The Politics of Global Mental Health

The UK All Party Parliamentary Groups (APPG) on Global Health (http://www.appg-globalhealth.org.uk) is jointly chaired by Lord Nigel Crisp and Meg Hillier MP. The aim of the APPG on Global Health is detailed as follows:

 

“At a time of rapid globalization and growing instability, global health is emerging as an important concept and has been adopted as a key policy theme by the UK Government. The APPG on Global Health is connecting parliamentarians with a growing global health community of academics and civil society groups, to inform and improve policy in this vital area”

 

On 10 June 2014, the APPG convened a joint hearing to discuss Global Mental Health. Victoria de Menil and Valentina Iemmi  (a PhD Student and a Research Officer respectively) within the Personal Social Services Research Unit at the London School of Economics and Political Science summarized the proceedings in a blog entry that can be viewed here:

 

http://blogs.lse.ac.uk/healthandsocialcare/2014/06/19/have-your-say-on-the-treatment-gap-in-global-mental-health/

 

At the hearing, the APPG heard representations from prominent members of the Movement for Global Mental Health (including: Prof Vikram Patel, London School of Hygiene and Tropical Medicine; Prof Graham Thornicroft, Institute of Psychiatry; and Dr Gary Belkin, New York University). Key themes that were discussed included: 1) The extent to which mental health difficulties are a significant problem in low- and middle-income countries (LMIC); and 2) What evidence exists for cost-effective interventions to address mental health difficulties in LMIC?

 

Professor Patel emphasized the timeliness of this hearing and highlighted four recent developments that make now an important time to act for mental health:

  1. The WHO has recently issued the Comprehensive Mental Health Action Plan (http://www.who.int/mental_health/action_plan_2013/en/) that details key targets for addressing mental health difficulties across the globe;
  2. Middle-income countries (including Brazil, India and China) are investing heavily in mental health care but require assistance and advice in how best to utilize these funds;
  3. The World Bank will devote a session in its annual finance meeting to mental health in spring 2015.
  4. There is emerging evidence that mental health interventions can be delivered by non-specialists (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009149/full).

 

Professor Patel warned against the myth that there is no treatment available in LMIC by emphasizing that: “They are getting treatment, but they are getting the wrong treatment”. He explained to members of the APPG, for example, that people with a common mental disorder in India are prescribed sleeping medicines (benzodiazepines) and vitamins. Professor Thornicroft also highlighted that the gap for mental health care is not for any treatment, but for ‘evidence-based’ treatment.

 

The issue of the mental health treatment gap in LMIC, and how it should be addressed, is however a contentious issue. Critics have highlighted that the mental health evidence based is heavily skewed toward research that has been conducted in high-income countries (HIC) and that it cannot be assumed to be valid for LMIC. As I discussed in my recent editorial in the British Journal of Psychiatry (mentioned in the last blog entry), there are risks associated with assuming that mental health interventions that we routinely use in HIC will constitute acceptable and effective interventions in LMIC. The Critical Psychiatry Network (CPN: http://www.criticalpsychiatry.co.uk – a forum for Psychiatrists, Psychiatry Trainees and Medical professionals interested in critical thinking and alternative approaches to psychiatry) has also voiced concerns about the ‘scaling up’ of psychiatric services in LMIC. Derek Summerfield (a member of the CPN) was at the hearing on the 10th June, and voiced his concerns about the globalisation of psychiatric services. In addition, Suman Fernando (http://www.sumanfernando.com) has been coordinating efforts by members of the CPN, and other parties sympathetic to their position, to communicate their concerns to the APPG on Global Health. To this end, Suman Fernando has sent a joint statement to Jonty Roland (Coordinator of the APPG’s programme of research, events and policy reviews). This statement concludes:

 

“In our view, the export of western models of diagnosis and treatment is causing serious harm to the social fabric and cultures of the LMICs and likely to worsen the physical, mental and social well-being of people in these countries. Many LMICs have long standing non-western traditions with regard to ways of understanding ‘mental health’ and supporting people who are deemed to suffer from problems that may be termed ‘mental’. In our view, although there is scope for improving systems for promoting mental health the world over, the best way forward is to facilitate sharing of knowledge across cultures and nations on a level playing field where western knowledge does not dominate as it has done since colonial times. In particular there is scope for rich countries (usually with western cultural backgrounds) where psychiatry dominates the mental health scene to learn from poor countries where a variety of systems for helping and supporting people with mental health problems are available”.

 

A 2nd APPG hearing is due to be held on 7 July 2014. Lord Crisp has appealed to anyone wishing to convey information relevant to addressing the mental health treatment gap to come forward for this hearing. It will be interesting to see how the discussions progress.

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