Global mental health praxis: Perspectives from cultural psychiatry on research and intervention

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Journal Article

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Re-Visioning Psychiatry




© Cambridge University Press 2015. Introduction As psychiatric discourse continues to spread throughout the world, there is a need to ask how psychiatric knowledge is generated, what forms of psychiatric knowledge hold power in different settings, and what determines how knowledge is transformed into practice. In this chapter, we explore the issues of knowledge and practice at the intersection of cultural psychiatry and global mental health (GMH) to guide the revisioning of psychiatry, with special attention to how psychiatric care is delivered in low- and middle-income countries (LMICs). The 2001 World Health Report entitled Mental Health: New Understanding, New Hope outlined the state of the mental health around the world and proposed key steps forward (World Health Organization, 2001). This was followed by the 2007 Lancet series, "Global Mental Health,"which established goals and approaches for research and intervention to address worldwide disparities in care (Chisholm et al., 2007; Prince et al., 2007). Broadly, this GMH movement has the mission to reduce the gap between the burden of mental illness and the availability of effective mental health services. This mission entails advocating for increased funding for mental health services and personnel, expanding research to develop evidence-based practices for LMICs and low-resource settings, developing government mental health policies, and advancing the rights of persons with mental illness (Collins et al., 2011; Drew et al., 2011; Patel, Collins, et al., 2011; World Health Organization, 2010). The GMH field includes clinicians, government policy makers, public health researchers, mental health consumers, and members of development agencies and the World Health Organization (WHO). The formal Movement for GMH (MGMH) emerged from the 2007 Lancet call to action on scaling up GMH. Along with practitioners and researchers in the general field, MGMH emphasizes improving services in LMICs, where an estimated additional 1.2 million healthcare providers are needed to deliver adequate mental health services (Kakuma et al., 2011). This shortage has led to support of task-sharing, also referred to as task-shifting, as a delivery solution. Task-sharing is the process of training primary care and community health workers to assume some care responsibilities that are traditionally the province of mental health specialists (World Health Organization, 2010).

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