Equitable and sustainable funding for community-based organisations in global mental health

Larrieta, June; Wuerth, Milena; Aoun, May; Bemme, Dörte; D’souza, Nicole A.; Gumbonzvanda, Nyaradzayi; Esponda, Georgina Miguel; Roberts, Tessa; Yoder-Maina, Angi; Zamora, Emilia; Qureshi, Onaiza; Giacaman, Rita

doi:10.1016/s2214-109x(23)00015-3

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…The current funding landscape in GMH evolves around processes and priorities set by funders in the global North, which are insufficiently attuned to local realities at the community level. This pod produced a commentary published in the Lancet Global Health, advocating for more equitable partnerships between funders and community organizations [ 39 ].…”

Section: Outcomes: What Did We Learn From Each Other? What Difference...mentioning

confidence: 99%

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Bemme

Roberts

Ae-Ngibise

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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Purpose Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. Methods We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. Results Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. Conclusion Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.

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Section: Outcomes: What Did We Learn From Each Other? What Difference...mentioning

confidence: 99%

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Bemme

Roberts

Ae-Ngibise

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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View full text Add to dashboard Cite

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“…Applied in a global context, co-production and participatory methods also seek to shift epistemic power away from academics and funders in the Global North and to generate priorities tailored to the needs of communities (Burgess & Choudary, 2021; Larrieta et al, 2023). However, the risk here is that lived experience and recovery narratives, as they become increasingly mandatory for funding (Gatera & Singh, 2023), are co-constructed with the organizations’, funders’ and anticipated audiences’ idea of recovery in mind, which can have negatively impact service users (Kaiser et al, 2020).…”

Section: Making Middle-groundsmentioning

confidence: 99%

Contingent universality: The epistemic politics of global mental health

Bemme

2023

Transcult Psychiatry

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The field of global mental health (GMH) has undergone profound changes over the past decade. Outgrowing its earlier agenda it has performed a reflexive turn, broadened towards a social paradigm and developed new modes of knowledge production, all of which reshaped ‘mental health’ as a global object of knowledge and care, and the epistemic politics of the field. Drawing on long-term ethnographic fieldwork among GMH experts and recent agenda-setting publications, I discuss how GMH advocates and critical observers alike have created conceptual and practical middle-grounds between different forms of mental health knowledge – across culture, epistemic power, lived experience, policy platforms and academic disciplines – framing their dynamic encounters as dialogue, adaptation, participation, co-production or integration. Ultimately, I argue, GMH today is focusing less on establishing mental health as a universal problem than on managing its inherent multiplicity through alignment and integration across different bodies of knowledge. Global knowledge, so conceived, is fluid and malleable and produced in open-ended knowledge practices, governed by what I call ‘contingent universality’. It is not new that the concepts and practices of the psy-disciplines are malleable and multiple, internally and externally contested, rapidly changing over time and not easily transferrable across space. What is new is that within the increasingly heterogenous epistemic space of GMH, these features have become assets rather than liabilities. GMH knowledge achieves both global reach and local relevance precisely because ‘mental health’ can be many things; it can be expressed in a wide range of idioms and concepts, and its problems and solutions align easily with others, at many scales. These fluid and integrative knowledge practices call for renewed empirical, critical and collaborative engagement.

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“…As GMH policy pushes for a renewed shift from specialised institutions to community-based services, a closer context-based conceptualisation of the role of communities in mental health care is central. Communities are often defined by physical geography, constituting the boundaries of the space within which services are delivered, as in the concept of ‘going to the community’ [ 19 , 48 ]. While they are assumed to share values, in practice, communities of place may include considerable diversity, presenting challenges to simplistic harvesting of community resources for mental health care.…”

Section: Introductionmentioning

confidence: 99%

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa

Mathias,

Bunkley,

Pillai

et al. 2024

PLOS Glob Public Health

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Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a ‘deficit model’. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in ‘informal’ community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.

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Equitable and sustainable funding for community-based organisations in global mental health

Cited by 5 publications

References 8 publications

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning

Contingent universality: The epistemic politics of global mental health

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa

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