Inverting the deficit model in global mental health

People who study or work in mental health in countries with few resources usually focus on what people need and the obstacles they face in meeting those needs. This usually plays out in programs that try to strengthen medical systems so that people can get medications, counsellors or psychological/psychiatric treatment which has been the main approach in the Global North. The dominant questions asked are: “What do people in low income countries not have (compared to us in higher income countries)?” and “How do we close treatment gap and deliver those medications and services to them?”

Disrupting thinking around global mental health

In our study we challenge this way of thinking. It emphasises what people and community ecosystems do not have and assumes a single “right” way to address mental health. This pulls those from lower income countries into the lower levels of the same bio-medical hierarchy or pyramid within which rich countries have structured thinking and practice. This devalues (or just plain misses) the many assets and systems of care that exist in the informal health systems and cultures in Global South. “Drugs -and-psychiatrists are the only way” undermines and colonises positive practises and resources others have developed.

Our challenge is grounded in the words and knowledge of community mental health workers in Ghana, India, Palestine and South Africa who describe resources in their communities for addressing mental health issues in ways appropriate to them. We try to understand what these communities do have and how these resources emerged from the culture and political systems around them.

Forming a relevant research group

Keeping this study relevant and real, we formed a team with both community mental health ‘experts by experience’ in communities in the global south alongside mental health practitioners and researchers, making a group of 39 of us from 24 countries. We shared stories and our understandings of community mental health care and then decided to focus on the countries of Ghana, India, the occupied territory of Palestine and South Africa as we had groups of practitioners and researchers who lived and worked in each of these countries for many years.

Front and centre was the question “how do people define and care for mental health when medical or Western resources are not available?” We wondered whether people in different contexts self-organise common social systems and structures to define mental unwellness and channel community resources to those who suffer. We found common threads which we refined as a team.

Common threads in four countries

In all four countries of focus we found that families care for and nurture mentally unwell members, faith-based organisations often play significant roles of care and non-government organisations were often also important in different ways. In the big picture global economic and cultural factors and power exerted by national or international structures affect community mental health systems everywhere and we explored colonisations and neoliberal economics as two examples of these.

When we start by looking at what communities do have and how these resources have evolved we have the possibility of a win-win solution and we develop care that is relevant to that place and people. If communities are offered support and training they can give their huge cultural and language expertise to help create mental health interventions that are relevant, acceptable and more effective.

Although grounded in four specific locations we hope our study highlights how important it is to understand community-based care wherever you are. We suggest all who hope to improve community mental health start by looking positively at what people have and do themselves, take notice when social and treatment structures end up being more to benefit the professionals rather than the people who use services and change switch that and both search for and use resources that surely exist, in even the most low-income communities.

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa by Mathias, K. et al. was published in PLOS Global Public Health.