1. Community mental health services everywhere in the world should: aim to meet the mental health
    and social care needs of people as perceived by people themselves; be relevant and sensitive to
    local conditions and cultures; involve all stakeholders including marginalised groups; and be
    culturally and economically sustainable. In planning services in LMI countries, cross-cultural
    psychiatric research carried out using psychiatric diagnostic categories are of limited use, but
    there are some pointers that may help. “Mental illness” identified in a psychiatric model, during
    the 1960s and 1970s, had better outcomes in LMI countries (compared to that in the (then)
    industrially-developed countries) although this “better outcome” may no longer be as evident,
    since the spread of westernisation. It seems that attendance at healing centres in South India may
    provide as much benefit for people diagnosed as “schizophrenic’ as psychiatric treatment, and
    that the best system may be one where people suffering psychological distress and their relatives
    have a choice as to what system they access for help. The “global mental health” movement being
    pursued by the US NIMH requires considerable modifications if it is to be ethically acceptable in
    a post-colonial world. Otherwise, the result will be the imposition of Euro-American psychiatry
    en masse, amounting to cultural imperialism. The present priorities for alleviating mental distress
    in LMI countries include: developing social support and community development – for example,
    to re-build communities disrupted by the effects of war, civil conflict and natural disasters;
    addressing breakdown of social systems resulting from rapid industrialization and urbanization;
    counteracting the effects of poverty and oppression; and providing human-rights sensitive ways
    of controlling people who are behaviorally disturbed. Also, there is an urgent need for regulating
    the marketing of psychoactive drugs in order to prevent the exploitation of vulnerable people in
    LMI countries.

    # vimeo.com/48900799 Uploaded 112 Plays 0 Comments
  2. Globalisation is leading to rapid urbanization. This is bringing with it new environments that have
    significant impacts on mental health. The burden of mental health problems and illnesses is
    increasingly being identified in low- and middle-income countries, but its clear link to poor
    infrastructural planning and the poor investment in social capital has not received as much
    attention. In new urban environments communication, competition and consumption are key
    values. These lead to predictable stresses on individuals and their communities. The solutions are
    varied, but the development of more services is not an efficient or even desirable answer. If needs
    have been generated by inadequate planning of the urban environment, scaling up services to meet the needs to "consumers", professionals and governments is not the solution. The commodification of illness may be understandable in this context but does not speak to the real issue which is how to convince the globalization movement to develop societies that promote health and how business can be made to bear the true costs of their initiatives.

    # vimeo.com/48899691 Uploaded 112 Plays 0 Comments
  3. Psychiatry has no answer to the question “what is a mental disorder?”, and instead exalts a way of
    working it has devised: if there are sufficient phenomena at sufficient thresholds, a mental
    disorder is declared to exist! Nonetheless, an emergent global mental health field, including the
    WHO, claims that annually up to 30% of the global population develops a mental disorder,
    representing a substantial “though largely hidden” proportion of the world’s overall disease
    burden. Are these figures credible? What exactly is “global mental health”? Can any definition or
    standard of mental health be definitive universally? This paper will critique the knowledge base
    for global mental health in light of the routine use of methodologies not validated for the
    populations under study, largely non-Western. To assume that Western knowledge is universal,
    whereas indigenous knowledge is local, casts culture as an obstacle and ignores the plight of huge
    numbers of non-Western peoples mired in bare survivalist ways of life. This is a form of
    imperialism, with global mental health workers as the new missionaries. The paper asks whether
    it is axiomatic that mental health services are a good thing worldwide, albeit with adaptations in
    culturally diverse, resource-poor settings. Or, is the question still open as to whether non-Western
    societies do need mental health services at all as we recognise them in the West?

