Global mental health: A resource map for connecting and contributing
By Kelly O'Donnell, PsyD
“But the world is not so happy a place…can we really offer justice and freedom from want to a mid-twenty-first-century earth of perhaps nine billion people, one-third of whom may live in squalor and desperation?....the only answer, as I can see it, is by trying…and not giving up.”
~Paul Kennedy, The Parliament of Man: The Past, Present, and Future of the United Nations (2006, p. 289)
When was the last time you were lost — professionally? For me, it was last year. I was trying to better understand a vast, amorphous entity that has recently blossomed into a major social movement — the multisectoral and multidisciplinary field of global mental health (GMH). I wanted to explore this strategic health domain and its priority of improving and achieving equality in mental health for all people worldwide (Vikram Patel and Martin Prince. Global Mental Health: A New Global Health Field Comes of Age, Journal of the American Medical Association 2010; 303(19): 1976).
I thought sorting out GMH would be pretty easy going, having lived and worked internationally as a consulting psychologist for nearly 25 years. But it reminded me of trying to grasp the multi-layered reality in movies like Matrix, Syriana or Inception. It was as intriguing as it was daunting. And I was not alone in this mixed experience.
Over the course of a year, I read, researched, attended conferences, listened to lectures and met with some of the GMH’s remarkable movers and shakers. I figured that if I could at least identify some recent hallmarks and some major precursors, I could begin a map of GMH.
A global map for a global movement
A first entry is to map out the resources, priorities and policies regarding global mental health. This mapping shows a large population of vulnerable people and great disparities in resources. For example, an estimated 450 million humans have some type of mental, neurological or substance use disorder, accounting for about 14 percent of the "global burden of disease." Nearly 75 percent of neuropsychiatric disorders occur in low- and middle- income countries, with the majority receiving no care. Pouring over such statistical realities from the World Health Organization (WHO) was the most disconcerting part of my GMH mapping project.
The global map for GMH is characterized by missing pieces and shifting, overlapping borders. It is analogous to a 17th century map of the earth — a cartographic work in progress just waiting to be further refined.
Touring the terrain: The 60 minute GMHer
The real voyage of discovery consists not in seeking new landscapes but in having new eyes. ~Marcel Proust
Want to get a quick overview of GMH without getting lost? Have a go at exploring this list of 10 concise resources —written and multimedia. Reviewing these materials takes about 60 minutes. This overview is also a great tool to stimulate discussion about ways to connect and contribute to GMH. These materials can also be accessed via the links in the Mental Health section.
But beware: It can be both inspiring and unsettling to journey into the core of GMH: the plight of the millions of people with mental conditions. Some courageously overcome their difficulties and lead productive lives via supportive communities and quality care. Most others though live in misery, often marked with social isolation, discrimination, human rights abuses and increased mortality.
Two initial quotes on mental health and human rights.
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community."
~World Health Organization, 2010
"All persons have the right to the best available mental health care, which shall be part of the health and social care system. All persons with a mental illness, or who are being treated as such persons, shall be treated with humanity and respect for the inherent dignity of the human person….Every person with a mental illness shall have the right to exercise all civil, political, economic, social and cultural rights…"
~United Nations General Assembly, 1991
Global video tour of GMH, WHO (2009; five minutes)
GMH overview in the British Journal of Psychiatry (2011):
• Movement for Global Mental Health
Brief article in Health Policy and Planning (2008):
• 10 Best Resources on Mental Health
World Mental Health Day (WMHD, 1992-2011), World Federation for Mental Health. Convened annually (October 10) via many events around the world, WMHD over the last two decades reflects many of the historical concerns of GMH. The 2011 theme is Investing in Mental Health. Click here to see a list of all the WMHD themes (on the NGO Forum for Health website).
Journalistic articles and personal accounts of mental conditions. Here is an example from Nepal: (Lamichhane, Jagannath (2011). An Uncharacteristic Happy Ending. The Kathmandu Post.)
Human development and vulnerable groups in GMH perspective (2010): WHO Report on Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. (See Executive Summary on pages xxiv-xxvii)
Intervention guidelines for priority conditions (2010): mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings (See the introductory materials on pages 1-8)
Video from the Banyan in Chennai, India
This is one of the many organizations that have inspired me during my research. This five-minute video about their work with homeless women who have mental disorders, is an aesthetic and encouraging reminder of the raison d‟être for our GMH efforts — improving the lives of fellow humans in dire need. For more information, please visit the Banyan website.
