Global mental health: Finding your niches and networks
By Kelly O'Donnell, PsyD
Climb traveler, or stiffen slowly on the plain. ~ Irish proverb
Kelly O’Donnell, PsyD, is a consulting psychologist based in Europe. He is an APA International Affiliate, the CEO of Member Care Associates, Inc., and Coordinator of the Mental Health and Psychosocial Working Group of the Geneva-based NGO Forum for Health. Kelly’s publications include over 50 articles in the member care field focusing on the well-being and effectiveness of mission/aid workers and their organizations. His two most recent books are Doing Member Care Well: Perspectives and Practices from Around the World (2002) and Global Member Care: The Pearls and Perils of Good Practice (2011).
This article is the second in a series exploring the domain of global mental health (GMH). The first article, "A Resource Map for Connecting and Contributing," lists 10 core materials for understanding GMH and presents practical suggestions for GMH involvement (Psychology International, July 2011). This current article takes a similar approach, offering additional materials (written and multimedia links) that reflect important aspects of GMH. The materials are organized into 10 overlapping "niche-net" areas that can be quickly reviewed. The goal is for colleagues in the health fields to relevantly participate in GMH by identifying and considering opportunities in various GMH niches and networks.
I define GMH as an international, interdisciplinary, and multisectoral domain which promotes human wellbeing, the right to health and equity in health for all. It encourages healthy behaviors and lifestyles; is committed to preventing and treating mental, neurological and substance use conditions (MNS); and seeks to improve policies and programs, professional practices and research, advocacy and awareness, and social and environmental factors that affect health and well-being. Psychology, as a vast field of practice and practitioners serving humanity, plays a central role in the GMH domain.
Niche-working and networking in GMH
Trying to make inroads into GMH can be a challenging and lonely experience. This domain is behemoth, and it is easy to get lost or discouraged in the effort to meaningfully connect and contribute. In addition, not every colleague, organization or graduate program is oriented towards global issues and global applications of mental health. In spite of our increasingly globalized world, there are many challenges that keep us focused on our own immediate, nearby "worlds." Making a living, paying off school loans, raising a family, keeping abreast with one's own field, or meeting the demands of a rigorous academic program can seriously affect living our lives as "global citizens."
Let me quickly balance the above comments with a far more influential, positive factor in light of having lived and worked internationally for 25 years as a consulting psychologist. During this time I have seen the increasing desire of mental health professionals and students around the world to be more meaningfully involved in international issues. Regardless of challenges, they want to use their training, passions, and resources to help make a positive difference in the quality of life for people. To support these growing aspirations, I recently set out on a collaborative project called GMH-Map to further orient people to GMH through publications, presentations and web-based resources1. The materials listed in this article are an example. Have a look at the 10 au courant areas below to see what interests you. Do so with others! They can help us go further into our GMH "niche-working and networking."
Niche-Net 1: Human rights. Here are quotes from two foundational instruments that describe the rights of all humans and those with disabilities, including mental conditions. The first is from the Universal Declaration of Human Rights (UNDHR, 1948, currently in over 380 languages). The second is from the Convention on the Rights of Persons with Disabilities (CRPD, 2006, currently in six languages).
"All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood." (UDHR, Article 1).
"The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others" (CRPD, Article 1).
Going further: See the website, United Nations Office of the High Commissioner for Human Rights as well as the Quality Rights project by the World Health Organization (WHO—e.g. two-page fact sheet).
Niche-Net 2: GMH overview. WHO has produced several educational videos that overview GMH facts and issues. Mental Health (2011) is a 7-minute video presenting general GMH information along with examples of mental health improvements in Jordan.
Going further: Watch the 6-minute video interview about GMH in 2011 by the Global Health Institute at Duke University. It is an interview with Vikram Patel who highlights the serious issues in GMH, shares strategies for reducing mental health gaps and argues for the global prioritization of mental health.
Niche-Net 3: Updates. The Movement for Global Mental Health (MGMH) is a premier network connecting the diversity of GMH colleagues. It was launched in 2008 and currently has nearly 100 institutional members and over 1,800 individual members. The MGMH compiles regular newsletters with updates and information and offers various resources on its web site. Have a look through the listed news items to get a feel for what is happening in GMH.
Going further: Stay in touch via the newsletter-updates from the WHO's mhGAP Programme and the news stories from the World Federation for Mental Health.
Niche-Net 4: GMH research. Two recent publications that reflect cutting edges of research are the Grand Challenges in Global Mental Health (Nature, 7 July 2011) and the Lancet's second series on GMH (17 October 2011). The "Grand Challenges" article is four-pages and worth a careful read, noting especially the chart which identifies 25 research priorities for GMH (e.g., integrating mental health into primary health care, reducing cost and improving supply of effective medications, providing community-based care, improving children's access to care in low-middle income countries, and strengthening mental health training for all health personnel). The Lancet's special GMH issue has six articles summarizing research on mental health and poverty, child and adolescent mental health, mental health in humanitarian settings, scaling-up mental health services, human resources for mental health and human rights.
Going further: Read the Executive Summary of the WHO Mental Health Atlas 2011 (pp. 10-11) on how mental health resources internationally continue to be "insufficient, inequitably distributed, and inefficiently utilized." There is also a 7 minute podcast interview/transcript about the findings.
Niche-Net 5: Humanitarian and developmental assistance. Prioritizing Mental Health in Development Aid Programs (2010) by the Global Initiative on Psychiatry is a six-page overview for "improving psychosocial and mental health care in transitional and developing countries."
