Member Care and Lausanne 3: Blog Four

Global Mental Health
and Unreached People Groups

The Lausanne 3 Conference brought together some 4000 people this past October in South Africa. Here are excerpts from one of the seven MCA blogs at the Global Conversation portal at Lausanne 3.

The main question of this particular blog:
How do mental disorders affect those in Unreached People Groups--and other vulnerable groups? Is the mission/aid community, like other social sectors and governmental bodies, focusing adequate resources on identifying and helping the millions of people who struggle with psychological conditions? Yes, No, or Probably?!

“Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
World Health Organization, October 2009 http://www.who.int/features/factfiles/mental_health/en/index.html

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Mental disorders: What exactly are the issues, who has the responsibility to help, and what has been done and can be done? Have a look at these statistics as well as the resources below from the World Health Organization (WHO). See also our 20 March 2010 entry on Well-Being for All.

Global Mental Health Statistics—The Quick Overview

**According to WHO, mental, neurological, and substance use disorders “are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected—75% in many low-income countries—do not have access to the treatment they need.” (WHO, launch of the mhGAP program)

http://www.who.int/mental_health/mhgap/en/index.html

WHO estimates (2002):

• over 150 million have depression

• 25 million have schizophrenia

• 50 million have epilepsy

• over 100 million have drug or alcohol use disorders

• over one million suicides/year.

**In addition, “people with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are the cause of staggering economic and social costs.” (WHO Department of Mental Health, The Bare Facts).

**Ten Facts on Mental Health (click link for a quick overview)

http://www.who.int/features/factfiles/mental_health/en/index.html

Some Core Resources—The Big Picture

**The WHO Report on Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. “The WHO report demonstrates that people with mental health conditions are vulnerable – not because of any inherent weakness, but as a result of the way they are treated by society. It illustrates how people are not only missed by development programmes, but can be actively excluded from these programmes, this despite the fact that an explicit goal of development is to reach the most vulnerable. It also presents a number of evidence-based strategies which are known to improve development outcomes for persons with mental health conditions and all vulnerable groups. The WHO report is a call to action to all development stakeholders – multilateral agencies, bilateral agencies, global partnerships, private foundations, academic and research institutions, governments and civil society – to focus their attention on mental health. By investing in people with mental health conditions, development outcomes can be improved.” (Dr. Michelle Funk, WHO Department of Mental Health and Substance Abuse)

**The mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings is a technical tool developed by WHO to help health care providers who are non-specialists manage primary conditions like depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints. It is a model guide to be adapted for national and local needs.

**Integrating Mental Health into Primary Care: A Global Perspective is a special report by WHO/Wonca on how mental health has been integrated into primary health care systems in different countries (e.g., India, Iran, South Africa, Brazil). The report also outlines skills needed to help people with mental disorders.

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Reflection and Discussion

1. Based on the opening video and your own perspectives, whose responsibility is it to help those in “Unreached People Groups” who struggle with various mental conditions?

2. Can a focus on mental health conditions, like other major areas of human need, be a distraction from the more “spiritual” emphasis of mission and the more physical emphasis of aid? Or can mental health needs get lost between these two emphases? What do you think?

3. Share an observation or a practical example about how mental health, as defined by the WHO towards the top of this entry, has been practically integtrated into mission/aid work.

Culture and Diversity in Member Care—Part 7

International Cases:

Understanding the Diversity of Disorders

The Captive Robin, John Anster Fitzgerald, c.1864

Up the airy mountain, down the rushy glen,

We daren’t go a hunting, for fear of little men.

Wee folk, good folk, trooping all together;

Green jacket, red cap, and white owl feather….

By the craggy hillside, through the mosses bare,

They have planted thorn trees, for pleasure here and there.

Is any man so daring, as dig one up in spite,

He shall find their sharpest thorns, in his bed at night.

