4. Perspectives

SMS-SOS 

"For any social movement, flexibility and trust are vital to bind its diverse communities to a central goal.

The [Movement for Gobal Mental Health's] members believe that a selfless moral struggle

built on a partnership of professionals and civil society is essential to mutually strengthen

all global mental health communities." Patel, Collins, Copeland, Kakuma, Katontoka, Lamichhane, Naik, and Skeen.

The Movement for Global Mental Health, British Journal of Psychiatry, 2011, 198: 88-90; doi: 10.1192/bjp.bp.109.074518

I have poured over this quote many times, focusing mostly on the need for "selfless moral struggle" in order to work effectively together. I abbreviate this phrase as "SMS" and then liken it to an SMS text being sent to all of our colleagues in global health and related areas. I also liken it to an SOS message being sent to all the world regarding the urgent need to scale up mental health resources on behalf of humans with MNS conditions and others in dire need of psychosocial support. So, keep these two linked terms in mind--SMS and SOS--as you partner with others for human health and wellbeing. 

And if you want, keep this term in mind as you watch this vintage song by Sting/Police, originally released in 1978, "Message in A Bottle."  http://www.youtube.com/watch?v=1OyfpS6pEcQ  "It seems I'm not alone in being alone..."

Kelly O'Donnell

Note March 2021: Some of the links below are no longer active.

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Viewpoints 

*Beyond Evidence: The Moral Case for International Mental Health (Patel, Saraceno, and Kleinman, American Journal of Psychiatry, 163:8, August 2006).

*GMH and its Discontents (a summary of conference/workshop at McGill University in July 2012 on GMH: Bridging the Perspectives of Cultural Psychology and Public Health)

*Justice and Well-Being (Isaac Prilleltensky; presented at the Canadian Counseling and Psychotherapy Association, Ottawa, 20 May 2011). Power point presentation: click here

*World Medical Association, Declaration of Geneva, comparing the original 1948 and current 2006 versions (there are several adjustments)

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More Maps

Do We Need More Maps?

To begin, it would be helpful to identify (or develop) a "GMHmap for mhGAP." In other words, how can we relate Global Mental Health (GMH), as typified by the WHO mhGAP program, to the broader domain of Global Health (GH). Taking this a step further, we understand that world problems are, as stated in the inaugural issue of the International Perspectives in Psychology, "imbedded in economic, environmental, political, and social contexts" (August 2011, inside cover). World problems of course also include problems addressed within the overlapping domains of GMH and GH. Hence, utilizing (or developing) a "macro map" as a contextual grid for GMH-GH could be very handy indeed. Such a macro map would seem to be a core purview of the area of International Studies, a broad field which is currently very popular in academic settings. 

And More Maps (Guidelines)? 

Perhaps a fourth map is also necessary which would be more of a personal map of values which guide our work in GMH. It could include a individual's demarcation of personal ethical principles and personal moral convictions which we aspire to emulate. Related to this personal map is another map--a consensually-derived ethical map for GMH. One related example that crosses national boundaries is the 2008 Universal Declaration of Principles for Psychologists endorsed by the International Union of Psychological Science and the International Association of Applied Psychology (four principles: respect for the dignity of persons and peoples, competent caring for the well-being of persons and peoples, integrity, and professional and scientific responsibility to society. A related consensually-derived document to also review is the 2007 Principles of Partnership by the Global Humanitarian Platform, a group which brings together United Nations and non-United Nations humanitarian organizations (five principles: equality, transparency, result-orientated approach, responsibility, complementarity). See also the World Association of Non-Governmental Organization's Code of Ethics and Conduct for NGOs (2004).

Some Critiques of GMH

GMH is not without its critics. Here are some examples which critique certain emphases and perceived emphases of GMH--and the non-homogeneous, diverse domain of GMH.

Update May 2019: See From 'Invisible Problem' to Global Priority: The Inclusion of Mental Health in the Sustainable Development Goals. China Mills. Development and Change, 49(3), (published on line 6 March 2018).

Update January 2017: See Primum Non Nocere. The Case for a Critical Approach to Global Mental Health . P. Bracken, J. Giller, D. Summerfield. Epidemiology and Psychiatric Sciences (December 2016). DOI: https://doi.org/10.1017/S2045796016000494

Update July 2015: See Toward a New Architecture for Global Mental Health by Laurence Kirmayer and Duncan Pedersen,  Transcultural Psychiatry, December 2014. Available for free download as part of the special journal issue on GMH. : http://tps.sagepub.com/content/51/6/759.full.pdf+html 

[Moderator input: A helpful review of some of the concerns with GMH--a good place for a "one-stop" overview. One thing among many that I appreciate in the article is the position that it is important to recognise the influences and agendas that are shaping what and how things are done in any field of global health. Yet I continue to want to see concrete examples and suggestions for how to go about helping the millions of humans in distress, especially the poor, regardless of the nosological systems being used or not used. Further and from my perspective, it is not clear that the GMH being typified in the article represents core GMH thinking/practice--GMH of course is a diverse domain and there are many emphases that reflect GMH's understanding and prioritising of cultural formulations of distress, for example. If I could summarise one large part of the critiques of GMH it would be the reminder to make sure that we "humanise GMH"--that is that we make sure that the humanity of the recipients of GMH services is preserved and prioritised and that the human qualities of empathy and authentic care are not lost as we apply manuals and good practice guides and statistics across peoples, cultures, and communities. Doing GMH well is not easy.

Just a short note (July 2014), to say that it would be helpful to consensually address the main critiques that have been directed towards (against) the GMH movement over the last several years. There is much to appreciate in these critiques as well as much to challenge. Perhaps one of the unifying (and extreme) critiques could be this: GMH proponents are trying to naively/irresponsibly/manipulatively/lucratively/selfishly/imperialistically and above all harmfully import "Western" approaches to mental health (diagnosis, treatment, pharmacology, mindset) in spite of the mixed evidence-bases on efficacy and cultural traditions/practices for health and healing.  There are unspoken agendas and power bases that exploit fellow humans in distress and which need to be confronted. Transcultural psychology/psychiatry and public health approaches do not adequately address these problems with GMH. Mainstream GMH, which is coalescing into a more organised movement since perhaps 2008, and as proffered by WHO and MGMH, is at best largely irrelevant for huge cultural groupings of humanity and at worst is highly destructive, For a more thorough articulation of some serious critiques of GMH, see:

• • The interview in the May 2014 MGMH Newsletter, with China Mills and her book Decolonizing Global Mental Health: The Psychiatrization of the Majority World (2013).

  • GMH and its Discontents, a summary of conference/workshop at McGill University in July 2012 on GMH: Bridging the Perspectives of Cultural Psychology and Public Health.

  • GMH: Concerns, Conflicts, and Controversies. Epidemiology and Psychiatric Sciences (2015), 24, 285-291. R. Whitly.

  • For additional perspectives see the International Critical Psychiatry Network.