Mental Health Research in the Global Era: Training the Next Generation.

Abstract

Psychiatric disorders are among the leading cause of disability worldwide, yet fewer than 25 % of affected individuals are estimated to have access to treatment. In many low-income settings, it is estimated that less than 10 % of affected individuals are able to access basic mental health care and, even when they do, it is often below minimum ethical and clinical standards [1]. The discipline of global mental health is dedicated to reducing mental health disparities within and between countries by preventing mental disorders and improving access to psychiatric treatment, particularly in low-resource settings [2]. The study of cross-cultural mental health dates back to the late 1800s, when European psychiatrists and anthropologists began to identify and document locally specific mental diseases in their colonies [3]. Transcultural psychiatry branched into two research traditions: “relativists,” who were focused on characterizing culture-bound syndromes, and “universalists,” who sought to identify universality across cultures in the manifestation of mental disorders [2]. Both research traditions emerged from a colonial paradigm, wherein Western researchers studied the non-Western “other.” Whereas relativists relied primarily on qualitative and ethnographic methods [4], universalists employed epidemiological methods to estimate the cross-cultural prevalence of mental disorders, as defined by Western criteria. Cross-cultural mental health research has evolved significantly from its colonial roots to what is now a global partnership model emphasizing interdependency, bi-directional knowledge generation and transfer, and shared ownership (see Fig. 1). Though the relativist and universalist perspectives still exist, most global mental health researchers have gravitated towards an integrationist perspective, recognizing both broad universality in mental disorders across cultures as well as meaningful cross-cultural variation. Global mental health research now requires an interdisciplinary approach to bridge multiple perspectives and address complex questions related to cultural adaptation, effectiveness, dissemination, and implementation. It is grounded in the social justice and human rights perspective that all people have the right to health and mental health [5], with an emphasis on creating sustainable interventions to reduce mental health disparities. This paradigm shift has many implications for the training of the next generation of global mental health researchers, including both identifying and developing critical new skill sets to propel the field forward. Fig. 1 History and evolution of global mental health research and training