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A Multidimensional Approach to Poverty: Implications for Global Mental Health

Jean-Francois Trani and Parul Bakhshi

Introduction

Poverty and mental disorders[1] have been shown to interact in a cyclical process (Lund et al. 2011). People with mental disorders are often marginalized in low- and middle-income countries (LMICs) and fall through the gaps of international development efforts (De Silva 2015; World Health Organization 2010). Mental disorders represent an increasing contributor to the global burden of diseases; there was a 68% increase in the number of deaths between 1990 and 2010 (Lozano et al. 2012). There is agreement that the unmet needs of hundreds of millions of people with mental disorders should be included in the international community target for the post-Millennium Development Goals agenda (Thornicroft and Patel 2014). The United Nations working group on the new Sustainable Development Goals (SDGs) has indeed included mental health and wellbeing in SDG #3.4.

Yet, evidence of a link between poverty and mental disorders is scarce and few studies have investigated the direction of the relationship between mental illness and poverty in LMICs. Research has explored whether poverty increases the risk of mental disorders—the social causation pathway—or whether people with mental disorders are at greater risk to fall into or remain in a state of poverty—the social drift pathway. Studies reflecting a social causation pathway investigate if poverty increases the risk of mental disorders through discrimination and social exclusion, violence, stress and anxiety, malnutrition, poor health status and increased obstetric risks (Das et al. 2007; Khan et al. 2008). According to studies exploring the social drift pathway, increased health expenditure, reduced productivity, stigma, unemployment and low income increase risk of poverty among persons with mental disorders (Perese 2007; Trani et al. 2015). Evidence from systematic reviews conducted by Lund et al. (2011) concluded that, although some asset promotion initiatives demonstrated some potential benefit, poverty alleviation interventions had an inconclusive effect on mental disorders. On the other hand, interventions addressing mental disorders were related to improved economic outcomes in all studies. The review brought to light the variations in definitions of poverty as well as in the methods and tools that were used to assess Common Mental Disorders (CMD). The study also stated that some aspects of poverty (education, food insecurity, social class, socioeconomic status and financial stress) seem to be more strongly related to CMD than other (income, employment and consumption). Going beyond the one-dimensional analyses that seek to establish links between one aspect of poverty and CMD, in this chapter we strongly argue that poverty needs to be reframed within specific contexts as a multidimensional phenomenon. Poverty is not merely defined as lack of income but is also characterized by deprivation of education, healthcare, food intake, shelter, employment, social status, citizenship, physical safety and psychological wellbeing among others. Deprivation thresholds thus can be set with relevance to the population considered. We further argue that in order to better grasp the complex relations between poverty and mental disorders, psychological and social factors (social exclusion and stigma and self-esteem) need to be considered to decipher both the social causation and social drift pathways.

To investigate the link between mental disorders and multidimensional poverty, the authors draw on their research about developing innovative ways of defining and measuring poverty in three different countries (India, Nepal and Afghanistan). This body of research follows the Capability Approach (CA) of Amartya Sen and Martha Nussbaum (Nussbaum 2000; Sen 1985) and aims at demonstrating the need for more contextually sensitive multidimensional measurements of poverty to be employed in Global Mental Health-related initiatives. We offer a unique perspective of measuring poverty based on a choice of dimensions, indicators and weighting schemes that tailor the measurement of poverty to the local context. Most existing studies measure the same indicators across countries, which can serve to facilitate international comparison, but may serve to inhibit a deeper understanding of what dimensions of poverty are of concern to specific social groups in a given context. In the absence of such context-specific measures, mental health interventions are defined broadly and risk excluding some groups of people with mental disorders. Furthermore, it may be that the services that are available are not appropriately adapted to meet the needs of the people in that context.

  • [1] I n the present chapter, mental disorders refer to mental illness diagnoses, learning or intellectualdisability. J.-F. Trani (*) George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA P. Bakhshi Department of Occupational Therapy and Surgery, Washington University,St. Louis, MO, USA© The Author(s) 2017 R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectiveson Global Mental Health, DOI 10.1057/978-1-137-39510-8_19
 
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