    # vimeo.com/48897710 Uploaded 325 Plays 0 Comments
  4. Global health is the new avatar for what we once called “international health” and, going back
    further in time, “tropical medicine”. Global health stands out from its predecessors in three key
    respects: first, its priorities are determined by the science of the burden of disease; second, its
    driving philosophy is equity, i.e. justice and fairness in the distribution of health in society; and
    third, its scope is global, i.e. it concerns actions which can benefit the health of people globally.
    This presentation will present evidence to make the case that mental health is not only relevant to
    global health in all these respects, but in fact lies at its very heart. The presentation will then address
    some key road-blocks to global efforts to improve access to care for people with mental disorders,
    in particular the grave shortage and iniquitous distribution of mental health specialist resources.
    New evidence from low resource settings is showing how task-sharing of mental health care with
    lay and community health workers is an effective model for delivery of evidence-based treatments
    for mental disorders. Armed with the knowledge that one can unpack complex mental health
    treatments, and train and support non-professionals to deliver them, perhaps the promise of mental
    health for all is realizable. In particular, we will need to empower those who are affected by mental
    disorders to assure their right to receive care that enables recovery and live a life of dignity. We can
    attain the lofty goal of “mental health for all” only if we involve all in the process.

    # vimeo.com/48897107 Uploaded 589 Plays 2 Comments
  5. The notion of culture has been under attack in anthropology during the last decades. People have
    particularly denounced what appears as a double process of objectification: internally, when
    cultures are presented as coherent and homogeneous entities; externally, when societies and
    cultures are presented as well-bounded and clearly separated from one another. These critiques
    have been formulated against a double horizon: (i) a historical one where colonization is analyzed
    as having produced a certain vision of the Otherness of the alien cultures: a vision built on
    processes of exoticization that facilitated the colonizer’s domination and the play of power
    relationships; and (ii) a transversal horizon with the current awareness of the power of
    globalization forces including the importance of large-scale movements of populations, the
    circulation of images and products through trade and the media, and individuals’ concrete and
    imaginary travels throughout societies and cultures where they can live and imagine themselves
    as participating in multiple worlds. It is striking to see that at the very same moment when
    anthropology was criticizing the notion of Culture, mental health clinicians and researchers
    seemed to have discovered Culture. However, most of them seem unaware of the traps that this
    notion entails. Cultures are generally heterogeneous, plural and paradoxical; they are infused and
    modulated by power relationships at the global and local levels. Individuals circulate between
    various cultural worlds and often belong simultaneously to several of them. This paper will
    discuss the implications of a critical medical anthropology for global mental health.

    # vimeo.com/48895098 Uploaded 106 Plays 0 Comments

Advanced Study Institute (ASI) 2012 Global Mental Health

This channel features select talks given at the ASI 2012 conference on Global Mental Health.

The emerging field of global mental health aims to address the enormous disparities in mental health outcomes that beset low and middle-income countries. A…

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This channel features select talks given at the ASI 2012 conference on Global Mental Health.

The emerging field of global mental health aims to address the enormous disparities in mental health outcomes that beset low and middle-income countries. A growing body of research has established mental health as a priority for global health research and intervention. Significant advances have been made in identifying targets and strategies for intervention. However, there continues to be controversy and debate about the appropriate methods for establishing priorities, research themes and approaches, and modes of developing and/or adapting interventions in global mental health. In particular, there are tensions between a public health approach grounded in current evidence-based practices (which are still largely produced in high-income countries) and a culturally-based approach that emphasizes starting with local priorities, problem definitions, community resources and solutions. The cultural critique of global mental health has raised basic issues that will be explored in this conference:
• The priorities of global mental health have been largely framed by mental health professionals and their institutional partners located in wealthy countries, and therefore reflect the dominant interests of psychiatry which may give insufficient attention to local priorities;
• Global mental health tends to assume that the major psychiatric disorders are biologically determined and therefore universal;
• In focusing on existing evidence-based treatments, global mental health assumes that standard treatments can be readily applied across cultures with minimal adaptation;
• And finally, global mental health tends to emphasize mental health interventions and may marginalize indigenous forms of helping, healing, and social integration that can contribute to positive outcomes and recovery.
This conference brings together experts in cultural psychiatry, medical anthropology and global mental health to consider ways of bridging these perspectives. Sessions will address four broad themes:
• Setting the agenda in global mental health;
• Understanding the relationship between local and universal aspects of mental health;
• Developing culturally and community-based interventions;
• Implementing and evaluating culturally-grounded and community-based interventions to
foster resilience and recovery.
The conference will focus on ways to generate an ongoing constructive critique of the global mental health movement to ensure its goals and methods are responsive to diverse cultural contexts and communities.
The conference will be of interest to mental health practitioners, researchers, policy makers and others concerned with global mental health.

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