Going further: Read the Development and Maturation of Humanitarian Psychology article in the American Psychologist, November 2007 (link is for abstract only). See also The Sphere Project: Humanitarian Charter and Minimum Standards in Humanitarian Response (2011) that includes mental health assistance in emergency-humanitarian settings (pp. 333-336).
Niche-Net 6: Training. The Centre for Global Mental Health (CGMH) in London is launching a Masters of Science course in GMH, the first of its kind, in association with the London School of Hygiene and Tropical Medicine and the Institute of Psychiatry. In addition, a special GMH module can be incorporated into a person's current masters program, and there are opportunities for doctoral research related to GMH. See also the summary on Internationalizing Psychology Education (Monitor on Psychology, July 2008).
Going further: Review the Training and Education and the Capacity Building Atlas sections on the MGMH website. More examples of training include the international mental health courses at the University of Melbourne's Centre for International Mental Health and GMH-related presentations at conferences such as the Annual APA Convention and the International Congress of Psychology.
Niche-Net 7: GMH advocacy. Two good examples among many recent advocacy efforts are the Cape Town Declaration (2011, one page) by the Pan African Network of People with Psychosocial Disabilities and the Joint Statement on Mental Health and the Scope of Noncommunicable Diseases (2011, two pages) prepared by the NGO Forum for Health (Geneva) and the NGO Committee on Mental Health (New York) for the United Nations General Assembly's High-level Meeting on Noncommunicable Diseases (19-20 September 2011).
Going further: To get a better sense of the global issues and power structures that influence human health, see the summary and materials from the 2010 workshop on Democratizing Global Health Governance, organized by Global Health Watch and other international organizations.
Niche-Net 8: Personal stories. Patient Voices is a special part of the Health section in the online New York Times with audio and photos or people discussing their experiences with chronic diseases and mental health conditions. Listen to the short personal accounts.
Going further: Have a look at the stories from around the world in the Mental Health-Global Faces section of the NGO Forum for Health website.
Niche-Net 9: Resources for practitioners and consumers. Psychological First Aid: Guide for Field Workers (2011) is an international effort to provide helpful principles to help people support those affected by distressing events. Reading through the table of contents will give you a good idea of the approaches used and looking over the three case scenarios at the end provides a good sense of how psychological first aid can be applied in natural disasters, violence, displacement, and accidents. See also the Universal Declaration of Ethical Principles for Psychologists consisting of four broad principles and values related to each principle. The four principles are: respect for the dignity of persons and peoples; competent caring for the wellbeing of persons and peoples; integrity; and professional and scientific responsibility to society.
Going further: The National Institute of Mental Health is one of many organizations offering materials on mental health for the general public, including their four-minute video on major depression (symptoms, help, neuroscience research). Other examples based in the USA are Athealth, National Empowerment Center, and National Alliance on Mental Illness.
Niche-Net 10: Media matters. Madness Radio has over 125 archived radio programs online for free. The programs are diverse both in the subject matter and the perspectives shared on mental health. One example: Listen to the personal story and comments by Dr. Daniel Fischer, a psychiatrist who recovered from schizophrenia and has helped to develop the consumer survivor movement (aired 1 August 2011).
Going further: To explore the broader context for GMH involvement, watch a promotional video for the International Day of Peace on the homepage for APA‘s Division of Peace Psychology as well as the United Nations Year in Review from the United Nations News and Media Department.
Staying the course in GMH
I want to encourage all of us in the various health fields to take the time to explore the GMH domain. A great way to do this is by reviewing the materials in this short article to identify niches — relevant areas of focus — and networks — supportive groups of colleagues — for going further into GMH. GMH involvement is not always easy. Persevere as you seek to connect and contribute, knowing that GMH involvement is part of a lifelong journey that many mental health professionals around the world are undertaking together.
Seek to integrate GMH materials into: training curriculum, coursework, and research at academic institutions 2; topical themes, presentations and interest groups at conferences; your areas of professional practice; and above all, as part of a lifestyle that reflects commitments to equality, justice and well-being for all. Ultimately GMH is not about our own fulfilment but about the fulfilment of others. It is about resolutely rallying on behalf of vulnerable people and populations around the world such as the estimated 450 million people currently struggling with MNS conditions, often exacerbated by stigma and discrimination, poverty and despair, and inadequate resources to help. Through it all, diligently maintain your work-life balance as you stay the course in GMH. Celebrate life in spite of its hardships. Climb, don‘t stiffen on the plain!
This article is part of a collaborative project to research, organize and share important GMH resources. The project includes articles, presentations at conferences and courses and a website (GMH-Map). The principle article for the project is currently submitted for publication and is to be posted on the website. It extensively highlights materials from the last two decades of GMH developments via a "resource map,"organizing the materials into six categories: organizations, conferences/events, publications, training, human rights, and the humanitarian sector.
Many people with GMH interests are clustered at schools/departments of public health, international health or medicine at particular universities (e.g., U.S. examples: Johns Hopkins University, Bloomberg School of Public Health; Columbia University Mailman School of Public Health; Harvard Social Medicine Department and the School of Public Health; and the Global Health Institute at Duke University). Currently health professionals and graduate students usually need to connect with such academicrelational clusters having a strong global emphasis, especially in mental health, as a key way to pursue more training, research, and future career opportunities in GMH. I strongly believe that the academic-professional psychological community must also intentionally offer GMH training.