Tuesday, September 27, 2005

Mental Health and the Third World

NAMI plans a protest this week in Washington to draw attention to the WHO/World Bank initiatives to expand access to mental health care in third world nations. Their concerns revolve around two main points: that treating mental health as a separate problem draws attention away from the social and political problems that exacerbate psychiatric symptoms, and that this initiative can be used by multinational drug companies as a way to expand the reach of biological psychiatry. These are legitimate issues, and I think that policy makers ought to take them into account when deciding how to respond to the mental health care system's deficits in these countries.

But disparities in mental health care access do exist. Disorders like bipolar disorder, schizophrenia, and post-traumatic stress disorder clearly respond to treatments that are available in first world countries--some medication treatments, but also psychosocial treatments. Moreover, it's easy to reverse the direction of causality when thinking about poverty and mental illness in developing countries, while the relationship is seen as synergistic here in the US. The 2001 WHO report notes:


Poverty can also be both a cause and a result of ill health and may contribute to brain disorders through poor nutrition, unhygienic living conditions and inadequate access to health care. According to the report, research indicates that in many countries "poverty and several psychiatric disorders, such as depression, exacerbate each other."


The "primary health care model" for general medical care delivery has been implemented in many developing countries, but mental health has been slow to adopt it (Link). "Primary health care" is a strategy of integrating technology and support from outside countries into the political, administrative, and cultural framework of the host developing country. It should be developed for mental health purposes, especially to deliver psychosocial treatments which engender less reliance on outside sources of funding and medications.

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