Movement For Global Mental Health Research Articles

Globalising dementia research: echoes of racialisation and colonialism

This paper offers some provocations regarding the contemporary globalisation of dementia research. I begin with a brief account of the late 20th-century genesis of the dementia research economy in the US and subsequent initiatives to extend that research across the majority world. I then trouble this political movement. I consider racialisation in dementia research as a parallel process to globalisation, with minoritised groups being positioned as new subjects for moral and knowledge claims regarding dementia. I suggest resonances with critiques of the global mental health movement as a technology of coloniality, which I argue are relevant to the current globalisation of dementia research. I contend that majority world populations are being positioned – scientifically and morally – as new research sites and as examples of why Anglo-American approaches to dementia are superior. These parallels require critical gerontologists to ask who is benefiting from the globalisation of dementia.

Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse.

Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.

Global Mental Health Movement: Need for a cultural perspective.

The present commentary reviews the goals and differing positions on the Movement for Global Mental Health (GMH), with a distinct emphasis on the cultural differences in the understanding of the aetiology of mental health issues. The proponents and advocates of GMH support its intentions and primary agenda of scaling up mental health services, especially in low-income and middle-income countries where the prevalence of mental health disorders is continually rising. However, many cultural psychologists and sociologists critique the movement for universalising psychiatric symptoms, as this universalisation could actually suppress local voices and might also undermine the significance of culture and political and psychosocial predictors which may contribute to mental health challenges. After discussing the pros and cons of the GMH movement, this commentary concludes with a conceptual analysis of the GMH position and offers predictions about its future discourse.

The Movement for Global Mental Health: Critical Views from South and Southeast Asia.Edited by WilliamSax and ClaudiaLang, Amsterdam: Amsterdam University Press. 2021. pp. 336.

The Movement for Global Mental Health: Critical Views from South and Southeast Asia.Edited by WilliamSax and ClaudiaLang, Amsterdam: Amsterdam University Press. 2021. pp. 336.

Journeying Through Different Mythic Worlds

Abstract: The global mental health movement (GMHM) seeks to close the treatment gap in low- and middle-income countries including those in Southeast Asia. However, the GMHM has been criticized for its overemphasis on a Eurocentric approach to mental health care, ignoring the diversity of knowledge and resources in local communities. Given the pluralistic health care systems in most Southeast Asian countries, people may utilize both Indigenous healing and Western mental health services. Therefore, indigenous healing systems can be integrated into mental health care to offer additional resources to local people to cope with emotional distress. Using a single case study approach, this article aims to explore the therapeutic aspects of indigenous healing systems relevant to mental health care. The case is about Jing, a Chinese woman who simultaneously consulted psychiatrists, a dang-ki (Chinese shaman/spirit medium), and a traditional Chinese medicine physician in Singapore. I attempt to answer three questions. First, what is Jing’s experience of seeking help from different forms of healing systems? Second, what are the therapeutic aspects of indigenous healing systems relevant to mental health care? Third, what are the challenges for reconciling the experiential truth with the empirical truth? Based on her narrative, although these healing systems were structured in different mythic worlds and explanatory models, Jing found all of them helpful without experiencing any cognitive dissonance. This may be because she did not passively respond to the treatments but actively negotiated her expectations with the healers, constructed meanings, and adopted a pragmatic attitude to meet her needs.

Health and care system assessment aimed at cultural adaptation of MhGAP modules

IntroductionAs part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.ObjectivesAs part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.MethodsThe methodology used was mixed.A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.ResultsThe data collected from 9 health centers in the two provinces allowed us to learn about:- Poor knowledge of mental health and school readiness- Identification of barriers to access to care- Beliefs around mental health, mental suffering and care- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.ConclusionsThe evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.Disclosure of InterestNone Declared

Adjusting intervention of trade war subjective feelings: An analysis of the relationship between psychological characteristics and mental health of foreign trade workers