Charting your course: Suggestions for connecting and contributing to GMH
“The capacity to cause change grows in an individual over time as small-scale efforts lead gradually to larger ones. But the process needs a beginning — a story, an example, an early taste of success — something along the way that helps a person from a belief that it is possible to make the world a better place. Those who act on such a belief spread it to others. They are highly contagious. Their stories must be told.”
~David Bornstein, How to Change the World: Social Entrepreneurs and the Power of New Ideas (2004, p. 282).
Would more people consider GMH as a career, or as a significant part of one’s career, if the path were clearer? Definitely. Is it possible for people to get a better idea about how to access GMH-related updates and core resources? Definitely. Could GMH perspectives/practices be included more as part of health-related training programs, professional conferences, collegial interactions, and work activities? Definitely. And above all, would the wellbeing of the most vulnerable people drastically improve, as a result of the greater integration of GMH into the lives and practices of health care workers, policy makers and government leaders? Definitely! Here now are seven items to help people from a variety of backgrounds further connect/contribute to GMH.
Enjoy exploring GMH. Review GMH via reading/discussing, taking the time to explore several of the links and materials. Identify a few core newsletter updates and information places (websites) to which you want to regularly connect.
Find your GMH passion(s). What are you already interested in or involved in, such as a specific disorder, population, language group, region, organization, network, issue, service, project or media form? Stay current and focused in your area(s) of GMH passion — your "global niche."
Stretch yourself. Be prepared to expand your personal and professional GMH boundaries. Take some risks and keep growing in your GMH mindset and involvement. Follow a continuum as you plot your GMH course, reflecting the extent (breadth) of your "global stretches," from Globe-small______________ to ______________Globe-all.
Stay sane. Maintain your work-life balance and avoid being overwhelmed with the expansive and almost "multi-everything" nature of GMH. Consider a GMH involvement continuum, with its two reference points, to help identify the degree (depth) to which you want to connect-contribute to a specific area: Informed______________ Immersed
Persevere. It will take time and effort to find your flow in GMH. You may feel lost, unappreciated, or alone, at times. This is certainly true of those who do GMH advocacy or pioneer new GMH areas. It’s like learning a language — it takes time and effort and social contexts to learn it well. Don’t go alone but try to find a "caravan of colleagues" to help you on your journey.
Get involved. Join a GMH-related organization — join the Movement for Global Mental Health (MGMH). There are GMH-related social networks, blogs, websites and groups of which you can be part. Be part of World Mental Health Days in October. Introduce GMH-related items/topics into your setting. Conferences —yes! A part of a commitment to lifelong learning can be to take advantage of informal training available on line. Keep going with GMH, in spite of obstacles.
Do life well. Be open to the ongoing exploration of your lifestyle choices, values, and barriers in our own minds including fears and prejudices in light of GMH realities. Continue to explore and refine this global map as you connect and contribute to GMH. Celebrate life in spite of its hardships. I finish now with a short video to guide us further: mhGAP: Mental health care in low resource settings.
About the author:
Kelly O'Donnell PsyD, is actively involved in GMH as Coordinator of the Mental Health-Psychosocial Working Group of the Geneva-based NGO Forum for Health. He is also a consulting psychologist and the CEO of Member Care Associates, Inc. and an APA International Affiliate. Together with his wife Michèle, also a psychologist, he provides member care internationally for personal, team, and organizational health. Kelly's publications include over fifty articles in the member care field, and four books including Doing Member Care Well: Perspectives and Practices from Around the World (2002) and Global Member Care: The Pearls and Perils of Good Practice (2011). He also enjoys providing a steady stream of “reflections and resources for good practice” via the Member Care Associates websites.
1. This article is based on a longer working paper that highlights the last two decades of GMH developments. It collectively forms a "global resource map" to a) help people from a variety of backgrounds to better "navigate the GMH world" and b) consider meaningful ways to further connect and contribute. The working paper explores six overlapping GMH areas: organizations, conferences/events, publications, human rights, training and the humanitarian sector. To review the working paper and to send suggestions, contact the author.
2. All the links in this article are available in the Mental Health section.