Global Mental Health: Medical versus Social Approaches to Treatment and Social Change

It has been just six years since the Movement for Global Mental Health took off on October 8, 2008. In that time, the Movement has sought to create a platform that connects the global network of the stakeholders in the field of mental health. While the movement has made much progress in the past few years, it has not been without controversy and criticism.

The most common allegation being that the Movement represents a bio-medical approach to mental health, where psychiatrists rule the roost and the discipline is defined in terms of medical, as opposed to social, parameters. Naturally, such allegations have come from the stakeholders within the field who work within the human rights framework and define mental health within socio-economic parameters. A recent book written by China Mills at Oxford University entitled Decolonising global mental health: The psychiatrization of the majority world (Concepts for Critical Psychology), examines this critique of global mental health well. Mills argues that there is a continued colonial mindset in the field of mental health global mental health.

However, there seems to be a misunderstanding among social-model advocates of mental health regarding the aims and methods of global mental health and in particular the Movement for Global Mental Health.

In this context, iFred wants to draw your attention to a recent interview taken of Professor Vikram Patel, a leading intellectual in vikram patelthe field of Global Mental Health, with Bio Medical Central.

Here, Patel talks about the impact of global mental health on traditional concepts of psychiatry and discusses the initiatives and platforms being developed to promote capacity building, research, policy, advocacy and human rights within the established Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine in London. The anticipated challenges, controversies, and future directions of the global mental health are also highlighted as well. You can also listen to the audio version of this interview here.

 

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Interview with Vikram Patel, reproduced via Bio-Medical Central

What is global mental health and how will it impact the field of medicine?

Global mental health is a discipline of global health and, as with the mission of global health, its primary goal is to improve the health of people worldwide, with a strong focus on equity and access. There is no health without mental health. I think we know, through a large body of evidence, that mental health and physical health interact with each other in very diverse and intimate ways. Therefore, any attempt that we make to improve the mental health of individuals and populations will inevitably have a positive impact on the physical health of those individuals and populations. Therefore, investing in global mental health is, ultimately, an investment in global health.

How was the Centre for Global Mental Health established?

The Centre for Global Mental Health is a partnership between the London School of Hygiene and Tropical Medicine, which is Europe’s leading school of public health, and the Institute of Psychiatry at Kings Health Partners, which is Britain’s leading school of psychiatry and neurosciences. It’s a perfect marriage between academics who have strengths in the various disciplines of global health, and academics who have strengths in the various disciplines of clinical sciences related to mental health. The centre was founded in 2008 to bring these two complementary sets of disciplines on to the same platform to further the science of global mental health. The goal was to promote research, capacity building, and advocacy for policy to improve access to care for people living with mental disorders around the world, with a particular focus on those countries where the treatment gaps were the largest; that is, the low- and middle-income countries of the world.

Can you describe the initiatives and platforms that are involved with this collaboration?

Let me give you examples from each of the three broad themes of work that the Centre for Global Mental health pursues. Firstly, with capacity building, we are delighted that, after many years of plotting and planning, we were able to launch our full-time Masters in Global Mental Health last year. This year, we have had more than 20 applicants successfully admitted and beginning the MSc program. The MSc is, to my knowledge, the only face-to-face residential MSc in this discipline in the world today.

In the area of research, we are currently involved with dozens of research projects in more than 20 countries within sub-Saharan Africa, Latin America and Asia. Some of this research focuses on randomized controlled trials of innovative new interventions to improve access to evidence-based treatments, but we are also engaged in some exciting health systems work that examines how these evidence-based packages of care can be integrated into routine healthcare systems. Our portfolio also includes social science and epidemiological research on mental health problems.

Finally, in the realm of policy and advocacy, we have recently embarked on a number of exciting developments. The first is that we led the Mental Health Forum for the World Innovation Summit for Health, which was held in Qatar in December 2013. Along with Shekhar Saxena of the World Health Organization, I co-chaired this forum, which produced a report specifically directed at ministers of health and other policymakers, to recommend policy actions based on the research evidence in global mental health. Another exciting development is the Mental Health Innovations Network, supported by Grand Challenges Canada, whose goal is to synthesize the rapidly growing evidence base in the field into products that can be useful to a variety of different audiences, from researchers and practitioners to civil society and policymakers.

This is very exciting in terms of all the initiatives and platforms. What do you think are the current anticipated challenges?

