Decolonizing mental health services
Decolonizing mental health services
Husna Ara writes about the ways we answer the problem of mental health.
A man in a therapist's office is looking out of a window at nature. Illustration by Andy Carter
About 75 per cent of suicides are from low and middle-income countries. The World Health Organisation’s solution to this terrible fact is to make it easier for people to get drugs like anti-depressants. In Strangers to Ourselves Rachel Aviv says the problem with this solution is that modern psychiatry doesn’t help illnesses that come from the marginalisation and oppression of people for generations. And he said that if we recommend drugs and not local or alternative therapies, it makes people think that they are the cause of the social problems.
This idea is very popular. Loren Mosher was the head of the American Psychiatric Association. In 1998, he resigned and said that the drug companies had bought out psychiatry almost completely and that psychiatry no longer tried to understand people as part of their social situations. The US Diagnostic and Statistical Manual of Mental Disorders took this idea to the Global South. But the World HO’s Global Mental Health Movement (MGMH) speeded up the idea when it tried to stop local therapies and said they made no sense.
China Mills writes about the fast growth of suicides in Indian farmers in debt. ‘Farmers write suicide notes to the government talking about their impossible lives after changes in agriculture. But the World Health Organisation’s Global Mental Health Movement wants to make it easier for farmers to get anti-depressants’.
People in distress are in a very difficult situation. The system relies on the overuse of drugs for profit and putting people into psychiatric hospitals like prisons. To change that is not easy. And for people to get good mental health support can be difficult or impossible. We see places including Ghana, India, and the Czech Republic using solitary confinement, electric shock without an anaesthetic, and caged beds. The World Network of Users and Survivors of Psychiatry is one campaign working to make stronger the international Convention on the Rights of Persons with Disabilities. It says that using pain as a treatment may be against international law.
The changes need to go further than Asia and Africa and into the Global North where the science has no answer to distress from oppression such as racism. For non-white people, the risk of mental illness increases the whiter the community they live in.
As Rachel Aviv says, a new mental health system must try to describe people’s mental life in their own way and not through ‘a list of symptoms’ found in the Diagnostic and Statistical Manual of Mental Disorders. But there are signs of change. In the US, the Black Panther Party’s remote ambulance service inspired the Anti Police-Terror Squad. ‘Mental Health First’ works to send help to Black people with serious mental health problems and not violent policing.
Organizations such as the Centre for Mental Health Advocacy at Bapu Trust, India, are working with people in distress to give them knowledge and understanding. Aviv says, ‘Counsellors at Bapu Trust helped families to understand their own experiences of illness. They don’t use language that seems to come from a different idea of the self.’ China Mills says this work helps patients to find support from traditional healing centres. Before local State governments forced them to go to psychiatric hospitals for drugs. There are also some hopes of answers to treatment for intergenerational trauma. Gardner Health Services in California were treating survivors of the genocide by the Khmer Rouge in Cambodia. They found that helping patients to understand their own belief systems is better than a weekly appointment with a psychiatrist and the jargon and cold language of Cognitive Behavioural Therapy. In Trieste, Italy, they now include in mental healthcare doctors without uniforms, lunches for patients eating together, access to nature, culture, and patient assemblies. The city is trying to change the role of the physician with mixed results.
We cannot blame politics for all forms of menatl illness, and many people find help from the right medication. But mental health support must try to understand individual patients’ needs and their stories of suffering. We need a number of options using creative and local therapies and not only confinement and drugs.
NOW TRY THE ORIGINAL:
https://newint.org/features/2022/12/05/what-if-we-decolonized-mental-health-services
(This article is in easier English so it is possible that we changed the words, the text structure, and the quotes.)
