The evolution of information and communication technologies, advocacy for global mental health, and social change

It is the use of advocacy for social change and for promoting global mental health that has spanned my career that is a key passion.

By Elizabeth K. Carll, PhD

When I was asked by the Amplifier editor, Krishna Kumar to write an article about my work, as he was asking the various award winners to submit an article, I thought, where could I begin? As a trauma and health psychologist, my experiences are diverse including developing media outreach public information initiatives for state and national disaster response activities; working with teens who were being harassed online; and community concerns about violence in video games and interactive media and testifying before regional, state, and the U.S. Congress on media and mental health; collaborating with journalists; and other activities. However, it is the use of advocacy for social change and for promoting global mental health that has spanned my career that is a key passion.

The recognition of the importance of the need to reach global agreement on complex problems such as broadening access to information, bridging the digital divide between the rich and poor, right to privacy, and the right of free expression, was the basis for the first United Nations World Summit on the Information Society (WSIS) in 2003 in Geneva, Switzerland. My participation in the Summit was the result of having read the draft proposal of the WSIS Declaration of Principles and Plan of Action and to my surprise, there was no mention of mental health anywhere in either of the documents, including the section on health.

The omission of any reference to mental health prevention, treatment, services, and promotion of mental health in the WSIS documents was reminiscent of the lack of parity between physical and mental health services in health plans and programs in the United States. The lack of parity in access, services, and costs reflects the failure of the integration of mental health services into the health care system even in a nation, which is considered one of the most affluent and technologically advanced nations in the world. It was this apparent glaring omission in relationship to the use of information and communication technology (ICT) which prompted my interest in attending the meeting.

Given this unfortunate lack of integration of mental health services in comprehensive health care, the landscape was ripe for replication of the existing problem of lack of parity on a much larger scale involving ICT. To prevent the recurrence of this problem, it became evident that integration of physical and mental health services needed to take place at the time of the inception and development of the basic services that would be included in global declarations as necessary and accessible through ICTs. This prompted my collaborating with mental health organizations and professionals to address this problem.

In consulting with the International Society of Traumatic Stress Studies (ISTSS), the organization decided to spearhead the initiative to address and rectify this problem and asked me to represent the organization at the Summit. The ISTSS Statement on Information and Communication Technologies, Mental Health and Trauma was drafted (Carll, Danieli, and Braak, 2003) identifying the issues and the importance of the integration and access of mental health information services via ICT.

Although representing ISTSS, it was also helpful to have the support of the NGO Committee on Mental Health at the United Nations, a consortium of multidisciplinary organizations established in 1996, for which I then served as the founder and chair of their Media/ICT Working Group. As the only mental health professional involved in the drafting of the CS WSIS Declaration, the successful inclusion of access to mental health information and services via ICTs, demonstrated for me the importance of multidisciplinary expertise and support in the complex and, sometimes, highly charged process of developing consensus in a multi-stakeholder community. As well as demonstrating the importance of a single or small group of voices in a democratic process.

Fast forward nearly a decade later, to the United Nations Summit on Non-Communicable Diseases (NCDs) in September 2011. NCDs were defined as cardiovascular disease, cancer, diabetes, and respiratory illnesses by the UN. Although mental health had been included in a variety of UN documents over the years through focused advocacy, in the meetings leading up to the Summit, there appeared to be concern that mental health would not be included as a risk factor for NCDs in the outcome Declaration of the U.N. Summit on NCDs, which would be agreed to by the 193 nations of the U.N. General Assembly. Therefore, it was urgent that mental health be included as a significant component of NCDs, as intervention and prevention services were expected to take place through primary care. In addition, the World Health Organization projected depression to be the greatest burden of disease by 2030, surpassing cancer and heart disease. Furthermore, due to the lack of health care specialists in developing countries, telehealth and other technologies would be important healthcare tools. Therefore, the NGO Committee on Mental Health in New York partnered with the NGO Forum for Health in Geneva and with the input from other NGOs globally, mental health was included as a risk factor for NCDs.

In May 2012, I attended the United Nations World Summit on the Information Society (WSIS) Forum in Geneva and participated on a panel on ICTs and Poverty Eradication. ICTs, such as mobile phones, have enormous influence in improving the economies of developing nations. Poverty is one of the key elements affecting the mental health of all people. The recognition of social media and technology as a powerful tool in accomplishing rapid social change and the potential for reducing poverty was recognized by the world’s nations in less than a decade from the first WSIS. It has been especially gratifying to be able to participate in the process of contributing to social change and the expansion of mental health information and services to benefit the well-being of people globally.

About the author

Elizabeth Carll, APA Council Representative, Chair, United Nations NGO Committee on Mental Health, was awarded the 2012 Division 46 Distinguished Professional Contributions to Media Psychology.