There are a number of different challenges. The key is limited resources. There has actually been a fantastic increase in the amount of resources available for research, and of course the Centre for Global Mental Health has been a great beneficiary of that largesse. However, there has not been a similar increase in resources for mental health for ministries of health, particularly in the poorest countries of the world, which rely, to a large extent, on development assistance for their health programs. Thus there has not been the needed increase in resources to scale up mental health services in these countries. So the first important challenge is to mobilize development agencies to finance mental health services in the poorest countries of the world.

The second important challenge is a continuing concern among some communities about the validity of some of the mental health problems that the field is grappling with, in particular the common mental health problems like depression and anxiety. The concern is really whether these conditions are biomedical categories that have universal validity in all cultures, and whether the biomedical approaches that are being utilized in medicine and psychiatry in particular, are relevant and appropriate to all cultures of the world.

Can you indicate also the controversies such as the debate against global mental health?

In fact, my second point is at the heart of the critique that certain mental illness categories, such as depression in particular, do not travel well across cultures. The critique is that the use of such labels represents a medicalization of a social condition where the solutions lie not within a medical approach but more likely within the social or political sphere. And related to this is the concern of exporting psychiatric paradigms of treatment and care which have been at the heart of the mental healthcare systems of the developed world to developing countries where there is very little formal psychiatric care.

Do you also think that global mental health will be influenced by DSM-5 with its recent launch, and ICD-11, which will be launched in the future?

The honest truth is that global mental health is a completely different animal from its predecessor, which comprised cultural psychiatry and international psychiatry. First of all, global mental health is not simply psychiatry. Like global health, it is an interdisciplinary endeavor, and is firmly grounded in the South (that is, in the developing world). Most of the leading practitioners of global mental health live and work in developing countries, not in the developed world. Global mental health is completely contextualized to the cultural and social circumstances of the country in which this work is being carried out, and is action-oriented, seeking to improve the lives of people affected by mental health problems.

An important implication of this reality, in relation to your question, is the replacement of rigid diagnostic systems, which are much more suited to psychiatry and the specialized mental healthcare systems you might encounter in developed countries, with broader, more public health-oriented and contextually appropriate labels and diagnostic systems that communicate better to local policymakers, primary care workers and most importantly, to local communities. Global mental health barely uses DSM-4 or ICD-10 in any concrete way, and I think it is unlikely that DSM-5 or ICD-11 will have much traction either.

What do you think are the future directions for global mental health?

The future directions of global mental health lie in three big areas. The first is to mobilize resources by advocating to policymakers, especially in middle-income countries which have more resources, to finance scaling up of mental health care. This is particularly important in the context of universal health care to advocate for mental health to be given at least parity with physical health in resource allocation and service provision in middle income countries. For low income countries that continue to be dependent on development assistance, we need to be similarly advocating with donors to increase their resources specifically for mental health.

The second is to build capacity. It has to be admitted that there is a great shortage of every kind of mental healthcare provider in the developing world, from specialists like psychiatrists and psychologists all the way through to community-based workers who can provide frontline mental healthcare. There is a great need for investing both in programs that can build capacity that is scalable, and in curricula and other kinds of tools that can be utilized in these sorts of settings for these diverse professional groups.

The third, of course, is research. We clearly need to continue to build evidence which focuses on addressing questions about how we can integrate evidence-based packages for care within routine healthcare systems, so that we can inform governments on how they can make their mental health programs more effective and efficient.

What are you most excited about in relation to the recent developments in global mental health?

What I am really most excited about is that mental health has come out of the closet. I remember 15 years ago when I began working in this field, it was usually embarrassing in India to say that you were a psychiatrist because, if they did not walk away from you, they would look at you perplexed and ask, “Is this really relevant in our country?” I think there has been a dramatic change in the attitudes towards mental health in every sector of society in India, which is the country I know best, whether it is in the community, in the media in terms of the amount and the quality of the reporting on mental health issues, and of course at the level of policymakers. Today, it is so straightforward for me to sit with a Secretary of Health and talk about mental health issues; they are much more receptive, and indeed, more importantly, are much more willing to back their interest with resources.

