9/03/2008

Global Movement for Mental Health: a Well-Paved Road to Hell?




The prestigeous medical journal Lancet launched a campaign to set up a global movement for mental health exactly one year ago. The envisaged movement has two main aims: (1) to scale up the availability of evidence-based treatments for mental health and (2) to ensure full human rights for people with mental health disabilities. The Lancet has been publishing a series on the theme, which gives us more insight on what the campaign initiators really mean under these noble goals. As no one can deny that the aims of the movement are most respectable. Of course, the devil is always in the details.

What are those "details" that make me the devil's advocate in this seemingly laudable effort? Below I am summarising some of my concerns.
  • The keynote of the Lancet articles leaves no doubt that the major focus is the globalisation of Western mental health services and treatments to the developing world. Much is said about evidence based drug treatment and (Western based) community mental health services and nothing, or just negative things are mentioned about the traditional community resources and healing methods available in developing countries, such as India. A famous (and because of the unexpected conclusions, repeated) major WHO study on the comparison between the prognosis of schizophrenia in a number of developed and developing countries has found that the outcome of this major mental health problem is significantly better in the developing world. The Lancet series, and the proposed campaign has not been informed by this finding. Advocating the globalisation of the Western, drug treatment based therapeutic regimes and services, when there is available scientific evidence that in the West major mental disorders have less promising prognosis, seems to be irresponsible.

  • Low and middle income countries are seen as retarded societies and civilizations who need to be emancipated by the Western wisdom. The initiated global movement clearly has not learned from the pitfalls of our Western colonialism. Instead of advocating a global discourse on what mental health is and what resources, methods, frameworks have been developed in various cultures across the globe and over the centuries to promote mental well-being, the movement want to sell the industrialised Western approach.

  • Human rights mostly means the right to treatment in this context. The Lancet series does not reflect upon its own self-contradiction: on the one hand involuntary treatment and hospitalization is mentioned as a human rights concern and source of stigma in the West, on the other hand there is no discussion on the causes of this reliance on force. Without such a deliberation advocating the right to treatment may easily end up in advocating force.
  • Human rights violations in the traditional healing regimes are widely popularised. All this being done without listening to those who voluntarily seek help at traditional healing centers. The fact that no one can be legally coerced to traditional healing, and all human rights breaches taking place in such centers are prosecutable offences, while caging people, depriving them of their liberty and their right to make own choices are backed by mental health laws and thus seen as lawful, is overlooked. Whether the declared full respect for the human rights of people with mental health disabilities is premised on this distinction? Depriving people with disability on grounds non-disabled people would never be lawfully detained is compatible with this "full respect"?
  • The approach adopted by the global movement does not feel a need to seek evidence base for traditional healing. Pioneering scholarly work on the effectiveness of traditional healing, such as the one conducted by the Bapu Trust, is ignored.

  • The entire movement is based on the premise that the task of defining mental health, developing indicators to measure it, is a professional task of the medics. What constitutes evidence is being decided by psychiatrists. Users of services are not seen as central experts in a broad, cross-cultural and multi-sectoral and interdisciplinary (i.e. genuinely global)discourse on what is mental well-being. No need for such a discourse is envisaged, as it is premised that medical professionals in the West and in intergovernmental organisations already know all the basics.

The global movement as it was initiated and as it has evolved so far is not a joint venture of equals. It is a colonisation attempt with hegemonical role and power of the Western industrialised countries, their psycho-pharmacological industry, which, if succeeds will globalise the legitimised human rights violations in the Western mental health sector. It is a hegemonical appropriation of mental health by the medical profession, ignoring the lived experience of the users and survivors of the services.

And this is certainly something that no one can want, who genuinely believes that human rights and human rights of persons with mental health disabilites are not two separate things.

6 comments:

Moosa Salie said...

I came to similar insights regarding the new global movement for more western styled mental health services, when I recently attended the first African Consultation of the Global Forum on Community Mental Health in Uganda. It seems that everyone has jumped on the human rights bandwagon and we even nowadays have psychiatrists advocating for the human rights cause.

Unfortunately to them it seems that human rights violations are exclusively seen to be a result of institutionalisation, which everyone concedes to have been a dismal failure. I want to echo remarks of Benedetto Saraceno of the WHO at the First Global Forum meeting in Geneva in 2007, when commenting on Community Mental Health; he said : "We are trying to foster Mental Health in the Community, and it does not mean more psychiatry in the community, but we need to discover what works to foster better mental wellness in the community".

My concern is that psychiatrists like Saraceno will largely be ignored by those who really pull the strings in this Global Industry called psychiatry.

Iris Hoelling said...

dear gabor,i am really impressed by your blog, the wonderful reports and the amazing work you are doing in india.looking forward to reading all the details, thanks for sharing these experiences.it is really fantastic work! congratulations to you and everybody at bapu,all the best,iris

Gyorgy Konczei said...

Hello Gabor,
egy letran allok Amerikaban hetek ota.

Hosszabb ido utan ma volt modom, hogy megnezzem a blogot.
Egeszen kitunonek tartom tartalmilag, es gratolalok, hozza, mikent a youtube-os interjuhoz is, ami egeszen fantasztikus.
Irj, ha van idod, ha nincsen nem baj, vigyazz Magadra, varunk haza, s, ha megjottel, jelentkezz kerlek; s, ha valamit tehetek, legy szives jelezd.

Baratsaggal,
Gy

Puja Modi said...

Dear Gabor
Thank you for sending the links to your blog. I find your blog extremely fascinating and really enjoyed reading every bit of it.Of course some parts of it are a little alarming. But I particularly enjoyed reading the posts on the global movement on mental health, the user survivor movement and Indian tradition, and the one on lord Ganesha (to be honest some of it was a learning for me as well about Ganesha).
Thank you!
Warmest
Puja

Mary Maddock said...

Thank you Gabor and many people like you who have helped to lead me and others from psychiatric slavery. Western psychiatry, with the help of the pharmaceutical industry, often causes more harm than good. Psycho/social problems are not medical problems. Human problems need human solutions.

I believe this is why what is described as 'mental health' is so poor in the West. When profit is the primary motivation and human problems are seen as diseases which need medical 'cures' then humanity suffers and people become guinea pigs. People are sold over and over again for 'thirty pieces of silver'.

Other parts of the world, like India, have not had the opportunity to do this. They have better ways, passed on from generation to generation, to help each other. They know how to relax because they have mastered the art of ' living in the now'. We need to learn their wisdom and warn them not to fall into the trap of medicalising human behaviour.

I wish you every success and happiness in your important work.

In solidarity and support,

Mary Maddock

karim said...

A valuable post on mental wellness.

Thanks,
Karim - Mind Power