Scholars take a global approach to mental health
Rotary clubs and districts support study in an emerging field
As the world becomes more connected, experts increasingly view social issues from a global perspective. That’s true even when it comes to our minds. The emerging discipline of global mental health explores how different countries diagnose and treat psychological issues.
Rotary clubs and districts have recently sponsored four students to study global mental health at King’s College London and the London School of Hygiene & Tropical Medicine. Here, these scholars discuss the social trends, cultural practices, and political and economic contexts that affect our mental wellness – often without us realizing it.
Sponsored by: the Rotary Club of Chiswick & Brentford, Greater London, England; District 6860
I had no idea that global mental health was its own field until I found this master’s program. It’s focused on public health and incorporating cultural awareness and cultural differences into medical practices. I’ve learned that there’s so much variability in mental health conditions. A condition will have different symptoms depending on where you are in the world.
People’s perspectives of mental health issues are also totally different. For example, there are a lot of countries where they wouldn’t refer to “depression” or “anxiety.” If you say, “We’re going to treat your depression,” they won’t really know what you’re talking about. And it’s not just the words – it’s an entirely different conceptualization. I read about a woman in India who was hearing voices. In the Western conceptualization, she would have had schizophrenia. But in her culture, hearing voices was linked to spirituality.
We also focus on working within the mental health infrastructure in low- and middle-income countries. Many countries have little access to mental health specialists. Very often, community health workers are used instead. They’ll be members of the community who are trained to deliver low-level interventions. A great example of this is Friendship Bench in Zimbabwe.
Sponsored by: the Rotary Club of Leytonstone and Woodford, Greater London, England; the Rotary Club of West U (Houston), Texas, USA
When I started college, I thought I was going to be a surgeon. But then I worked as a peer mental health counselor. As I spoke with my friends and classmates about topics like depression, anxiety, alcohol use, and so forth, it became apparent that there was a big gap between what was being done for students and what was needed. There was a lot of untreated and undiagnosed mental illness, even at a prestigious university. I became interested in a more public health–focused approach to mental health.
In the global mental health program, we learned how important cultural and societal perspectives are to mental health. High blood pressure in someone in eastern China is (to a large degree) biologically similar to high blood pressure in someone in southern Mexico. But mental health is very, very much tied to cultural beliefs and expectations – even attitudes about gender, age, and so on. You really can’t do a good job of addressing mental health without understanding the cultural context.
I’m currently working as a psychiatrist in Boston. I see patients one-on-one in my office. I try my best to integrate patients’ other relationships into the care I provide, but the model really is “one patient [with] one doctor.” One step beyond that is the family approach. In collectivist cultures, family is a bigger part of the picture. And even beyond that are places where there’s a bigger sense of family – where your whole community, or neighborhood, is one family. That expands the number of relationships that can play into someone’s mental health.
Sponsored by: the Rotary Club of Osaka Central, Osaka, Japan; the Rotary Club of Pall Mall, Greater London, England
Global mental health is about looking for the social determinants of mental health. Before I came to London to study global mental health, I was working for the Ministry of Health in Japan, focused on suicide prevention. We need to study suicide, but comparatively few people are interested in it. The number of suicides in the population is increasing. Around the world, 700,000 people die by suicide every year. In Japan and America, it’s a very big problem. Working for the Japanese government, I realized that the policy was mostly to ignore the situation.
People don’t really understand the social determinants of mental health. We tend to think suicide is rooted in individual experience, such as a person thinking they don’t have enough to contribute to the world. But there are so many social and economic factors involved, such as the overall political situation. The environment is very influential when it comes to individual well-being.
My research is focused on economic uncertainty. If I can find the relationship between that and the suicide rate, maybe I can influence policymakers to see that they should try to keep the economic situation stable.
Sponsored by: the Rotary Club of The North Downs, Kent, England; District 6000 (Iowa, USA)
It was at the University of Iowa that I was introduced to the concept of global health in general, in a lecture by [professor and global health advocate] Paul Farmer. His organization, Partners In Health, had just built a hospital in Mirebalais, Haiti, following an earthquake. I became captivated. I began focusing on questions like, “How do different communities see the concept of healing? What do they do about it? And how can I help?”
The vast majority of mental illness is inherently structural. That means that our experience with the world and with one another cannot be extricated from much larger forces. Poverty is huge. Imagine the mental weight of providing for yourself and your family on less than a dollar a day. Say you spend most of your days worrying about, “Where am I going to get food? How am I going to take care of my loved ones?” That feeds into your stress hormones, connecting your brain to your body.
I don’t think psychiatrists are the people who are going to change the mental health movement on a global scale. I was one of two psychiatrists, or psychiatrists-to-be, in the global mental health program. The others were social workers, case managers, psychologists, researchers, nurses. I think psychiatry has a very small role to play in this. There is a time and a place for antidepressant medications, but having a life well lived? That comes from people. It comes from community.