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- Convenor:
-
Gojjam Limenih
(The university of Western Ontario)
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- Format:
- Panel
- Sessions:
- Tuesday 6 April, -
Time zone: America/Chicago
Short Abstract:
The Movement for Global Mental Health has formulated standardized international health packages to address mental illness in low and middle-income countries(LMICs). The panel will consider the advantages and disadvantages of biomedical and WHO recommended mental health support strategies in LMICs.
Long Abstract:
The variation in the provision of mental health facilities across the world is considerable. It is estimated that more than 90 percent of global mental health resources are located in high-income countries (HIC), while approximately 80% of the world's population live in low- and middle-income countries (LMICs). In order to address this inequality, there have been calls for the scaling up of mental health services in LMICs, with the aim of providing 'effective, affordable and morally justified' services. The global mental health movement claim that global mental health's driving philosophy is equity, i.e. justice and fairness in the distribution of mental health in society between and within countries. Whilst this is a laudable aim, one fundamental question emerges here: Does increasing the availability of 'Western-type' mental health care in non- Western settings equate to meeting the needs of diverse cultural groups around the world? The solutions are varied, but the development of more services may not represent an efficient or even desirable answer. The way distress is labeled has also a range of consequences. This panel will consider the advantages and disadvantages of biomedical and WHO recommended mental health support strategies in LMICs.
Accepted papers:
Session 1 Tuesday 6 April, 2021, -Nadia Augustyniak (The Graduate Center, CUNY)
Paper short abstract:
Focusing on the network of mental health services available in an urban context in Sri Lanka, this paper highlights practitioners’ perspectives on the intersecting challenges and structural barriers they face in providing care for patients and families.
Paper long abstract:
At stake in the debates over Global Mental Health are critical questions about the ways in which socio-economic and cultural realities shape illness experiences and the degree to which proposed strategies for expanding mental health services globally address not only the diversity of lived experiences of illness but also the structural barriers to wellbeing. I draw on 22 months of ethnographic research with mental health practitioners and individuals and families seeking treatment in an urban setting in Sri Lanka to highlight how practitioners and patients relate to and shape available psychiatric services in meaningful ways. In highlighting practitioners’ perspectives on the challenges they face in treating patients, I further show how questions of cultural meaning are inextricably tied to political and material dimensions of care such as economic and social marginalization and lack of institutional resources. Observations in an outpatient clinic and interviews with doctors, counselors and patients illustrate that despite relatively robust mental health services in this context, systemic issues such as lack of long-term care facilities, high patient loads, and persistent economic inequality make it very difficult to implement services that are truly responsive to people’s diverse and intertwining needs—material, social, cultural, and spiritual. This paper thus stresses a focus on the cross sections of identities and socio-cultural and material realities within any given setting in order to examine the complex ways that practitioners and people experiencing mental illness or distress orient themselves to existing modalities of healing and strive to alleviate distress amidst structural barriers to wellbeing.
Carolina Martinez-Salgado (Universidad Autonoma Metropolitana (Xochimilco))
Paper short abstract:
This study is about the scopes and limitations of recent forms of provision of mental health services in primary care centers. The observation point was a low socioeconomic status area with an ancient rural and agricultural tradition in the southern part of Mexico City.
Paper long abstract:
It has been documented that Mexico, a middle-income country with great income inequality, have a serious lack of mental health services for its population size and its mental health troubles. The more recent trends in the country points towards new ways to face it through primary care attention. In this scenario, the question this panel proposes to think about is specially pertinent. Because even if Mexico is part of the Western societies, large segments of its population have a culture deeply influenced by ancient traditions whose roots go back to pre-Hispanic times. Large parts of these groups have been relegated, along the historical process, to the most disadvantaged socio-economic conditions, and their daily life goes on under complex threats to their mental health. In this presentation I work with the testimonies of a small group of medical students who I accompanied during the last stage of their professional training, when they performed their social service in first-level health centers in Xochimilco and Tláhuac, two Southern regions in Mexico City with an ancient rural and agricultural tradition. Through the scenes I reconstruct, I try to show the benefits these people obtained for their mental health problems, but also the gap between their needs and beliefs, and the kind of professional services they got. I express my aspiration that an approximation like this would contribute to nurture the reflection in the quest for better modalities of mental health care services, closer to the subjectivity of those who require that care.
sudarshan r kottai (Jain University)
Paper short abstract:
The COVID pandemic in India has unraveled profound failures of governance and discrimination of marginalised sections. One response of state which failed to provide transport/food to stranded migrant workers was to offer tele-counselling and psychiatric medicines for ‘mental distress’.
Paper long abstract:
The COVID-19 pandemic in India has unraveled both the profound failures of governance and the social fissures in society. While the privileged Indians abroad were flown in at the expense of the government, an estimated 40 million migrant workers were left high and dry to fend for themselves. Money-less, transport-less, jobless, they walked thousands of kilometers in an attempt to reach their villages. Recorded as a massive human tragedy, not seen since the partition in 1947, the migrant workers were often victims of police brutality and hundreds are documented to have lost their lives. One response of the state – which failed to provide transport, food and water – was to offer tele counselling for ‘mental distress’, and offer pharmaceutical support through task-shifting. This talk will unwrap the politics of psy disciplines, especially as it is brought to bear in India during the humongous crisis brought on by structural violence and social suffering; medicalizing, decontextualizing, depoliticising and psychiatrising these. Drawing from mental health policies, developments around COVID-19 and personal insights from mental health spaces, I will throw light on how mainstream mental health systems in India huddle with the state, in aggressively replacing social justice problems of vulnerable sections like migrant workers with a single story of ‘psychiatric disorders’.
Costanza Torre (London School of Economics and Political Science)
Paper short abstract:
This paper is an ethnographic study of the relationship between Global Mental Health interventions in a refugee settlement in Uganda and the country’s self-reliance policy. It argues that these interventions are used to deresponsibilise institutions, medicalising refugees' socio-economic distress.
Paper long abstract:
This paper offers ethnographic reflections on the introduction of Global Mental Health interventions in a refugee settlement in Uganda, and on their relationship to the country’s self-reliance refugee policy. Under Uganda’s self-reliance policy, often misleadingly depicted as a “humanitarian success story”, refugees are encouraged to become economically independent actors - a task that proves challenging for many due to insufficient basic humanitarian assistance. Since 2018, small Health Centres in Ugandan refugee settlements also include a Mental Health ward. The influence of Global Mental Health thinking and policy is evident in this recent addition, as the field is notably very reliant on psychotropic treatment and has in recent years been advocating for the expansion of mental health services and their integration in primary care ones, in an attempt to "bridge the treatment gap". Drawing on 13 months of in-depth ethnographic fieldwork in the refugee settlement of Palabek, northern Uganda, this paper argues that such programmes are anything but neutral actors in the Ugandan refugee response, directly supporting the “self-reliance agenda” by establishing an explicit connection between mental health and economic self-sufficiency. Consequently, refugees who struggle to navigate uncertain economic landscapes and to rebuild their lives in a displacement setting where assistance is constantly reduced are often diagnosed with psychiatric conditions and prescribed psychotropic treatment. This paper warns that the introduction of global mental health interventions in emergency settings risks medicalising socio-economic distress, de-responsibilizing governmental and humanitarian institutions and allowing them to disengage from issues of chronic poverty and profound inequality.