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David Ndetei: Global Mental Health in Low Income Countries (ASI 2016)

Global Mental Health in Low Income Countries
David Ndetei, University of Nairobi

Kenya, a low income country, faces a variety of challenges in the provision of mental health services. An overall lack of personnel to provide mental health services, exacerbated by the majority of available personnel being stationed in high income (urban) areas is one of the main challenges. Other challenges include: poverty and lack of financial resources to access available services, low mental health literacy, high levels of stigma and lack of investment in mental health by the government due to competing priorities for resources. Despite these challenges, with research and innovation it is possible to provide mental health services that are affordable, appropriate, available and accessible within the prevailing socio-cultural and economic situation. Many opportunities for research and the delivery of mental health services especially within the primary healthcare system exist. With mutually beneficial partnerships for the exchange of ideas and expertise, the dream of mental health for all can be realized.

David M. Ndetei, MBChB (Nairobi), DPM (London), MRCPsych, FRCPsych(UK), MD, (Nairobi), DSc (Nairobi), Certificate in Psychotherapy (London), is Professor of Psychiatry at the University of Nairobi, Kenya and the Founding Director of the Africa Mental Health Foundation – a Non-Governmental Organization dedicated to research for evidence-based policy and practice in mental health, and promotion of neurological health and healthy behaviour. His passion is research to generate evidence for policy and best practice in the provision of affordable, appropriate, available and accessible mental health services for all. He is the current Chair of the Africa Division of the Royal College of Psychiatrists (UK) and Zone 14 (East, Central and South Africa) representative of the World Psychiatric Association (WPA). He is also a member of the World Mental Health Federation, the Kenya Psychiatric Association and a member of the Kenya Medical Research Institute, National Ethical Research Committee. He has served as the Principal Investigator for nearly all Kenyan published clinical and community epidemiological studies on mental health, authored six books and 21 monographs, and over 250 publications in peer reviewed journals.

Frederick Hickling: Owning Our Madness: Contributions of Caribbean psychiatry to decolonializing Global Mental Health (ASI 2016)

Owning Our Madness: Contributions of Caribbean psychiatry to decolonizing Global Mental Health

Frederick W. Hickling, CARIMENSA, University of the West Indies

For the past five centuries Europeans have been fighting over possession and control of the Caribbean. Indigenous Taino populations practiced a form of communal psychiatry prior to the arrival of Europeans. Mental illness in African people was unrecognised in the initial period of African slavery by the European colonizers. In the nineteenth century the paradigm of involuntary commitment and custodialization were the principal tenets of British colonial public policy for the management of the violent, disturbed mentally ill, that led to the establishment of the Lunatic Asylum. Twentieth century political independence ushered in the pioneers of modern Caribbean mental health care by the establishment of training programs for psychiatry. Indigenous models of mental health legislation catalyzed the establishment of innovative community mental health services resulting in the negation of involuntary certification, incarceration and custodialization. This led to innovative ecosocial systemic approaches to mental health care, including: the promotion of family therapy; short-stay treatment in conventional primary and secondary care health facilities; systems for Diversion at Point of Arrest (DAPA) and the reduction of stigma through popular media and the arts. A gradual mental hospital deinstitutionalization process has been supported by novel psychotherapy models and development of primary prevention mental health institutions that have catalyzed the assimilation of psychiatry in medicine, stigma reduction and community engagement. However, these successes have unmasked high levels of violence, personality disorder, family fragmentation, migration, and dysfunctional children that have mandated the development of primary prevention programs, which have taken psychiatry to schools. These innovations point toward the need for continued decolonization of the architecture of Global Mental Health policy in the Caribbean.

Frederick W. Hickling was educated at the University of the West Indies, University of London, and University of Edinburgh. He is Professor Emeritus of Psychiatry at the University of the West Indies, and is the Executive Director of the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) UWI, Mona. Author of more than 100 scholarly articles and six books, he was elected a Distinguished Life Fellow of the American Psychiatric Association in 2009, and a Fellow of the Royal College of Psychiatrists UK in 2011. He received the Order of Distinction (Commander) by the Government of Jamaica in August 2012.

Sandra Hyde: Contemporary Chinese Hyper-urbanization and its Mental Health Consequences: Rethinking Small-Scale… (ASI 2016)

Contemporary Chinese Hyper-urbanization and its Mental Health Consequences: Rethinking Small-Scale Therapeutic Communities as Spaces for Drug Rehabilitation

Sandra Hyde, McGill University

I begin this paper by laying out a social epidemiology of China’s economic rise and its implications for mental health. I then focus in on China’s largely unexplored illegal drug crisis. Until the late 1990s, all Chinese drug addicts were treated as criminals and placed in either the justice system’s drug prisons or in labor camps. In the millennium, while the drug prison and the labor camp still exist, there is a small group of psychiatrists and AIDS activists who want to embrace what Foucault labeled the humanism of the asylum by providing clinical residential care to allow drug addicts to heal their addictions. As such there are two competing ideologies on controlling drug epidemics in China, the dominant one is punitive and the other therapeutic; however, within these two ideological positions, there remains a massive disjuncture between the reality of everyday life and official policy. In an effort to rethink mental health care in light of China’s massive internal migration and displacement, and its hyper-urbanization policies, how do health GONGOs manage rising rates of drug addiction? Here I am thinking at the intersection of subjectivity and the social-psychological dimensions of individual and collective lives in the onslaught of Chinese globalization, or planetization. I ask one: how do Chinese users of illegal street drugs learn to reform their emotions in an effort to rethink the modern Chinese healthy citizen? And two, thinking programmatically how does one write a clinical ethnography of a therapeutic community contemporary China? If Sunlight is a clinical space that rises and falls within a particular set of institutions and ideas that travel across the globe — behavior modification, AA/Narcotics Anonymous, Mind/Body treatments, abstinence — what do these modalities say about how ‘a complicated kindness’ travels across the globe? All of the therapeutic concepts that take root at Sunlight have travelled across global spaces both physical and metaphorical to reach Chinese psychiatrists, peer educators and former addicts. I end by problematizing the conditions and practices within Sunlight TC, where finding a new kind of post-millennial citizen in a highly urbanized world.