BackgroundWith the development of the economy and society and the further increase of social competition pressure, people often encounter some difficulties or pressure in academics, employment, economy, interpersonal relationship, marriage and other aspects. Mental health problems occur frequently. The burden of illness caused by mental health is growing. In recent years, it has had the greatest impact on our country’s foreign trade industry. The most profound social event is the China–United States trade war. On March 22, 2018, the US announced an additional 25 percent tariff on $60 billion of Chinese goods. On March 23, China retaliated by imposing additional tariffs on $3 billion of imported goods from the US, marking the official start of the “China–United States trade war”. Mental health is an important part of people’s health. Without a healthy mind, there will be no healthy life. In recent years, with the rapid development of the global mental health movement, the attention of all walks of life to mental health has reached a new height. The researchers investigated or studied the mental health status of teachers, school students, police officers, medical personnel, workers, left-behind children, sailors and supervised personnel from various perspectives. Based on the above, the study analyzes the impact of the trade war on the psychological characteristics and mental health of foreign trade employees and the relationship between them, in order to improve the anxiety of foreign trade employees.Subjects and MethodsThe research data was obtained through a questionnaire survey. At the beginning of the questionnaire, unified guidance is used to introduce the nature, purpose and filling method of the survey. The respondents are asked to select the corresponding answer for each item in a secret way according to their actual situation. The questionnaire is distributed centrally and filled out separately. The original data obtained from the questionnaire contains 438 samples, some of which have problems such as the mission of question filling, inconsistency of key information, and continuous selection of the same options in each question of the same scale, which need to be excluded. After pretreatment, the sample size was 354, and the sample effective rate was 81%. Stata16.0 software and SPSS22.0 software were used for the calculation and statistics of relevant data.Figure 1.Scores of index of Well-Being scale before and after the interventionResultsAs shown in Figure 1, under the psychological intervention of trade war subjective perception adjustment for foreign trade practitioners, scores of all index of Well-Being scales were significantly higher than before the intervention (P < 0.01).ConclusionsThe results of this study show that after the intervention mechanism of trade war subjective perception regulation, all the scores of indexes of Well-Being scale are significantly higher than before the intervention (P < 0.01), indicating that the trade war subjective perception regulation mechanism is intervening in the psychology of foreign trade practitioners, which can improve the work happiness of foreign trade practitioners. Avoiding social events such as the China–United States trade war may aggravate their psychological symptoms and reduce their mental health.

The new World Mental Health Report: Believing impossible things.

We examine whether the recent World Health Organization (WHO) report on global mental health uses severity of illness as a criterion in priority setting for resource allocation. The WHO does not prioritise severity in the recent landmark World Mental Health Report. It recommends instead the insuperable task of scaling-up interventions for broadly defined mental health conditions, including milder distress, amongst over a billion people, with the majority living in low- and middle-income countries. Schizophrenia, the most severe and disabling of all psychiatric illnesses, is relatively neglected in the WHO report, and the disability associated with bipolar disorder is underestimated. This is inconsistent with the ethical principle of vertical equity, where the most severe illnesses should receive the greatest priority. The global mental health movement must refocus on deinstitutionalisation, and ensure adequate community and general hospital treatment for severe illnesses, especially the 24 million people with schizophrenia.

Mental health law, policy & program in India – A fragmented narrative of change, contradictions and possibilities

There has been a long-standing history of over 150 years of mental health legislation in the Indian sub-continent. India formulated its National Mental Health Program (NMHP) in 1982 and National Mental Health Policy (MHP) only in 2014. In this paper we mark significant influences on the evolution of mental health law, policy and program in India starting from colonial laws. We suggest that discursive continuities from these colonial laws have existed for a few decades in post-independence India. International influences of deinstitutionalization and growth in community psychiatry took root in India by the late 1970s and considerably shaped mental health program thinking. The decade of 2000s with two major international developments, the UN Convention on Rights of Persons with Disabilities (CRPD) as well as Movement for Global Mental Health (MGMH) have had a significant impact on the mental health sector in India. We comment on a disjuncture between the progressive frames of the current mental health law and policy framework on the one hand and the national and district mental health programs in the country on the other. We then focus on technology assisted solutions for mental health care and their promise as widely promoted by the state and the market and what these mean for a country like India. Throughout the paper, we raise critical questions regarding dominance of western bio medical psychiatry as the epistemic frame guiding policy imagination at the cost of diverse, community resources and practices.

Social Vulnerability and Mental Health Inequalities in the "Syndemic": Call for Action.

Covid-19 is referred to as a “syndemic,” i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.

