Global voices

Citation

McKenzie, K. (2011), "Global voices", Ethnicity and Inequalities in Health and Social Care, Vol. 4 No. 3. https://doi.org/10.1108/eihsc.2011.54504caa.001

Global voices

Article Type: Guest editorial From: Ethnicity and Inequalities in Health and Social Care, Volume 4, Issue 3

Since the publication of the Lancet 2007 Series, global mental health has become a cause celeb. (http://www.thelancet.com/series/global_mentalhealth accessed 17 March 2012).

Numerous organizations including the World Health Organization have targeted improvement in access to treatment for mental illness in middle- and low-income countries as vitally important (WHO, 2012). They see as inequitable the comparative lack of availability of effective mental health services and treatments in these countries. A combination of advocacy for human rights and scientific evidence are considered the foundation for improving the number of services and access to services (Movement for Global Mental Health, 2012). Identifying promising practices, analyzing the results, developing new strategies and sharing these are the tools which may eventually convince decision makers to invest in the mental health of their populations and for the gap in mental health to be reduced (Mental Health Gap Action Program, 2012).

But, such strategies are not without their critics (Watters, 2010). The fundamental problem is that the foundations on which western psychiatric practices stand are not solid. The development of approaches to the diagnosis and treatment of mental illness has not been democratic. There is no true consensus between the public and professionals as to how mental illness should be managed. Indeed, within professional circles there is disagreement about whether the current focus on treatment as opposed to prevention, the individualization of treatment and the reliance on medication is the best way forward (Open Letter from the Society for Humanist Psychology of the American Psychological Association to the DSMV Committee, 2012). There are also questions about the medicalisation of suffering and what the long-term impact of this has on a community (Summerfield, 2008), plus a long-standing discourse about what constitutes evidence of effectiveness and how this evidence is produced (Fitzpatrick, 2000).

Add to these differences in illness models between cultural groups, ideological colonialism, and power imbalances between the rich and the poor, and the scene is set for disagreement.

This disagreement is heightened by criticism that western models may not be more effective than local paradigms that have endured the test of time in some low- and middle-income countries, but that these historic practices may be ignored (McKenzie et al., 2004). Even if this is not the intention it is argued that, rather than developing local ways of being, mental illness is being globalised (Watters, 2010).

But at times these arguments seem academic. The truth is that the majority of people who need care in low- and middle-income countries do not get any care at all (Mental Health Gap Action Program, 2012). Though there are evidence-based prevention strategies they are not deployed and though there are low cost treatment modalities they are not funded.

In the face of this there are people in low- and middle incomes who are trying to decrease mental health inequities by policy development, by research to understand needs and by direct service provision. There are also centres in high-income countries that are willing to put their own money and expertise into trying to support such developments, as well as academics who are trying to ensure that the new movement for global mental health does not make the same mistakes that colonial powers and international organizations often make. For example, moving to action without properly thinking through the politics, ethics, and long-term historical impacts of what they do.

These are the voices that have been assembled for this issue of Ethnicity and Inequalities in Health and Social Care journal. Papers in this issue are diverse and include: the development of mental health services in Kenya, what has been done and what there is still do to; the improvements that have been made to the treatment of serious mental illness in Jamaica, through the adoption of their own models of care; research that demonstrates the need for a better understanding of how to improve the mental health of survivors of genocide or state organized violence; and an in-depth account of the needs of women who have been the victims of sexual violence during civil war. They also include a brief account of the first methadone clinic to be set up in Africa and what has been learned by the Centre for Addiction and Mental Health in their attempts to support self-directed mental health and addiction training and service development in low- and middle-income countries. Lastly Dr Timimi offers a historical, political and philosophical critique of the global mental health movement which should give us all pause to think.

This issue is one of the first to link practitioners in low- and high-income countries and global mental health advocates and their critics in the same forum. The result is a number of different voices, with different perspectives but all of whom want the same thing, improved equity in mental health.

Kwame McKenzieProfessor of Psychiatry, University of Toronto, Toronto, Canada and Director, SAMI Training Program, Centre for Addiction and Mental Health, Toronto, Canada.