The roads less traveled: Mapping some pathways on the global mental health research roadmap

Abstract

The global mental health (GMH) research agenda should include both culture-general and culture-specific perspectives to ensure ecological validity of findings. Despite its title, the current GMH research agenda appears to be using a monocultural model that is individualistic, illness-oriented, and focused on intrapsychic processes. Ironically, issues of culture are prominently absent in many discussions of global mental health. This paper highlights some issues and concerns considered key to conducting ecologically valid and socially responsible GMH research. The concerns are particularly directed at researchers from dominant cultures who are working in low-income countries. Central to these issues is the balance between etic and emic perspectives in assessment, diagnosis, and intervention, as well as language, engagement of stakeholders and their agendas, and evaluation of the benefit of interventions to the community. New terminology is proposed that identifies broad cultural groups, and recommendations provided for a research agenda to encourage both basic and applied research that mutually benefits all stakeholders in the GMH research endeavor.

Toward a new architecture for global mental health

“…Estimates of the prevalence and burden of mental health problems in low and middle-income countries and regions of the world are based on limited data and uncertain or questionable extrapolations that may lead to inflated or misleading figures (Summerfield, 2008; for an overview of current methods, see : Murray & Lopez, 2013); 2. social inequalities, poverty and unemployment, structural violence, war and conflict on both local and global scales are far more important determinants of mental health outcomes than the types of problems recognized in conventional epidemiological studies (Geneva Declaration Secretariat, 2008;Lund, et al, 2010;Wilkinson & Pickett, 2006); 3. framing the disparities in terms of a treatment gap privileges mental health services and interventions by mental health professionals and ignores or downplays community-based and grassroots approaches (Fernando, 2012;Sax, 2014); and 4. evidence-based practices developed in Western countries may not be culturally appropriate, feasible, or effective in other contexts (Kirmayer, 2012). Moreover, the demand to scale up evidence-based practices may predetermine the types of intervention available since it may be much easier to provide medication or simple, standardized behavioural interventions, than to conduct more complex psychosocial interventions (Jain & Jadhav, 2009;Kirmayer & Swartz, 2013;Swartz, 2012).…”

Global Mental Health: concepts, conflicts and controversies

“…This suggests that traditional modalities of healing involving the family, social normalisation and spiritual approaches may play an important role in recovery. However, spirituality, traditional healers and traditional healing approaches are generally absent in the GMH literature and agenda, which focuses on neatly packaged Western-derived pharmacology or psychosocial interventions (Fernando, 2012). This relates to another critique.…”

Principles of epistemological accountability with methodological implications for measuring, assessing, and profiling human resilience

“…Gaithri Fernando's (2012) contribution to the same special issue illustrated the points made by the editorial. Herself a psychologist, Fernando illustrated her main argument by presenting the results of her quick search of PychINFO database (a database where predominantly psychology journals are indexed/catalogued) using the phrase "research agenda" as a search term with and without adding the term "culture."…”