Poles apart: does the export of mental health expertise from the Global North to the Global South represent a neutral relocation of knowledge and practice?

Abstract

The World Health Organization's Mental Health Action Plan 2013-2020 identifies actions for all member states to alleviate the global burden of mental ill health, including an obligation for mental healthcare to be delivered in a 'culturally appropriate' manner. In this article we argue that such a requirement is problematic, not least because such pronouncements remain framed by the normative prepositions of Western medical and psychological practice and their associated ethical, legal and institutional standpoints. As such, when striving to export Western mental health expertise, different paradigms for evidence will be necessary to deliver locally meaningful interventions to low and middle income countries. Our discussion highlights a number of philosophical concerns regarding methodologies for future research practice, including those relating to representation and exclusion in the guise of epistemic injury, presumptive methodologies arising from Western notions of selfhood, and related ethical issues.

Positioning ethnicity in dementia awareness research: does the use of senility risk ascribing racialised knowledge deficits to minority groups?

“…If a certain version of awareness is imposed on people, it will undoubtedly entail unforeseen effects, and may well be irreversible (Summerfield ). One potential outcome of awareness interventions could be epistemic injustice, whereby the knowledge of less powerful groups is stripped of its credibility, and the experiences of those people are rendered meaningless (Cox and Webb ). Ultimately, when seeking to intervene in a community's psychiatric awareness, we might ask: ‘Whose knowledge counts, and who has the power to define the problem?’ (Summerfield : 2).…”

“…This means that contemporary psychiatric categories manifest their own specific cultural contexts, having been developed in certain countries via institutionalised research programmes enacted by specific groups of people. They hence reflect a certain set of Western bio‐psychiatric and legal‐ethical ideals (Cox and Webb ). This psychiatric colonialism is typically justified through the assumed rationality of certain cultures in contrast to the irrationality of others (de‐Graft Aikins et al .…”

Building Research Capacity Across and Within Low- and Middle-Income Countries: The Collaborative Hubs for International Research on Mental Health

“…Integrating services developed in high income countries with local cultures and traditions represents a formidable challenge. A critique of the transfer of services and treatments to LMICs suggests that the global mental health movement ignores the various indigenous modalities of healing practices commonly applied in other cultures [8, 9]. It is our hope that by training local researchers, we can ensure that the interventions they develop will incorporate local cultural and socioeconomic contexts.…”

Enacting disability policy through unseen support: the everyday use of disability classifications by university administrators

“…The disavowal of the voice and identity of people with mental disabilities represents an epistemic erasure and injustice and, arguably, is a feature of Westernised, bureaucratised systems which accord privilege to medical (and psychiatric) discourse (Cox and Webb 2015).…”