 

Hidden Pictures and the World Health Organization: A Journey to Uncover Global Stories of Mental Health

Hidden Pictures Film

Here is a video we are all about right now at iFred. It’s a summary of the film Hidden Pictures by filmmaker and physician Delaney Ruston. Ruston’s work highlights both the serious need for global mental health resources and the power our personal stories can have

iFred joined global leaders to support the World Health Organization in crafting the Mental Health Global Action Plan by in 2012, that was then adopted by the United Nations in 2013.  Countries around the world convened to discuss implementation of the action plan for Global Mental Health Day in October, 2013, and, with policy highlighted in Ruston’s film. Have you browsed the document yet? You can read an mhGAP summery here or the entire document here. on creating social change.

Watch the WHO and Ruston’s video here and tell us what you think:

Hidden Pictures

A Touching Message from a South African Sacred Activist; Her Thoughts on Mandela, Healing, and Hope

Dear fellow Sacred Activists:
Nelson-Mandela-Quotes-Wallpaper2
I have a heavy heart and many tears I am shedding this morning.  I am crying for my beloved country.  My heart is aching for all those who sacrificed so much in service to a just and civil society, and continue to do so. I pray that those who are currently in power in South Africa will pause as they mourn our beloved Madiba, and remember that he transformed from freedom fighter and enemy to a revered leader who sought reconciliation. Mandela was arrested after being found by a CIA agent.  My great-uncle (by marriage) Bram Fischer, was Mandela’s attorney during his trial. I remember as a child seeing Robben Island and learning of the prison that held many who are now famous and a number who have died.  During my political activism I came to know people who had served at “the university” as it was called. Colleagues and friends would just disappear without explanation. When they ended up on Robben Island they would be part of conversations orchestrated by the leaders incarcerated there.  And then, on being released, would teach those of us working in townships and squatter camps, trade unions and community organizations, giving us word of what the leadership’s plans were.  Each and every one of their legacies lives on. In South Africa during that time we were not allowed to have images of Nelson Mandela.  Possession of the Freedom Charter that became the most progressive constitution on the planet was grounds for being imprisoned without trial.  We were all imprisoned by the draconian system, even the most privileged, even those who never saw the inside of a cell. When I left South Africa in 1986 during a State of Emergency, and into political exile, I never imagined that in my lifetime Mandela would be released. I never imagined I would ever be able to return to South Africa.  I never imagined that my mixed race daughter would have children who could be friends with children of different colors and cultures.  I never imagined that South Africa would ever be embraced by the rest of Africa because it had always been such a pariah in the eyes of the rest of the continent.  I never imagined that the world would support the change we all fought for and made huge sacrifices for – my imagination was limited by the oppression I grew up in. One never knows how the tides of change will shift the sands.  One never knows how orchestrated insignificant acts can create a crescendo of change such as was experienced in my homeland.   There have been rare moments in my life, as a 5th generation white South African, that I have felt proud to have that legacy.  Today, my pride is mixed with a depth of grief because I am not there on South African soil, to be caught up in the crowds of mourners honoring and remembering. As South Africa moves towards a presidential election, may we all pray that the current  leaders remember that power is to be shared, not hoarded and used to corrupt. In solidarity with all around the globe who mourn with me. Lyndall Hare

Schools for Hope; New Campaign to Prevent Suicide in Youth

High School Teens at Oak Park River Forest High School Planting Hope, 2013

Did you know 1 in 9 kids attempt suicide prior to graduating high school, and that 40% of those kids are in grade school?  (Journal of Adolescent Health via Family Matters, 2011).  And that the number one autofill on google is ‘Hope makes me…  depressed’?  We don’t know exactly why, but what we do know is that the primary predictors of suicide include hopelessness and depression.  (Association of Physicians, 2004).

The Good news?  HOPE is teachable and depression is treatable? (Rand and Cheavens, 2008),  It is true.  Research suggests that Hope can be taught  and that the greater the hope, the greater the level of well-being (Scioli, 2009).  Hope is defined as the perceived ability to create pathways to a desired result, and the motivation to follow those pathways through to the desired result (Rand and Cheavens, 2008).  Higher Hope corresponds to greater emotional and psychological well-being, greater academic performance, and enhanced personal relationships (Snyder, 2005).

With your help, we can bring a lesson plan of HOPE with activities to the classroom.  Our goal is to raise $85,000 throughout December for this project through our Indiegogo campaign, and then to spend January and February creating the research-based curriculum to launch in ten test schools in April of 2014.  Our goal is then to take the finalized curriculum global in 2015.