Prevalence and determinants of mental health among an indigent population in rural Burkina Faso: a cross-sectional study

Background In Burkina Faso, prevalence of mental health disorders and the characteristics of people living with these disorders are scarce, especially among the poorest. Methods This study aims at providing a descriptive portrait of the prevalence of psychiatric symptoms and their determinants among indigent individuals living in rural Burkina Faso. A cross-sectional design was chosen, using a stratified sampling procedure. A questionnaire comprising 73 questions was administered to 1314 respondents. Results Mental health symptoms were grouped into three types: anxiodepressive, somatic and psychotic. A total of 1234 (93.9 %) participants reported having experienced at least one anxiodepressive symptom and 1087 (82.7%) respondents reported at least one somatic symptom one month prior to the interview. Furthermore, 256 (19.5%) participants reported at least one psychotic symptom in their lifetime. Differences in the expression of distress between regions were noted as well as a feeling of exclusion among respondents to their communities were common to all symptomatic profiles, which opens up avenues of targeted intervention for future equitable mental health policies. Conclusions The mental health action plan 2014-2018 in Burkina Faso7 identified the lack of evidence in mental health as one of the most salient issues. This study contributes to addressing this limitation and participates in the Movement for Global Mental Health (MGMH) by providing knowledge on the prevalence of symptoms of mental health disorders in a vulnerable population living in rural areas.

Participatory mental health interventions in low-income and middle-income countries: a realist review protocol

IntroductionThe launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation...

Psychosocial interventions for community-dwelling individuals with schizophrenia: study protocol for a systematic review and meta-analysis

IntroductionDespite the recent global mental health movement of the transition from hospital-centred to integrated community-based services, comprehensive evidence of psychosocial interventions focusing on community-dwelling individuals with schizophrenia is still lacking....

Conceptualizing culture in (global) mental health: Lessons from an urban American Indian behavioral health clinic

The movement for global mental health (GMH) has brought perennial questions about human diversity in mental health to the fore through heightened debates over if and how established knowledge, institutions, and practices should be altered for ethical and effective interventions with diverse peoples around the world. Kirmayer and Pedersen (2014) encouraged dialogue between GMH scholars and communities considered for intervention to address differences and concerns about colonialism. American Indian mental health offers an instructive site for global mental health inquiry to understand frameworks that might facilitate this desired dialogue. Here, we draw from a clinical ethnography in urban American Indian behavioral health conducted between September 2014 and February 2015 to glean insights into a popular response to these differences: Incorporating Indigenous cultural forms into clinical practice. Our findings highlight a predicament this response presents to mental health professionals. They can either eschew their clinical training and its cultural assumptions to take up new lives enabling their representation of Indigenous cultural forms, or they can hold onto their professional training and modify what is clinically familiar to appear culturally different. Rather than a purposeful decision, in the clinic contextual factors—tacit assumptions, clinic structures, and popular culture concepts—powerfully shaped clinical practice and reconfigured Indigenous cultural forms to support familiar clinical processes (e.g., treatment-planning). Although potentially therapeutic, culturally repackaged mental health practices are not the therapeutic alternatives called for by many Indigenous communities, and when advertised as such, risk harmful appropriations and misleading reticent people into participating in culturally prescriptive interventions. Lessons for global mental health point away from incorporating Indigenous cultural forms into clinical practice, which is likely to result in cultural repackaging, toward ethnographically-informed dialogue of differences to inform models for medical and epistemic pluralism providing interested communities more culturally commensurate mental health services alongside well-supported Indigenous therapeutic alternatives.

Improving mental health care in rural Kenya: A qualitative study conducted in two primary care facilities

Mental health research is needed in African countries in order to improve quality of care at local levels. This paper presents the results of a study conducted in 2018 among one hundred care givers in two peripheral primary health care facilities in rural Kenya. Opened interviews were performed, with the aim of eliciting relevant issues. The body of knowledge generated by the Global Mental Health (GMH) movement was used as the theoretical frame of reference. Five broad topics emerged as particularly significant in the specific context of this study: a. a globally negative perception of mental illness; b. a lack of trained professionals associated with limited opportunities for task-sharing or task-shifting; c. an intense stigmatization of affected individuals; d. the importance of strengthening the collaboration between the formal health sector and traditional healers, and, e. the necessary efforts to be made in order to reach patients living in remote areas. Our study highlights the importance of actively detecting mental disorders, promoting initiatives to reduce stigma and adapting western designed tools for specific settings in low and middle income countries (LMICs).

Communalistic use of psychoactive plants as a bridge between traditional healing practices and Western medicine: A new path for the Global Mental Health movement.

