Global Mental Health

Latin America and Spanish-Speaking Populations

Javier I Escobar

• Publisher: Rutgers University Press
• Year: 2020
• ISBN:
  9780813595924
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

Global Mental Health provides an outline of the field of mental health with a particular focus on Latin America and the Spanish-speaking world. The book details evidence-based approaches being implemented globally and presents ongoing state of the art research on major mental disorders taking place in Latin America, including work being done on understanding Alzheimer's, Bipolar Disorder, Schizophrenia, and other psychoses. While supporting the initiative for building capacity of care in low income countries, the book warns about some of the potential risks related to the abuse of psychiatry, using examples from the past, focusing on early 20th century Spain.

1 • A BRIEF REVIEW OF GLOBAL MENTAL HEALTH

Challenges, Developments, and Needs

STANLEY NKEMJIKA, JAVIER I. ESCOBAR, AND HUMBERTO MARIN

BACKGROUND

Millennium Development Goals: The recent impetus of a global approach to health; followed the United Nations initiative on health objectives for the new millennium; launched in the year 2000.¹ These goals included:

• End of hunger
• Universal education
• Gender equity
• Child health
• Maternal health
• Combatting HIV/AIDS
• Environmental sustainability
• Global partnership

While it seems rather remarkable that problems related to mental health were not originally listed among these top priorities, in 2005 the World Health Organization’s European ministerial conference added the necessary sentence to correct this omission by stating, “There is no health without mental health.”²

In 2009 a committee of the Institute of Medicine of the United States strongly endorsed the new millennium initiatives and recommended large investments to fulfill the Millennium Development Goals. Additional investments were also recommended to combat injuries and noncommunicable conditions such as heart disease.

Today, almost two decades after the goals were drafted, it must be acknowledged that even though some of the objectives have been at least partially fulfilled in many countries (e.g., ending hunger, improving universal education, improving child and maternal health, and combatting HIV/AIDS), severe problems and disparities continue to exist, particularly in low-income countries, and many of these problems currently occur on the mental health front.

Global Health: George Bernard Shaw’s old dictum “There is no such thing as perfect health; nobody is ever really well” continues to resonate, despite countless efforts to define and catalogue the concept of health. The World Health Organization (WHO) defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” a broad, rather unrealistic definition that has not been modified since 1948. The concept of “health equity” and the attainment of the Millennium Development Goals have been central tenets to the notion of global health. As an area for study, research, and practice, global health places a high priority on improving health and achieving equity in health for all people worldwide. The Institute of Medicine has briefly defined global health as “health problems or concerns transcending national boundaries which may be influenced by circumstances or experiences in other countries and are best addressed by cooperative actions and solutions.” The emphasis on cooperation across borders is, in our view, the essential ingredient in this definition.

Thanks largely to unprecedented opportunities such as the emergence of new donors and philanthropists, efforts could be initiated to promote excellence and equity in health-care delivery for poor, underserved populations globally. More specifically, a number of successful programs geared toward reducing morbidity and mortality from infectious diseases have been rejuvenated through the use of viable platforms that incorporate provisions to comprehensive health care for those exposed to poverty and chronic disease.³

Global Health and the U.S. Government: The U.S. government took a significant interest in global health in the past two decades, in particular during President Barak Obama’s first term. Obama wisely stated, “The US global health investment is an important component of the national security smart power strategy” and even proposed a cabinet position in his administration to address health issues globally. Unfortunately, this initiative could not be realized due to political and budgetary issues, but it had a clear impact on a number of institutional settings, including academic medicine.

Global Health at the National Institutes of Health (NIH): Shortly following his appointment as NIH director in the early 2000s, Francis Collins, the scientist who led the project that catalogued the human genome, listed global health as one of his top four priorities for the organization and advocated the expansion of research efforts to aid developing nations and increasing research collaborations with low- and middle-income countries (LMICs). In early interviews following his appointment, Collins expressed a strong commitment to alter the view most countries had about the United States “by emphasizing the US role as that of a doctor rather than a soldier.” Unfortunately, political and budgetary issues also brought this initiative to a halt. On the positive side, however, some global mental health initiatives and investments continued to be seen at various NIH institutes, particularly the National Institute of Mental Health (NIMH) and the NIH-Fogarty Institute, the international arm of NIH. Thus, some NIH institutes (NIMH among them) have facilitated global research by allowing RO1 grants, the prototypic and most-valued awards at NIH, to be carried out in foreign lands, thus making the RO1 granting mechanism a bit more accessible to international projects.

