17 research outputs found
Reciprocity in global mental health policy
In an attempt to address inequalities and inequities in mental health provision in low
and middle-income countries the WHO commenced the Mental Health Gap Action
Programme (mhGAP) in 2008. Four years on from the commencement of this
programme of work, the WHO has recently adopted the Comprehensive Mental
Health Action Plan 2013-2020. This article will critically appraise the strategic
direction that the WHO has adopted to address mental health difficulties across the
globe. This will include a consideration of the role that the biomedical model of
mental health difficulties has had on global strategy. Concerns will be raised that an
over-reliance on scaling up medical resources has led to a strengthening of psychiatric
hospital-based care, and insufficient emphasis being placed on social and cultural
determinants of human distress. We also argue that consensus scientific opinion
garnered from consortia of psychiatric ‘experts’ drawn mainly from Europe and North
America may not have universal relevance or applicability, and may have served to
silence and subjugate local experience and expertise across the globe. In light of the
criticisms that have been made of the research that has been conducted into
understanding mental health problems in the global south, the article also explores
ways in which the evidence-base can be made more relevant and more valid. An
important issue that will be highlighted is the apparent lack of reciprocity that exists
in the impetus for change in how mental health problems are understood and
addressed in low and middle-income countries compared to high-income countries.
Whereas there is much focus on the need for change in low and middle-income
countries, there is comparatively little critical reflection on practices in high-income
countries in the global mental health discourse. We advocate for the development of
mental health services that are sensitive to the socio-cultural context in which the
services are applied. Despite the appeal of global strategies to promote mental health,
it may be that very local solutions are required. The article concludes with some
reflections on the strategic objectives identified in the Comprehensive Mental Health
Action Plan 2013-2020 and how this work can be progressed in the future
Is psychiatry becoming more coercive?
The rising trend is damaging for patients, unsupported by evidence, and must be reversed
Reciprocity in global mental health policy
In an attempt to address inequalities and inequities in mental health provision in low
and middle-income countries the WHO commenced the Mental Health Gap Action
Programme (mhGAP) in 2008. Four years on from the commencement of this
programme of work, the WHO has recently adopted the Comprehensive Mental
Health Action Plan 2013-2020. This article will critically appraise the strategic
direction that the WHO has adopted to address mental health difficulties across the
globe. This will include a consideration of the role that the biomedical model of
mental health difficulties has had on global strategy. Concerns will be raised that an
over-reliance on scaling up medical resources has led to a strengthening of psychiatric
hospital-based care, and insufficient emphasis being placed on social and cultural
determinants of human distress. We also argue that consensus scientific opinion
garnered from consortia of psychiatric ‘experts’ drawn mainly from Europe and North
America may not have universal relevance or applicability, and may have served to
silence and subjugate local experience and expertise across the globe. In light of the
criticisms that have been made of the research that has been conducted into
understanding mental health problems in the global south, the article also explores
ways in which the evidence-base can be made more relevant and more valid. An
important issue that will be highlighted is the apparent lack of reciprocity that exists
in the impetus for change in how mental health problems are understood and
addressed in low and middle-income countries compared to high-income countries.
Whereas there is much focus on the need for change in low and middle-income
countries, there is comparatively little critical reflection on practices in high-income
countries in the global mental health discourse. We advocate for the development of
mental health services that are sensitive to the socio-cultural context in which the
services are applied. Despite the appeal of global strategies to promote mental health,
it may be that very local solutions are required. The article concludes with some
reflections on the strategic objectives identified in the Comprehensive Mental Health
Action Plan 2013-2020 and how this work can be progressed in the future
The mental health of adult irregular migrants to Europe: a systematic review
The aim of this systematic review is to summarise the existing evidence on the mental health outcomes of adult irregular immigrants (IMs) to Europe. Database (MEDLINE, EMBASE, CINAHL, PsychINFO) searches were conducted according to PRISMA. The risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. The database searches yielded 2982 results. Eight cross-sectional studies from Western Europe were included, with 1201 participants. The prevalence of mental disorders varied between studies: depression from 8 to 86%; anxiety from 3.1 to 81%; and post-traumatic stress disorder (PTSD) from 3.4 to 57.6%. The studies had methodological flaws; in particular a risk of unrepresentative samples. There was methodological heterogeneity, therefore pooling of data, and direct comparisons were not possible. The majority of studies found higher rates of depression, anxiety and PTSD than previous estimates for the general population, and higher rates of depression and anxiety than previous estimates for other migrant groups
Global mental health in high income countries
Over the past decade there have been significant efforts to scale-up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two specific innovations used widely in low- and middle-income countries, task-sharing and a development model of mental healthcare, that we believe have the potential to address some of the current challenges facing mental health services in high-income countries
Institutional racism in mental health services : the consequences of compromised conceptualisation
Inequalities in mental health service use and outcome in the British NHS have been attributed to institutional racism. Institutional racism is widely understood in terms of the definition published in the Macpherson report, despite critique of its inability to differentiate the role of individual and institution in discrimination, and weakness in distinguishing racism from other forms of discrimination. The inquiry into David Bennett's death declared the NHS to be institutionally racist, and, although still contested, this has been widely accepted. Poor conceptualisation and the endemic failure to demonstrate how institutional racism leads to iniquitous outcomes can be seen in recommendations to tackle it through individual education. Policy based on a compromised conceptualisation of institutional racism is unlikely to reduce racialised inequalities and, in the face of progress for ethnic minorities else-where, may lead to the conclusion that discrimination is no longer a problem. In the light of recent shifts in what is implied by institutional racism, suggestions for research towards a re-conceptualisation are made