Reciprocity in global mental health policy
- Publisher: The Critical Institute
In an attempt to address inequalities and inequities in mental health provision in low\ud and middle-income countries the WHO commenced the Mental Health Gap Action\ud Programme (mhGAP) in 2008. Four years on from the commencement of this\ud programme of work, the WHO has recently adopted the Comprehensive Mental\ud Health Action Plan 2013-2020. This article will critically appraise the strategic\ud direction that the WHO has adopted to address mental health difficulties across the\ud globe. This will include a consideration of the role that the biomedical model of\ud mental health difficulties has had on global strategy. Concerns will be raised that an\ud over-reliance on scaling up medical resources has led to a strengthening of psychiatric\ud hospital-based care, and insufficient emphasis being placed on social and cultural\ud determinants of human distress. We also argue that consensus scientific opinion\ud garnered from consortia of psychiatric ‘experts’ drawn mainly from Europe and North\ud America may not have universal relevance or applicability, and may have served to\ud silence and subjugate local experience and expertise across the globe. In light of the\ud criticisms that have been made of the research that has been conducted into\ud understanding mental health problems in the global south, the article also explores\ud ways in which the evidence-base can be made more relevant and more valid. An\ud important issue that will be highlighted is the apparent lack of reciprocity that exists\ud in the impetus for change in how mental health problems are understood and\ud addressed in low and middle-income countries compared to high-income countries.\ud Whereas there is much focus on the need for change in low and middle-income\ud countries, there is comparatively little critical reflection on practices in high-income\ud countries in the global mental health discourse. We advocate for the development of\ud mental health services that are sensitive to the socio-cultural context in which the\ud services are applied. Despite the appeal of global strategies to promote mental health,\ud it may be that very local solutions are required. The article concludes with some\ud reflections on the strategic objectives identified in the Comprehensive Mental Health\ud Action Plan 2013-2020 and how this work can be progressed in the future.