The Global Mental Health (GMH) movement aims to provide urgently needed treatment to those with mental illness, especially in low- and middle-income countries. Due to the complexity of providing mental health services to people from various cultures, there is much debate among GMH advocates regarding the best way to proceed. While biomedical interventions offer some degree of help, complementary approaches should focus on the social/community aspects. Many cultures conduct traditional rituals involving the communal use of psychoactive plants. We propose that these practices should be respected, protected, and promoted as valuable tools with regard to mental health care at the community level. The traditional use of psychoactive plants promotes community engagement and participation, and they are relatively affordable. Furthermore, the worldviews and meaning-making systems of local population are respected. The medical systems surrounding the use of psychoactive plants can be explained in biomedical terms, and many recently published clinical trials have demonstrated their therapeutic potential. Psychoactive plants and associated rituals offer potential benefits as complementary aspects of mental health services. They should be considered as such by international practitioners and advocates of the GMH movement.

The Messiness of (De)Coloniality: An Autoethnography of the Cross-Cultural Researcher

In this paper I explore the complexity of psychological cross-cultural research, particularly noting the ways in which cross-cultural mental health research and the global mental health movement are still driven by Western conceptualizations of mental health. By taking up decolonial theory through autoethnographic methods, I consider the responsibility, ethics, and tensions in conducting cross-cultural mental health research, particularly as a White researcher with non-White, non-Western participants. Ongoing reflexivity as a researcher and practitioner offers the opportunity to engage in culturally responsive practices that continue challenging the coloniality of Western psychology which can pervade global mental health studies when unchecked. I put forth liberatory practices such as attending to insider voices and engaging in relational practices between researcher and participants as opportunities for cross-cultural researchers to engage in rigorous research that is responsive to the local culture and active in decolonizing the field of psychological and mental health research.

\u201cWe Need Other Human Beings in Order to be Human\u201d: Examining the Indigenous Philosophy of Umunthu and Strengthening Mental Health Interventions

This paper examines how cultural, historical and contemporary perspectives of mental health continue to inform ways of understanding and responding to mental distress even under the biomedical gaze of the Movement for Global Mental Health (MGMH). Based on experiences in Malawi, the authors explore three prominent interventions (practical support, counselling and support groups) employed by village health workers within a mental health task-shifting initiative and reveal how the ancient philosophy of Umunthu with its values of interconnectedness, inclusion and inter-relationships informs and shapes the direction of these interventions. Practical support is marshalled through traditional village structures, counselling provides advice and an encouragement to hope, and support groups provide a place for emotional exchange and a forum for the enactment of values, reflection and reinforcement of Umunthu. What are pronounced as biomedical psychosocial interventions are in fact the delivery of culturally embedded therapeutic approaches. Historical and socio-political evidence is offered to explain the dominance of biomedical perspectives and the HSAs’ responses and a call is made for a transformation of MGMH to embrace rich philosophies such as Umunthu and enact respectful, inclusive and democratic values to enlist collaborations between equals to develop relevant and effective knowledge and local responses to mental distress.

The Cultural Politics of Mental Illness: Toward a Rights-Based Approach to Global Mental Health.

The movement for global mental health (MGMH) has raised awareness about the paucity of mental health services, particularly in low- and middle-income countries. In response, policies and programs have been developed by the World Health Organization and by the Lancet Commission on global mental health, among other organizations. These policy initiatives and programs, while recognizing the importance of being responsive to local needs and culture, are based on Western biomedical conceptualizations of emotional distress. In the paper, we discuss how a rights-based approach canpromote thevoice and participation of people with lived experience into the MGMH. We argue that a human rights framework can be enhanced by incorporating the conceptual approaches of critical inquiry and community mental health. We also discuss how rights-based approaches and service-user activism can productively reconfigure Western psychiatric conceptualizations of distress and provide both a moral and empirical justification for a paradigm shift within the MGMH.

Hegemony versus pluralism: Ayurveda and the Movement for Global Mental Health

Under the aegis of the World Health Organization, the Movement for Global Mental Health and an Indian Supreme Court ruling, biomedical psychiatric interventions have expanded in India augmenting biomedical hegemony in a place that is known for its variety of healing modalities. This occurs despite the fact that studies by the WHO show better outcomes in India for people suffering from schizophrenia and related diagnoses when compared to people in developed countries with greater access to biomedical psychiatry. Practitioners of ayurvedic medicine in Kerala have been mounting a claim for a significant role in public mental health in the face of this growing hegemony. This study examines efforts by ayurvedic practitioners to expand access to ayurvedic mental health services in Kerala, and profiles a rehabilitation center which combines biomedical and ayurvedic therapies and has been a key player in efforts to expand the use of Ayurveda for mental health. The paper argues for maintaining a pluralistic healing environment for treating mental illness rather than displacing other healing modalities in favor of a biomedical psychiatric approach.