PSYCH PERSPECTIVES NOTES.

WEEK 3:

Two parts:
 Study discourses, positions, and entities
 Debate these positions as if you endorsed them.

Group work (Group 2)

Critic of GMH

How to approach readings:

 Basic content, is it convincing what is the evidence being used
 Don’t accept key arguments as fact-interrogate
 Who are authors-institutional placement, discipline, professional remit power and
influence?- wiki search, cv search. And how they influenced them? Important to do for
final papers.
 How does this influence the kind of research they conduct and the arguments they
make?
Advocating GMH (Global Mental Health
 Kleinman
o Global Mental Health, a failure of humanity
o US. Hispitals as prisons.
o Global south: inhumane practices being conducted all the time; high stigma
o Points at (blames): relgiions, modern prviders, family , police, folk healers.
 We always romanticize local solutions. Kleinman says local is bad,
contrasting vikram and others. Ex. Religious healing, talk therapy that’s
working? Bottom line is that they’re all the same. Share empathy,
listening, space etc… Go local., but kleinman does not think so.
o Moral question: people with mental illness regarded as sub-human
o What are proposed solutions? What framing?
 State protecting people from potential of mental illness being violent of
murderous. Making shift .
 Vikram Patel
o ”scaling up services for people with mental disorders” -wide representation in
the movement – why? -”struggle for social justice” (p.89) requires increase in
mental health services -not only an “evidence-based” argument
o measuring treatment gap.
 Summerfield
o Questioning the ontological status of “mental disorder” in GMH
 It must be biological (the cause of mental illness) and that science hasn’t
progressed to the point that we know what is causing it
o Diagnoses currently used not discrete/ high levels of co-morbidity
o False positives/disease mongering
o Focus on symptoms/suffering rather than resilience
 o Evidence of efficacy of treatments – medicines or talk therapy –
patchy/contested O Focus on treatment rather than prevention
o Disregard for “indigenous” local knowledge
o Disregard for social causes of mental illness
 Looks at income inequality and prevalence of MH

 Healy
Psychiatrists engaging with public health. Espousing sometimes dramatically different positions.

Mortality was first focused on until the 1980s when morbidity was also being looked at (to
reduce)… I guess that includes mental health.

Rise of global mental health

O 1995: World Mental Health: Problems and Priorities in LowIncome Countries
O 1997: First Global Burden of Disease study
O 2001: World Health Report (WHO): Mental Health: New Understanding, New Hope
O 2005: Global Burden of Disease calculations
O 2007: The Lancet series on Global Mental Health
Vikram Patel paper.
O 2008-09: WHO and Global Forum for Health Research: assessing mental health research
priorities
O 2010: Grand Challenges in Global Mental Health
Bill Gates. Especialy infectious diseases. (2010 first for mental health)
O 2011: New Lancet series on Global Mental Health

*mental illness is a luxury from industrial stress. But study shows that mental illness exists in
LAMI countries.
*statistics now looking at comorbidities.

Collins et al on Grand Challenges

-MNS = 13% GBD -”absence of cures and dearth of preventive interventions” (p. 27)
-”treatment gap”
-Prioritization exercise

Core GMH advocacy arguments found in 2007 Lancet series:

O Prevalence, spread, burden of disease (universality)
O “Treatment gap” calculation is central
O Salience of mental health for physical health more generally (co-morbidity, Prince et al, p.
869, stunting)
O Evidence-based packages of care (simple, feasible, scalable, culturally appropriate)
O Ripple effects of reducing treatment gap (co-morbidity, morbidity among care-takers,
economic loss)
O Mental disorders can “affect development potential of society” (Horton, p. 4)

GBD Video (Lancet):

 7.4% mental abuse disorder
 183 mill DALY years of mental health
 10-29
 depressive disorders highest burden, followed by anxiety and alcohol
 37.6% of mental disorders increase .
o pop growth and ageing
o proposed solution: prevention and intervention.
*alcohol and substance abuse is now included in mental health issues.
Global mental Health is a way for US to look at US healthcare critically (contrasted that with
how US is always at the forefront of health, despite US suffering from GMH )

Vikram Patel TED Talk:

 Suicide is one of the leading causes of death in all countries
 Mental health creates a almost 20 years less life expectancy
 Mental health illness account for 15% of global burden of disease
 400-500 million people suffering from mental illness
 3rd ranking in DAILY

Derek Summerfield Video: Against GMH

 no independent way of differentiating depression as a biomedical category and sadness
o we categorized them
 MH a way we tell people how to be, how to think. A way of control third world
 Western mental health is already bad.
o Depression false positive
 o Pharmaceutical companies play in GMH
o Globalization of use of antidepressants.
 Overuse in our own society of SSRIs
o Assumption of citizen is resilience. We need to assume our toughness rather
than view us all vulnerable and weak

Debate: Against GMH