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Global mental health: Major challenges persist, Stanford Health Policy Forum speakers say

Tackling the entire field of global mental health in less than two hours is no easy task. Yet moderator Paul Costello and speakers Vikram Patel, PhD, and Angela Garcia, PhD, managed to address some of the field's most pressing problems, and current opportunities, in a wide-ranging discussion at the Stanford Health Policy Forum -- which was sponsored by the Center for Innovation in Global Health -- yesterday.

First, Patel, a psychiatrist at the London School of Hygiene and Tropical Medicine who specializes in children's mental health, and Garcia, a Stanford associate professor of anthropology who has worked on addiction and mental health in New Mexico and Mexico City, provided a few definitions.

"Global mental health is a relatively young discipline, a child of global health," Patel said. "Its most important principle is a focus on health disparities, on reducing health inequalities both between populations but also within populations."

No longer is it simply that richer nations help the poor, he said. Instead, a coalition of governments, psychiatrists and other health-care workers, non-profits, communities and patients themselves — from both high- and low-income nations — are working together to improve the lives of the mentally ill.

Creating such truly interdisciplinary and cross-cultural coalitions is exciting, but also challenging, Garcia said, referencing her work in the informal drug treatment centers known as anexos in Mexico. "I am a little concerned that with increased professionalization we may lose some contact with the broad specialities represented... It could create greater distance between what is happening on the ground. This is an opportunity for us to exercise some caution and to think critically and expansively."

There is "a danger of losing the local as we apply the global," Patel agreed. "It is a fundmental tension... I don't think there is an easy answer."

Could technology be the solution? The disruptive thinking that characterizes Silicon Valley innovation?

Some form of disruptive thinking is needed to address the major disparties in quality and access to care, Patel said. And technology has the potential to reach people who lack access to the formal health-care system. Yet some types of technological innovations, such as many self-help apps, haven't been examined rigorously to test their efficacy, he said. Garcia said she also has reservations about the application of technology, which she emphasized cannot subsitute for human connections.

Patel said that one of the greatest challenges in global mental health is that in some nations, even patients with severe mental illnesses like schizophrenia have little access to psychotropic drugs. How can those drugs be provided — in concert with other therapies — in a cost-effective manner?

Another persistent challenge is incorporating evidence-based recommendations into governmental policies, the speakers said. "To me this is a real struggle," Patel commented. "Governments on one hand supposedly back science, but what they often do is based on ideology. I often feel that we’re swimming against the tide."

The war on drugs stands out as among the most destructive policies, Garcia and Patel agreed. In Mexico, for example, although alcoholism has been recognized as a pervasive problem, drug abuse has been overlooked, in part because acknowledging massive use of drugs in Mexico conflicts with the government's narrative that drugs end up in the United States, Garcia said. In one Indian state, the use of opioids affects one in three families, Patel said. "The government's response is continuing to criminalize both the user and the supply chain. The whole thing is absurd, completely absurd."

After reflecting on strategies for improving mental health in refugee camps, and the plight of some severely mentally ill patients who are restrained in their families' homes in India, Costello's final question made both speakers pause: "Where is the hope?"

"What is exciting about global mental health movement is the desire of young people to make a difference, to become engaged and to make a difference," Garcia said.

Patel said the growing empowement of patients is a bright spot in the field. "I think we're beginning to see people say, 'I live with schizophrenia and I have a right to live with dignity.'"

Previously: Study links air pollution with anxiety; calls it a "leading global health concern", Turning loss into hope for others: New website teaches about mental health and Full-length video available for Stanford's Health Policy Forum on serious mental illness
Photo by Norbert von der Groeben

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