GLOBAL MENTAL HEALTH

The WHO defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” The state of mental well-being includes cognitive, emotional, and attitudinal components. It is a continuum rather than a state that is either present or absent. Three components of mental well-being—emotional, psychological, and social—have been proposed. Definitions of mental health need to consider the attributes of each particular society, its needs, resources, social ideals, and values. Being mentally healthy refers primarily to the absence of mental distress or disease, specifically, the absence of a specifiable or diagnosable mental disorder.^4,5

As many of these global mental health concepts and constructs have evolved from values endorsed by Western Europeans and North Americans, beyond literal translation, they need to be properly adjusted and calibrated before they are applied to other world regions and countries. Certain psychological and behavioral components appear to be universal, however, such as the “positive” traits of altruism, respect, and ability to relate to others or to consider the needs of others. Also, “negative” traits such as violence, lack of regard for others, and antisocial behavior are universally discouraged. Moreover, severe mental disorders such as mania and psychoses appear to be clearly differentiated and recognized in most cultures.

Critical Issues for Global Mental Health

Currently, the most pressing mental health issues globally include:

• Early identification of disorders and interventions for those in need
• Access to quality mental health care for all
• Integration of mental health and primary care services
• Scientific collaborations

—Early identification of mental disorders is critical and carries prognostic value. As availability of mental health professionals is scarce in many regions, primary care workers need to be properly trained, and individuals with mental disorders should be helped to recognize and understand their illnesses through such processes as psychoeducation. This empowerment lessens stigma and helps those suffering from mental disorders to pursue available therapeutic options and to access information on the effectiveness and side effects of potential treatments, ideally, as part of a process of shared decision making.⁶

—Regarding access to services, the mental health needs of a population should be ideally fulfilled in an equitable, accessible, and acceptable manner. Building on the advances of research on the management of mental disorders, the promotion and strengthening of a wide network of support resources that are evidence-based and geared toward recovery and prevention are essential.^7,8 These approaches attempt to address and correct the enormous health disparities and disadvantages that exist in many regions of the world regarding the provision and quality of mental health care, and they reinforce respect for the human rights of people with mental disorders globally.^9,10

—A significant improvement in delivering mental health services can be achieved through integrating mental health care into existent primary care programs, yet true integration is lacking in most countries, including the United States. For most vulnerable groups, such as those plagued with intellectual disabilities and those with chronic and severe mental disorders such as schizophrenia and dementia, there is an urgent need for more research, for adequate resources toward the provision of acute care management, for cost-effective and continuous follow-up strategies, and community resources to aid deinstitutionalization of those with chronic mental health problems. A more coherent and cordial interaction between specialists and nonspecialists is needed for these efforts to reach their true potential. This integration may revolutionize the care of the mentally ill through facilitating clinical care and management and reducing global inequalities to health care access.^7,8

—To achieve a balance between high-income and low-income countries, the field also needs to address transnational influences on mental health such as migration, conflicts, disasters, and the impact of global trade policies. Although much remains to be achieved, the successful proliferation and implementation of global health projects in selective low- and middle-income nations should serve as a pilot and a model for mental health care delivery in other regions as forecasted by the Movement for Global Mental Health.¹¹

Global Burden of Mental Disorders

What follows are critical and challenging statistics pointing to the heavy burden that mental disorders impose globally.

—Mental illness constitutes an estimated 7.4 percent of the world’s measurable burden of disease.¹²

—The economic burden of mental disorders exceeds those of the four major categories of noncommunicable diseases: diabetes, cardiovascular diseases, chronic respiratory diseases, and cancer.¹³

—Major depression is the second-leading cause of years lived with disability (YLDs).¹⁴

—Anxiety disorders, alcohol/drug disorders, schizophrenia, and bipolar d...

Table of contents

• Cover
• Series Page
• Title Page
• Copyright
• Dedication
• Contents
• Series Foreword
• Introduction
• 1. A Brief Review of Global Mental Health: Challenges, Developments, and Needs
• 2. Looking at Cultural Aspects of Global Mental Health: The Culturally Infused Engagement Model in Latin American and Asian Populations
• 3. The Abuse of Psychiatry Globally: A Focus on a Little-Known Historical Example from Francoist Spain
• 4. Task-Shifting Strategies in Latin America: The Key Role of Primary Care Health Agents in Mental Health Policy and Research in Northern Argentina
• 5. Genetic Research on Chronic, Severe Mental Disorders in the Paisa Population in Latin America: A Review of Past and Current Research
• 6. A Brief Rejoinder and Future Projections
• Acknowledgments
• Notes on Contributors
• Index