Summit on Global Mental Health Sparks Critical Response from Service-Users and Rights-Groups
Mental health service-users, rights-groups and professionals advise caution before implementing a 鈥榮caling up鈥 of mental health care globally.
On October 9th聽and 10th, 2018, World Mental Health Day, the UK government hosted a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement mental health policies globally. In the same week, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal for 鈥渟caling up鈥 mental health care globally. In response, a coalition of mental health activists and service-users have organized an detailing their concerns with the summit and report. The response has attracted the support of policy-makers, psychologists, psychiatrists, and researchers.
The open letter raises several concerns with the positioning of the UK summit and calls on the organizers and leaders of the event to reflect on issues of discrimination and human rights abuses in mental health treatment in their home countries before recreating these systems abroad. The signatories raise the issue of representation and participation, writing:
鈥淪ignificantly, there has been little or no involvement of organisations led by mental health service users, survivors and persons with psychosocial disabilities in the thinking, planning and design of this event. While a few networks were approached to provide 鈥榚xperts by experiences鈥 to attend panels on themes already decided on, there has been no meaningful consultation or involvement of user-led and disabled people鈥檚 organisations not already signed up to the 鈥楳ovement for Global Mental Health鈥 agenda or funding to enable a wide range of representatives to attend.鈥
Jhilmil Breckenridge, a poet, writer and activist and founder of the Bhor Foundation in India, believes that it is a matter of concern that the plan being discussed in the UK this week 鈥渨ill just be 鈥榙umped鈥 into low resource settings with programmes聽planned in India, Ghana, Nigeria, Uganda and Kenya.鈥
鈥淭here needs to be more thought as what works for an anti-stigma campaign in a first world country will definitely not work in the same way in a country like India,鈥 she said.聽鈥淚n addition, these kind of campaigns聽continue to perpetuate an ableist lens, one that may portray a person with psychosocial disability as a 鈥榖urden鈥 and an economic cost. The language needs to change, the lens needs to change, and we certainly should not be 鈥榙umping鈥 or 鈥榚xporting鈥 medication, treatment, or marketing plans to these countries. Furthermore, there are聽problems other than stigma that need tackling first in a country like India, and the words 鈥榮tigma鈥 and 鈥榬ecovery鈥 are all ableist concepts聽that need more critical thought.鈥
In the latest report, the Lancet commission places an increased emphasis on a 鈥渞ights-based鈥 approach and demonstrates a greater appreciation for cultural differences and respect for the lived-experiences of those affected than previous reports. However, critical psychologists have raised issues with the details of how the global mental health movement will be implemented.
Dr. China Mills, a leading scholar in the field of global mental health, has raised concerns that 鈥渨hile the Commission talks about partnership with people with psychosocial disability, the production of the Report did not involve consultation with experts by experience, who should be involved right from the start鈥. She also takes issue with the way the Report frames 鈥渕ental distress as an economic burden, which while perhaps successful in getting governments on board, also risks constructing distress in stigmatizing and discriminatory ways (e.g. as 鈥榗ostly鈥 and burdensome), and overlooks the economic and political determinants of mental distress鈥.
Lisa Cosgrove, PhD, a psychologist and Professor at the University of Massachusetts Boston along with her doctoral students, has organized professionals in support of the open-letter. She explains that attention should be given to the voices of mental health service-users and activists who 鈥渃hallenge the current paradigm of mental health care.鈥 鈥淪cientific research, as well as the lived experience of those who have been diagnosed with a mental disorder, points to the need for change.鈥
In a podcast聽聽with UMass Boston doctoral student Justin Karter, psychiatric epidemiologist, Dr. Melissa Raven, from the 成人大片 in Australia, takes issue with the numbers being used to justify the urgency of the global mental health movement. She explains that 鈥渢hese alarming statistics about the prevalence of mental disorders and the treatment gap鈥 contain multiple issues including, 鈥渢he validity of using diagnostic criteria that have been developed in Western settings and using them in other countries, particularly lower and middle-income countries.鈥
Cosgrove and her team of doctoral students will continue to work with mental health activists and professional groups to call for revisions to the global mental health proposals to reflect a greater appreciation for a social-justice approach.
For more information, visit聽
Social Media:
Use hashtag #WhatWENeed
Podcast:
UMass Boston doctoral student, Justin Karter, is carrying out a series of interviews on this issue for the Mad in America podcast. The links to the episodes are below:
10/10/18 鈥 Interview with Dr. Melissa Raven, psychiatric epidemiologist 鈥撀