Our Overall Vision for Schools for Hope:

Our aim is to expand on our Field for Hope project that cultivates Hope through seeing through a planting of sunflowers; from seed to flower and back to seed.  With your help we aim to take this project further and share messages and symbols of hope with others; creating curriculum around the planting specifically to teach Hope to children.  And then to nurture Hope and through peer to peer support to teach this to the next classroom.

  • Engaging children through a 360° support and wisdom sharing system—peer-to-peer, teachers, counselors/psychologists and parents.
  • Partnering with mental health education experts, curriculum will be targeted, self-paced and ready to implement into school systems.
  • Leverage online and new social mobile application technology to implement the program. Content will be engaging and inspirational and delivered on a relevant youth-oriented platform.
  • Integrate a yearly sunflower planting symbolic of HOPE in the Spring, writing messages of Hope to those that then harvest the seeds in the fall, starting the infinite spiral for Hope.
  • Garner research through metrics analysis, evaluation and optimization.
  • Pilot in Chicago schools; adapt to deploy tailored program focused in PTSD and tragedy to those areas as needed. (i.e. Sandy Hook, Columbine, Oklahoma, etc.)

Please help us make this campaign a success!  With your generous donation of time, brain power, and/or contacts we can get this moving.  Hope is teachable, depression is treatable. Let’s help make ALL kids feel value and like there is always a way to resolve problems in a positive, productive way.

Please visit www.schoolsforhope.org and help us make this project a reality.

The Past, Present, and Future for Depression; A Perspective of Hope from Geneva

 

As I sit here at a crowded Starbucks in sunny Geneva Switzerland, preparing for the meeting tomorrow at the headquarters of the World Health Organization, I marvel at how far we have come in the field of mental health since my father’s suicide over 20 years ago.  In those days, we looked upon suicide as a poor choice a person made and simply did not talk about it.  Today, while we still have a long way to go, we are starting to understand that it is more than a choice; it is a complicated combination of life circumstances, chemical processes of the brain, genetics, and childhood trauma.

Last year I had the privilege of attending the discussion of the ground breaking resolution for the UN to make global mental health a priority throughout the world with a proposed Global Mental Health Action Plan.  On May 27th, 2013 the World Health Assembly adopted the “Comprehensive Mental Health Action Plan 2013-2020“, putting the world on notice that mental health must be a priority.   I have the honor of attending the WHO follow-up conference tomorrow October 7th, during Global Mental Health week, to hear across the globe how member states and affiliated organizations are going to put the plan into action.

In 2004 when I began my work to end the stigma of depression through rebranding, less than 25% were receiving treatment leaving a full 75% of the world population untreated.  Last year, the World Health Organization statistics reported that the number untreated is now 50%, so while progress might not be evident it is improving.  These statistics bring me joy and gratitude that the tireless work of the people in the field of mental health, creating awareness and bringing services to the 350 million with depression, is not happening in vain.

That being said, there is much left to do.  Depression is now the leading cause of disability worldwide, yet it is treatable.  It is significantly underfunded and still highly stigmatized and there is much more to do to bring treatment numbers to 100%.

I encourage you to join us October 10th, Global Mental Health Day, to learn more about depression.  Join us in watching the free, live Global Web Screening of Hidden Pictures, the first feature documentary on global mental health.  Read and share information on mental health from organizations like Psyhcentral and Webmd with perspectives from both the medical profession and patients.  Or take the pledge to plant a virtual sunflower, showing your solidarity in our movement to bring dignity and respect to those living with depression.

Follow us on Twitter and join our Facebook community for posts throughout Global Mental Health week.  There is Hope.  Depression is treatable.  Share the word and help save a life today.

 

 

“Four simple words…I suffer from depression”

I recently came across this video of Kevin Breel speaking to a group of people at a recent TED-X conference and was blown away by his poignant account of what it’s been like living with depression and his hopes for a future without stigma.

As you may remember from my earlier posts, I lost my father when I was Kevin’s age to suicide and I consider myself a depression survivor. It is through the sharing of these stories and personal accounts that I believe we will be able to shine a light of HOPE for the 350 million worldwide living with depression.

I hope you’ll take 11 minutes to watch this video of Kevin. If you live with depression, someone in your life lives with depression, or you don’t think you know anyone living with depression – you need to watch this video. It will be well worth your time.