The Fairies by William Allingham (1824-1889)

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Elves, spooks, dwarves, demons, spirits, faeries, jinns, and all kinds of other-worldly creatures. The folklore of people around the world—and their serious belief systems too—are filled with them. Some of these entities are seen as elusive, playful, and mostly benign; others are viewed as noisome pranksters whose mischief interferes with one’s work and life; and still others are seen as malignant predators who can destroy people and thus need to be avoided or placated on a regular basis.

In member care, as in life, we want to promote understanding, respect, and competency regarding human diversity and cultural variation. Yet how far do we go when someone’s belief system significantly contrasts with our own worldview, scientific approach, and understanding of the development and resolution of human health issues? In some cases we can find some sturdy common ground (e.g., seeing sadness as being related to hard experiences). In other cases though the only common ground is quicksand (e.g., an acute life-threatening bout of appendicitis or cerebral malaria being related to the evil eye and needing to be treated via a potion or talisman.)

As the culture-bound syndromes and international case studies below indicate, people from so many cultures do in fact attribute their “visible wellbeing to invisible beings” along with nasty curses and a host of other ideas which baffle our understanding of “cause and effect” (e.g., shenkui in China involves marked anxiety or panic accompanied by semantic complaints in males, attributed to excessive semen loss.) Many cultures still view human health, including the origin and cure of problems then, as inextricably influenced by a supernatural or at least paranormal world.

Ready to be stretched in your understanding of mental health in different cultures? If so, tighten your belts, unpack your conceptual bags, put your conventional member care tools temporarily in the file cabinet, and try to get a hold of (and grasp!) the “unusual” materials from the sources below!

Or if you can’t wait to locate/access these sources, then check out Curious Mental Illnesses Around the World and read the short descriptions of koro, latah., brain fag, anorexia, and amok.

For an overview of culture bound syndromes, go to: http://homepage.mac.com/mccajor/cbs_intro.html

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Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition TR (DSM IV-TR)
(American Psychiatric Association, 2000)

This is the most widely used diagnostic manual for psychological disorders. The fourth edition was published in 1994, revised in 2000, and the next version is due in 2013 (DSM-V). One of its most helpful contributions regarding the role of culture is found in the appendix "Outline for Cultural Formulation and Glossary of Culture Bound Syndromes". It consists of two parts:

• a. Part one is a short outline to evaluate the cultural context as it relates to diagnosis and treatment (e.g., cultural identity/connection, cultural explanations of a person's problems, cultural understanding of social stressors and supports, cultural factors influencing the client-clinician relationship, and the overall impact of cultural factors on diagnosis and care).

• b. Part two provides a fascinating list of some of the more common "afflictions and illnesses" that are found in different cultures and which can be encountered in clinical practice. Some of these conditions overlap with DSM-IV diagnoses although often the types of symptoms, course, explanations, and social responses are influenced by the local cultural perspectives. Unfortunately we have not found an online source for viewing this material (please let us know if you find one) and hence one has to get a hard copy of the book.

Diagnostics and Statistics Manual IV-TR Casebook

(American Psychiatric Association, 2000)

The very helpful casebook includes 70 pages of various examples of diagnoses and problems in different countries and cultures. These examples are included in the section called "International Cases." This section offers the local cultural/indigenous views of afflictions/illnesses along with DSM IV diagnostic considerations. You will note that in many of these cases there is the attribution and complaint some sort of spirit possession/influence. Unfortunately we have not found an online source for viewing this material (please let us know if you find one) and hence one has to get a hard copy of the book.

Reflection and Discussion

1. What did you think of the descriptions of the disorders mentioned in:

Curious Mental Illnesses Around the World

2. How might some of the supernatural attributions in other cultures affect the member care work you do or as you live and work cross-culturally? Any examples?

3. Disorders in Western psychology usually involve three elements:

**Distress emotionally

**Disability behaviourally

**Duration over time.

Recall a situation in your life when you were really struggling and all three elements were going on.

Did you have a “disorder” and if so what was it?

4. Some argue that disorders are better understood as responses to life circumstances/challenges rather than some invading pathogen or pathological entity. What do you think?

5. In your worldview, is there a distinction between imaginary spirits and actual spirits? If so, describe.