Astute scholars involved with Global Mental Health (GMH) have recently noted “the hostile intellectual climate” which dominates the field. Indeed, since its inception, the discipline has been the recipient of many critiques by anthropologists, social scientists and local service user organizations, which have emphasized its role in promoting Western biomedical interventions that lack in cultural validity and neglect the role of socio-economic determinants of mental health . In doing so, it has been perceived as failing to address the ‘ecologies of suffering’ of the people with whom it claims to engage. However, key advocates of the GMH movement have recently responded to these critiques by claiming that the discipline had undertaken efforts to practically address these issues.
Indeed, GMH increasingly claims to promote interventions that tackle the suffering and socio-economic needs of people in a culturally sensitive way, working side-by-side with service users and advocacy groups. Yet, beneath the veneer of this polished discourse, has the discipline of Global Mental Health really changed? Has it learned from its critics, or is it simply paying “lip service” to their arguments in a bid to silence them? There is a pressing need to examine GMH’s apparent ‘epistemological’ shift and the validity of these new claims.
To do so, academics involved in the debates surrounding GMH must urgently move beyond what has become a deadlocked intellectual exchange dominated by discouraging hyperbolic accusations of “neo-colonialism” and “anti-psychiatry”, depending of one’s proclivity. The time for collaborative actions has come. If GMH is serious about its proclaimed transformation and its willingness to engage with its detractors and the communities it aims to serve, it must learn to routinely co-produce and “audit” its activities with these parties. Having gained international traction, it must now come of age and think of the sustainability of its legacy. It must abandon its “top-down” approach and obsession with epidemiological data and methods, and must begin working from the “bottom-up” by placing local needs at the center of its interventions, focusing on outcomes rather than outputs. It must overcome reductionist temptations to engage with the ecologies that shapes people recovery . Similarly, rather than opposing it as a matter of principle or contenting themselves in working at its margin, its critics must be ready, if offered, to work within the current confines of the GMH movement; only through a cohesive approach will opportunities emerge to transform and innovate within the discipline.
A few resources:
Cooper S. Global mental health and its critics: moving beyond the impasse. Critical Public Health. 2016 Mar 18:1-4.
Mills, C. and Fernando, S. Globalising mental health or pathologising the global South? Mapping the ethics, theory and practice of global mental health. Disability and the Global South, 2014; 1(2): 188-202
Ingleby D. How’ evidence-based’ is the Movement for Global Mental Health?. Disability and the Global South. 2014;1(2):203-26.
Jadhav S, Jain S, Kannuri N, Bayetti C, Barua M. Ecologies of suffering. Economic & Political Weekly. 2015; May 16; 50(20): 13.
Bayetti C, Jadhav SS, Jain S. The recovering Self: a critique of recovery based approach in India’s mental health care. Disability and the Global South. 2016 Jun 30.
Bemme, D., & d’Souza, N. (2014). Global mental health and its discontents: An inquiry into the making of global and local scale.Transcultural Psychiatry, 51(6), 850–874.
Bracken, P., Giller, J., & Summerfield, D. (2016). Primum non nocere. The case for a critical approach to global mental health. Epidemiology and Psychiatric Sciences, 25 (6), 506–510.
Jain, S., & Orr, D. M. (2016). Ethnographic perspectives on global mental health.Transcultural Psychiatry,53(6), 685-695.