fluoxetine) in the 1980s have permanently altered mental health care; while many in the West view these as treatments for specific disease states, populations in other parts of the world continue to view mental illness as primarily related to spiritual afflictions (Kohrt & Mendenhall, 2016). Labels, symptom lists and criteria for psychiatric diagnoses have changed significantly over the history of these documents, the current formulations include mood disorders (such as depression or bipolar disorder), anxiety disorders (such as panic or generalized anxiety disorder), stress and trauma disorders (such as post-traumatic stress disorder), psychotic disorders (such as schizophrenia), substance use disorders (such as alcoholism), child development disorders (such as autism and ADD/ADHD), somatoform disorders (such as chronic pain), cognitive disorders (such as Alzheimer’s or dementia), personality disorders (such as borderline personality disorders) and neurological disorders (such as epilepsy) – see Table 1 (Kohrt & Mendenhall, 2016)
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