Mental health service-users, rights-groups and professionals advise caution before implementing a "scaling up" of mental health care globally.

On Oct. 9-10, 2018, World Mental Health Day, the United Kingdom (UK) government hosted a Global Mental Health Ministerial Summit with the intention of laying out a course of action to implement mental health policies globally. In the same week, The Lancet Commission on Global Mental Health and Sustainable Development published a report outlining a proposal for “scaling up” mental health care globally. In response, a coalition of mental health activists and service-users have organized an open letter detailing their concerns with the summit and report. The response has attracted the support of policy-makers, psychologists, psychiatrists and researchers.

The open letter raises several concerns with the positioning of the UK summit and calls on the organizers and leaders of the event to reflect on issues of discrimination and human rights abuses in mental health treatment in their home countries before recreating these systems abroad. The signatories raise the issue of representation and participation, writing:

“Significantly, there has been little or no involvement of organizations led by mental health service users, survivors and persons with psychosocial disabilities in the thinking, planning and design of this event. While a few networks were approached to provide ‘experts by experiences’ to attend panels on themes already decided on, there has been no meaningful consultation or involvement of user-led and disabled people’s organizations not already signed up to the ‘Movement for Global Mental Health’ agenda or funding to enable a wide range of representatives to attend.”

Jhilmil Breckenridge, a poet, writer and activist and founder of the Bhor Foundation in India, believes that it is a matter of concern that the plan being discussed in the UK this week “will just be 'dumped' into low resource settings with programs planned in India, Ghana, Nigeria, Uganda and Kenya.”

“There needs to be more thought as what works for an anti-stigma campaign in a first world country will definitely not work in the same way in a country like India,” she said. “In addition, these kind of campaigns continue to perpetuate an ableist lens, one that may portray a person with psychosocial disability as a 'burden' and an economic cost. The language needs to change, the lens needs to change, and we certainly should not be 'dumping' or 'exporting' medication, treatment or marketing plans to these countries. Furthermore, there are problems other than stigma that need tackling first in a country like India, and the words 'stigma' and 'recovery' are all ableist concepts that need more critical thought.”

In the latest report, the Lancet Commission places an increased emphasis on a “rights-based” approach and demonstrates a greater appreciation for cultural differences and respect for the lived-experiences of those affected than previous reports. However, critical psychologists have raised issues with the details of how the global mental health movement will be implemented.

China Mills, PhD, a leading scholar in the field of global mental health, has raised concerns that “while the Commission talks about partnership with people with psychosocial disability, the production of the Report did not involve consultation with experts by experience, who should be involved right from the start”. She also takes issue with the way the report frames “mental distress as an economic burden, which while perhaps successful in getting governments on board, also risks constructing distress in stigmatizing and discriminatory ways (e.g. as ‘costly’ and burdensome), and overlooks the economic and political determinants of mental distress”.

Div. 32 member Lisa Cosgrove, PhD, a psychologist and professor at the University of Massachusetts Boston (UMass Boston) along with her doctoral students, has organized professionals in support of the open-letter. She explains that attention should be given to the voices of mental health service-users and activists who “challenge the current paradigm of mental health care.”

“Scientific research, as well as the lived experience of those who have been diagnosed with a mental disorder, points to the need for change,” said Cosgrove.

Psychiatric epidemiologist Melissa Raven, PhD, from the University of Adelaide in Australia, takes issue with the numbers being used to justify the urgency of the global mental health movement, as described in a podcast interview with UMass Boston doctoral student Justin Karter, who is also the Div. 32 newsletter co-editor and student affiliate. Raven explains that “these alarming statistics about the prevalence of mental disorders and the treatment gap” contain multiple issues, including “the validity of using diagnostic criteria that have been developed in Western settings and using them in other countries, particularly lower and middle-income countries.”

Cosgrove and her team of doctoral students will continue to work with mental health activists and professional groups to call for revisions to the global mental health proposals to reflect a greater appreciation for a social-justice approach. This work is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation.

More information is available at the UK’s National Survivor User Network.

Social Media: 

Use hashtag #WhatWENeed.

Podcast: 

UMass Boston doctoral student and Div. 32 student affiliate, Justin Karter, has developed a series of interviews on this issue for the Mad in America podcast. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team. Over the past three weeks, they have published interviews with many of the leading voices in this debate.

Immediately following the release of the report and the beginning of the Summit, on World Mental Health Day, psychiatric epidemiologist, Melissa Raven, PhD, was interviewed by Karter. She questioned the evidence base of the movement, pointing to statistical issues in the prevalence rates of mental disorders internationally and called for a focus on addressing barriers to health rather than on individualized treatment.

Shortly after, mental health service-user activists, Jhilmil Breckinridge, of the Bhor Foundation in India, and Bhargavi Davar, PhD, of Transforming Communities for Inclusion (TCI) Asia Pacific were also interviewed for the podcast series. Each discussed the lack of involvement of service-user and disability rights groups in the UK Summit and Lancet report and laid out alternative frameworks for addressing distress in ways that are sensitive to culture and social context.

Next, China Mills, PhD, a critical psychologist and author of Decolonizing Global Mental Health, was interviewed by UMass Boston PhD student, Zenobia Morrill, about her experience attending the UK summit and the lack of attention that has been given to the ways in which austerity policies in Britain have contributed to the increased demand for mental health interventions.

The full list of podcasts in this series is available below:

Div. 32 Contacts:

Lisa Cosgrove, PhD, Div. 32 member
Justin M. Karter, MA, Div. 32 student affiliate and newsletter co-editor