Watch Kevin’s video here: http://www.causes.com/causes/101854/updates/793004

 

 

In this light, I bring you Field for Hope

Kathryn Goetzke, iFred founder

When someone suffers from depression the effects ripple out to those they love.

I can still remember the moment. As I was getting ready for an upcoming weekend visit to see my dad, I called to see how he was doing. I knew something was terribly wrong when I heard a voice that wasn’t his. My mother took the receiver and told me the news that would forever change my life. My dad had taken his life.

My father was a successful businessman, but his pain was no mystery to me. He had resisted treatment because he did not want to admit to weakness in character. I cannot accurately describe in words the deep sense of abandonment, betrayal and total loss of self I felt when he died. I believe that, had he sought help earlier, he might well still be alive today.

Just weeks before he died he sent me a Valentine’s Day card telling me how much he loved me.  How he hoped I would never have to deal with the pain, deep regret and unhappiness he felt all the time. I carry the card with me as a reminder of his pain. It serves as my fuel to change the world for the better as a way to honor his life.

Depression is treatable, yet less than 25% of those with depression are getting treatment in part because of the stigma associated with the disease. This misunderstanding about depression is what prevented my father from getting treatment. As a branding expert, I know that by doing the following we can and will end the stigma of depression.

1. Use a universal symbol, the sunflower, around the world showcasing just how many are working for positive progress.

2. Engage celebrities, politicians, business leaders and activists to talk about their own depression

3.  Bring awareness of the biology of depression, and how our neurotransmitters, hormones, and brain chemistry are affected by everything we put in our body.

4. Focus on hope for those suffering from depression, instead of the negative depictions of depressed people that are often present in the media.

It is in this light I bring you Field for Hope. This global campaign asks people to come together and Pledge to Plant a sunflower to show honor and respect for the 350 million people around the world who live with depression. They need our help.

My dad had it all and did not deserve or need to die.  Do not let one more life be wasted. Pledge to Plant. Join our movement today at Causes.com/FieldforHope or visit www.ifred.org to find out how you can get help for yourself or someone you love.

Dogs Teaching Adults How to Teach Kids to Read

Some fantastic research has shown that the benefits of dogs can go beyond being good friends – they can help kids learn how to read.  This article goes into detail about how, but a University of California Davis School of Veterinary Medicine did research on kids reading to dogs vs. kids not reading to dogs, and overall effect on reading.   I think it would behoove us adults to learn from the techniques used by the dogs, so that we can be as effective (or better) than our four-legged friends.

The reasearch showed that kids reading to dogs had both improvements in both fluency and speed of reading.  How did this happen with kids?  The children reported:

  • The dogs made them feel more relaxed
  • The dog didn’t care or judge them if they made mistakes
  • It was more ‘fun’

Kids reported a boost in self-confidence, worth, and esteem.  So while this is fantastic research about dogs and the benefit of animals on health and wellbeing, I think it also should serve as a lesson to other kids or adults teaching reading or other life skills; be patient and non-judgemental.  Perhaps the dogs in this study are not just teaching kids how to read – they are teaching people how to treat kids learning to grow up in this world.  In any event, enjoy!

Fantastic Q&A on Exercise and Depression

Our wonderful advisory board member, Kirsten Straughan, was kind enough to let iFred present to the students in UIC’s Human Nutrition program, preparing students to become registered dieticians.  Students interested in volunteering and learning more about depression took up the topics of exercise, nutrition, and the brain, and we are so thankful that Ann Haibeck researched and compiled these common questions and answers about depression and exercise.  THANK YOU and keep up the great work! 

General clinical depression 

Why should I consider exercise as a way to alleviate depressive symptoms? How does exercise help? 

Exercise provides a distraction or “time out” from the stresses of daily living. Most people also feel a sense of accomplishment, self-esteem, and increased self-efficacy as a result of exercise. 

[Read more...]

Mood-factory Color Advisor Denise Turner Talks Art Therapy

Did you know that art can be therapeutic? This comes to no surprise to museum goers, who have a visual and emotional experience when viewing art. Aware of the importance of art, color and design on people’s health and well being, who are at the forefront are an amazing group of “Art Therapists.”

With the rising health care costs and overworked medical staff, there’s is greater demand, to fill the void between medical professionals and patients. With the increased acceptance of complementary medicine Art Therapists are filling the void.

[Read more...]