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Saturday, November 21, 2015

Defining Global Mental Health

Global Mental Health & Psychiatry Newsletter

Global Mental Health Forum


Prof. Vincenzo Di Nicola, MPhil, MD, PhD, FAPA
Université de Montréal


Defining Global Mental Health & Psychiatry


Issue: What is Global Mental Health & Psychiatry?

Forum Question: Is there an emerging consensus for re-visioning mental health and psychiatry in a global way that includes social concerns, recognizes cultural diversity, and embraces the mission of public health, comparing mental illness across cultures and around the world?

A metaphor for health: If we imagine health as a river winding around the world, there are tributaries which feed into the larger river, which flows into the sea.

The river of health and its tributaries:

* Medicine and well-being is the river
--“Global Health & Medicine” is its name
* Psychiatry is a tributary, with many rivulets: 
--Social Psychiatry
--Transcultural or simply Cultural Psychiatry (Lim, 2006)
--HBM Murphy (1982) of McGill defined this field as Comparative Psychiatry, “the international and intercultural distribution of mental illness”
* Public Health and Epidemiology are tributaries

In this view, Global Mental Health & Psychiatry is the emerging term for the tributary that collects all the rivulets (e.g., Social Psychiatry, Cultural Psychiatry, and Public Health) merging into the river of Global Health & Medicine (Cf. Okpaku, 2014; Sorel, 2012).

These rivulets and tributaries represent broader envelopes or contexts for psychiatry than more narrowly-defined disease-specific (e.g., mood disorders, eating disorders), age-specific (e.g., child, geriatric psychiatry), or intervention-specific (e.g., by therapeutic approach – psychodynamic psychiatry; or by activity – consultation-liaison psychiatry, integrated care) approaches.  


Challenges for GMH:

1.     Re: “Global”

Why does global mean?
(Cf. Okpaku, 2014; Sorel, 2012)
A global – i.e., “general” – approach?
A globally “embracing” approach, collecting and integrating approaches, schools, and traditions?
Global as in “worldwide” – in a democratic way or an imperialistic way?
(Cf. Ethan Watters, Crazy Like Us, 2011)

2.     Re: “Mental Health” vs. Psychiatry

Why mental health instead of psychiatry?
Marketing (health is more appealing than illness or “disorder”)
vs. identity (as physicians)

3.     Who is invited/feels welcome under this new umbrella?

Psychiatrists? Psychologists? The therapeutic communities of practice?
Public Health and Epidemiology?
Social scientists?
Policy makers?
Legislators?
Client groups?


References

Lim, Russell F. (2006). Clinical Manual of Cultural Psychiatry. Washington, DC: American Psychiatric Publishing, Inc.

Murphy, H.B.M. (1982). Comparative Psychiatry: The International and Intercultural Distribution of Mental Illness. Berlin: Springer-Verlag.

Okpaku, Samuel, Ed. (2014). Essentials of Global Mental Health. Cambridge, UK: Cambridge University Press.

Sorel,  Eliot, Ed. (2012). 21st Century Global Mental Health. Burlington, MA: Jones & Bartlett.

Watters, Ethan (2011). Crazy Like Us: The Globalization of the American Psyche. New York: Free Press.

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