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Global Mental Health, Cultural Appropriation & Medical Imperialism

Updated: Jun 22, 2023

In the last decade, Global Mental Health has emerged as a prominent topic within psychological professions and medicine. Simply put, It is the "research and practice that aims to alleviate mental suffering through the prevention, care and treatment of mental and substance use disorders, and to promote and sustain the mental health of individuals and communities around the world.” While this domain has transitioned from its orphanage to an internationally recognised domain, firmly grounded in social medicine and science, it has received substantial critique - and to some extent - caution. Among the analysis made by stakeholders on this development - such as by anthropologists or critical psychiatrists - many underscore the detrimental effects of exporting Westernised concepts of health into developing countries with distinct cultural, social and political dimensions. To some, this practice may merely foster medical imperialism, or is ineffective at least and could result in cultural appropriation. However, an approach that develops culturally-sensitive interventions through efforts such as community collaboration or participatory surveys, while integrating a rights-based approach into practice might just be the right kind of antidote needed.

In recent years, Global mental health has become a trending topic within medicine and health; It's encouraged by means of funding, research interest, and institutional validity - especially in the developed world. Several international organisations, such as the World Health Organisation (WHO), the World Bank, Grand Challenges Canada and various philanthropic foundations, such as the Wellcome Trust have recognised the prevalence of mental ill-health and the scarcity of resources within the developing world, and have allocated funding to support global mental health efforts. For the same reason, there has been an increase in programs and activities within developing countries that focus on closing the treatment gap such as capacity building through task-shifting, prevention of substance misuse, or incorporating mental health services in the routine health setup.

Many health researchers argue that cultural adaptation, which is the adjustment to a program or practice to more appropriately fit the needs and preferences of a particular cultural group or community, is required in order to develop effective psychosocial interventions, especially in non-western countries. Such as in the study by Rathod et al. where through a practice-focused review of meta-analyses they concluded that culturally adapted interventions for mental health disorders can be effective in improving outcomes for individuals from diverse cultural backgrounds. Such interventions are said to work better as they minimise stigma by addressing cultural misconceptions, encouraging dialogue, and creating community acceptance. Or by building a stronger therapeutic alliance, as they align with cultural beliefs and values, and address barriers to care that may be specific to one’s culture. Therefore, a shift in designing and delivering more contextual and tailored interventions could drastically improve the success of global mental health as a practice and its beneficiaries’ health outcomes.

To give you a quick example, a culturally adapted intervention from Murray et al. implemented a modified version of TF-CBT (a form of psychotherapy focused on trauma) for children in Zambia using a Design, Implementation, Monitoring, and Evaluation (DIME) methodology outlined for identifying and addressing mental health problems in LMICs. It is built on the principles of community-based participatory research (CBCR), which is an applied approach with the purpose of influencing change in community health, systems, programs, and policies via collaborative researcher-community efforts at each step. The steps of DIME include:

  1. A qualitative assessment to identify priority problems from the local perspective.

  2. The development/adaptation, translation, and validation of an assessment tool(s).

  3. A population-based assessment to gauge prevalence and severity.

  4. The overall design of the program, including the design of monitoring and evaluation.

  5. The selection, adaptation, and implementation of an intervention.

  6. An assessment of intervention impact.

But the critique of Global Mental Health is not just the problem with cultural appropriation. It also calls attention to the fact that global mental health might have its roots in colonialism and medical imperialism, which is the dominant influence exerted by powerful countries on the knowledge and practice of healthcare in less powerful countries. Furthermore, It could possibly have dire implications such as mass medicalisation, marginalisation, reliance on countries for psychotropics, loss of indigenous knowledge, power relations etc.

Such as in the research article by Rob Whitley, he analysed critiques within the domain and put forward that the critique suggests “global mental health (GMH) ignores the various indigenous modalities of healing present in non-Western cultures, which may be psychologically adaptive and curative” and that “critics argue that GMH could be an unwitting Trojan horse for the mass medicalisation of people in developing countries, paving the way for exploitation by Big Pharma, while ignoring social determinants of health.” Howsoever this article also suggests that global mental health could be an attempt to correct a historic wrong, which was caused during the colonial and post-colonial eras when the mental health of certain populations was accorded a very low priority under a pretence, and then fuelled by scientific racism which alleged that mental illness was uncommon in developing countries; Now global mental health aims to close the massive 'treatment gap' between those in need and those actually receiving formal mental health care through innovate methods, focused on cost-effectiveness and scalability.

In spite of the critique, global health practitioners continue to advocate for the promotion of global mental health (GMH) as it offers an ingenious solution to a global crisis . Such as in the noted research article by Patel and Prince where they lay down “three critical foundations” of evidence to account for the emergence of the new field of global mental health. “First, a large body of cross-cultural research and, equally important, the narratives of health workers and people living with mental disorders, have finally put to rest any notion that mental disorders were a figment of a “Western” imagination and that the imposition of such concepts on ‘traditional’ and ‘holistic’ models of understanding amounted to little more than an exercise in neo-colonialism. Second, a growing body of epidemiological research attested to the considerable burden of mental disorders in all world regions. The Global Burden of Disease report surprised the global health community with its finding that five of the top ten contributors to years lived with disability globally were mental disorders. The vicious cycle of disadvantage, social exclusion and mental disorder was a key message of the World Mental Health Report and the subsequent World Health Report of 2018. Third, the evidence that there are efficacious drug and psychological treatments for a range of mental disorders and that non-specialist healthcare workers can deliver psychological treatments or multi-component stepped care interventions for mental disorders, with large treatment effect sizes that are sustained for extended periods of time.”

In support of the GMH practitioners’ previous claims, there does happen to be substantial evidence from lived experience narratives that attest to GMH interventions playing a significant role in their recovery from mental distress, and improvement in living conditions. Here is one such narrative attached from Kaiser et al.

Now, there are basic grounds to say that in the face of such scarcity of resources, and poor economic conditions, a revolutionary mode of treatment that is effective - at least - in closing the apparent treatment gap is needed. Secondly, GMH's beneficiaries, and other stakeholders, have attested to the interventions being helpful for most, and in some cases life-changing. But there are also strong reasons to believe that GMH should be practised with more cultural sensitivity, and with the implementation of a rights-based approach. Not only to ensure that it achieves it goals ina timely and effectual manner but also to account no repercussions.


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