Are Alternative Forms of Support Being Neglected?
It is suggested that the WHO and the MGMH fail to consider how efforts to ‘scale up’ mental health services may serve to undermine or subjugate local understanding and forms of support (White and Sashidharan 2014a). Across the world, a multitude of ‘alternative’ systems of healing exist that reflect different worldviews and have shaped understanding about the distress that people experience. For example, a broad range of ‘indigenous’ or ‘traditional healing’ systems exist (Davar and Lohokare 2009) which have predated the development of psychiatry as a specific branch of medicine. Some forms of support however have developed as alternatives to, or in opposition to, psychiatry. In the Global South, examples of this include the work of Bapu Trust (in India), and the Pan African Network of People with Psychosocial Disabilities (PANUSP) (South Africa). These organizations advocate locally relevant healing, such as meditation and drumming, alongside peer support, and understand people who experience distress as the ‘experts’ (PANUSP 2011/2014). They are among a growing number of user/survivor organizations that explicitly develop alliances with international user and survivor organizations, such as the World Network of Users and Survivors of Psychiatry (WNUSP), Mental Health Worldwide, and MindFreedom International. Alongside this, several organizations throughout the Global North provide advocacy, support, and alternative treatment approaches, such as the Hearing Voices Network, the
Soteria Network, and the Icarus Project, and are increasingly establishing links with partner organizations in the Global South.
Rather than focusing specifically on psychiatric diagnoses and treatments that may not be valid or desirable in LMICs, White and Sashidharan (2014b) propose an alternative approach in which social problems linked to difficulties with the emotional well-being of people in particular locations are targeted. Specifically addressing these social problems (e.g. marginality, gender-based violence, substance use, stigma associated with HIV/AIDS) may provide an opportunity to utilize bottom-up approaches to understanding and addressing emotional distress that are informed by effective forms of support that have traditionally been used to alleviate this distress. They suggest this will maximize the extent to which interventions will be shaped by local priorities and be bought into by local stakeholders.
A key issue relating to GMH discourse is the lack of reciprocity regarding the onus on LMICs compared to HICs to implement change in mental health policy and practice (White and Sashidharan 2014b; Procter 2003; White et al. 2014). Traditionally, the transfer of knowledge about mental health has been unidirectional. This has served to downplay the need for critical reflection on how mental health difficulties are understood and addressed in HICs. For example, Collins et al. (2000) reflect on how the experience of developing countries might influence reform within the National Health Service in the UK, concluding that ‘while the (global) South can learn from the (global) North, so too can the North from the South’ (p. 87). For example, it may be that mental health services in HICs (such as the UK or USA) could better engage with migrant populations by being more sensitive to the diversity of beliefs and practices associated with their distress. In addition, McKenzie et al. (2004) previously highlighted important lessons that HICs can learn from LMICs in terms of models for the provision of mental health care. White et al. (2014) highlight, however, that rather than restricting the analysis to models of care provision, there is a need for critical reflection on the assumptions and rationale that underlie models of explanation advocated in HICs.
A greater willingness to embrace alternative ways of conceptualizing mental health difficulties, pluralistic methods of support in HICs, and ‘counterflows’ of knowledge from LMICs to HICs, may facilitate people to engage with forms of support that they believe to be appropriate for them (White et al. 2014). Mindfulness, a practice aimed at facilitating non-judgmental present moment awareness, provides an example of a counterflow. Mindfulness has its roots in meditative practices used in Buddhism. Over the last 25 years, writers such as Jon Kabat-Zinn and Thich Nhat Hanh have helped to promote mindfulness as a way of enhancing well-being, and it is now widely used for treating a range of mental health difficulties in HICs (Germer et al. 2013). There are accounts of reciprocal mental health and well-being work being done between countries of the Global North and South, for example, between Canada and Cameroon (Suffling et al. 2014). However, it should be noted that the discrediting of alternative and indigenous forms of healing is also a daily reality in some countries of the Global South where mental health care is dominated by bio-psychiatry (Jain and Jadhav 2009). For example, in India, it is reported that alternative forms of healing are increasingly ‘vanishing’ (Davar 2014).