The Need for a Human Rights-Based Approach to Global Mental Health
By Lisa Cosgrove
The more we learn about mental health, the clearer it becomes that Western psychological practices don’t always work for other cultures and countries. This isn’t simply a matter of low-income nations not having the resources to support treatments involving psychiatric drugs and one-on-one talk therapy. Costs aside, the treatments themselves are often ill-suited to the contexts they are applied to—they can obscure the root causes of mental health challenges like poverty and violence, inadvertently increase stigma, or sideline traditional healing methods that have been used effectively for centuries.
As May is Mental Health Awareness Month in the United States, perhaps we should take the opportunity to raise our own awareness of the risks of exporting Western mental health practices.
The Western psychological profession often fails to acknowledge that such risks exist, a fact thrown into relief in October 2018 by Mental Health for All: A Global Goal, a Lancet report. The report issues a call to “scale up services for people living with mental health problems and to close a substantial treatment gap, especially in low-income and middle-income countries.” It goes on to make broad assertions that are informed predominantly by the Western experience: that most mental health challenges originate in childhood, that adolescence should be accompanied by “educational and social skills programs,” and so on.
But local contexts can be eclipsed when applying such practices on a global scale. For instance, India has a very high suicide rate. In 2010, 187,000 people in India died of suicide, comprising one-fifth of suicides globally. This high rate is propelled by forces that are cultural and economic in nature. Suicide rates in rural areas, for example, are twice as high as those in urban ones, a reflection of an agricultural system in which farmers often end up deeply in debt because they don’t own their land, and because of the introduction of non-sustainable farming practices like the use of genetically modified crops.
As one account puts it in a 2014 paper on farmer suicides in India, published in the journal Globalization and Health, “The build-up of farmer debt is a direct result of the deepening agrarian crisis, and the wave of farmer suicides is a direct outcome of mounting debt.”
Therefore, globalizing Western psychological practices as the Lancet Commission endorses—by prescribing antidepressant medication, for instance—would be a woefully inadequate response to India’s high suicide rate. Treating India’s suicides as a mental health issue papers over the real issue of farmer indebtedness. It also shifts responsibility for rural suicides away from the systemic causes and onto the farmers themselves.
Even the very terminology of Western psychology pushes in this mistaken direction. Phrases like “burden of disease,” employed often in the Lancet report, imply that mental health is primarily an economic burden to a country. This framework reinforces the idea that emotional distress is best conceptualized as a “disease” that can be eradicated and that the “burden” can be quantified by an economic calculus (e.g., Disability Adjusted Life Years). The heavy emphasis on a Western biomedical framework undermines an appreciation for the ways in which communities can work together to offer support.
In India, this community support often comes via the temple, through a mix of faith healing, herbal remedies, and the ancient ayruveda system of medicine, all of which may help to decrease feelings of isolation in people with lived experience of mental health challenges. The individualistic focus of Western psychology—which is often practiced one-on-one, with a single doctor prescribing treatment to a single patient—can sideline these communal practices that have been effectively used for centuries.
Involving community is also important to prevent the stigmatization of people who experience emotional distress. In fact, anti-stigma campaigns imported from the West may make stigmatization worse. This is because models and interventions that conceptualize distress as “illness” may themselves be stigmatizing and discriminatory. Research has demonstrated that disease-based and biological explanations for mental distress are more stigmatizing and more likely to increase public desire for distance than psychosocial explanations (such as distress as response to trauma or difficult living conditions).
When exporting Western mental health methods and treatments, local contexts can get lost, traditional methods of healing can be discounted, and stigmatization and isolation can increase. “Mental health for all” is a worthy goal, but the way to get there isn’t by exporting one model to the whole world. For many communities, the path to better mental health begins at home, by allowing those most affected by the global mental health movement to have a voice.
Lisa Cosgrove is professor of counseling and school psychology at the University of Massachusetts Boston’s College of Education and Human Development.