Sandra Teresa Hyde is an Associate Professor at McGill University in the Department of Anthropology; an Associate Fellow in the Departments of East Asian Studies in the Faculty of Arts and Social Studies of Medicine in the Faculty of Medicine. She is also affiliated with the Institutes for Gender, Sexuality and Feminism and the Institute for the Study of International Development in Arts, and Global Health and Global Mental Health in Medicine. Her current project is a manuscript titled – Chasing the Dragon: Chinese Market Socialism, Psychosociability and the Malleable Addict – that is based on six years of research in the first therapeutic residential drug treatment center in China. She has published two books, the first, Eating Spring Rice: The Cultural Politics of AIDS in Southwest China (2007), and, the second, Postcolonial Disorders (2008), co-edited with Mary-Jo DelVecchio Good, Sarah Pinto and Byron Good. She has also published articles in a wide range of journals from Public Health to Philosophy.

Ashlee Cunsolo: Mourning Nature: The Mental Health Impacts of Ecological Grief in a Changing Climate (ASI 2016)

Mourning Nature: The Mental Health Impacts of Ecological Grief in a Changing Climate

Ashlee Cunsolo, Labrador Institute of Memorial University

Anthropogenic climate change has been an increasing global concern, and with the recent release of the Intergovernmental Panel on Climate Change’s (IPCC) 5th Assessment Report, it is clear that we are facing a new planetary reality for decades to come. The resulting changes in climate and environment are anticipated to have widespread, profound, and unequally distributed impacts on global mental health, particularly among populations who rely directly and intimately on the environment for sustenance and livelihoods, such as Indigenous populations, fishers, and farmers. Indeed, emerging evidence from nine years of community-led and community-directed participatory research in the Inuit Settlement region of Nunatsiavut, Labrador indicates that changes in climate and environment, and the resulting disruption to land activities, were a direct and indirect threat to mental health and well-being, and led to: intense emotional reactions associated with loss of activities, identity, and sense of place (grief, mourning, anxiety, stress, distress); real and potential increases in consumption of drugs and alcohol; potential increases in suicide ideation; and potential to aggravate acute anxiety disorders and major depression. Climate change was also reported to act as a magnifier for other forms of stress and distress and to highlight socio-economic inequalities, leading to further negative ramifications for mental health and wellbeing. This presentation will draw on 9 years of community-based and community-led research in the Inuit Settlement Region of Nunatsiavut, Labrador, examining the numerous ways in which a changing climate and environment is impacting mental health and psychosocial wellness, and combine it with theoretical and praxiological work on the role of grief and the work of mourning when it is expanded to encompass nature and the more-than-human worlds. In so doing, this presentation will seek to examine how mourning and grief can expand associated political and ethical dialogues and discourses, and provide new insights for mental health programming and adaptive responses.

Ashlee Cunsolo, PhD, is a passionate researcher, environmental advocate, and ally, working with research and policy to make a difference in how we live with and in this world. As a community-engaged social science and health researcher working at the intersection of place, culture, health, and environment, she has spent a decade working with Indigenous communities and leaders across Canada on a variety of community-led and community-identified research initiatives, ranging from climate change impacts on physical and mental health, cultural reclamation and intergenerational knowledge transmission, suicide reduction and prevention, land-based education and healing programs, environmental grief and mourning, and Indigenization of higher education. She is a pioneer in climate change and mental health research, and has given over 200 talks and received wide media attention for her work. In 2014, she released a documentary film, collaboratively produced with the five Inuit communities in Nunatsiavut, Labrador, about the impacts of climate change on Inuit culture, livelihoods, and wellbeing (www.lamentfortheland.ca). She is currently the Canada Research Chair in Determinants of Healthy Communities at Cape Breton University, and an inaugural member of the Royal Society of Canada’s College of New Scholars, Artists, and Scientists and one of Nature Canada’s 75 Women for Nature.

Panel: Political Economy and the Governance of Global Mental Health (ASI 2016)

Chair: Laurence Kirmayer, McGill University

Fernando Lolas Stepke, University of Chile
Peter Victor, York University
Peter Brown, McGill University
Frank Elgar, McGill University


Fernando Lolas Stepke: Bioethical Implications of Globalization for Global Mental Health (ASI 2016)

Bioethical Implications of Globalization for Global Mental Health

Fernando Lolas Stepke, University of Chile

The main thrust of this presentation is to identify the bioethical implications of the globalization process as it is currently understood, emphasizing those areas in which a “differential ethics” approach, as advocated by HM Sass, may provide a framework for research and intervention. One of the implicit assumptions to be elaborated upon is the notion of the “moral equivalence of cultures”, as presented by Oswald Spengler, with the distinction between a “systematic” and a “physiognomic” approach to cultural diversity and understanding. In this regard, emphasis is placed on language in its denotative, connotative, and performative dimensions and the narrative constitution of human experience, which renders it untranslatable but amenable to comprehension and intervention. In this narrative, the “human dimension of the environment” and its attendant implications for mental health are scrutinized within the scope of its practical implications for furthering and refining a hitherto vague conception of “global mental health” and its relation to “global ethics.”

Fernando Lolas Stepke is Professor and Director of the Interdisciplinary Center for Studies on Bioethics at the University of Chile and Specialist in Psychiatry and Psychosomatic Medicine. He studied Medicine and History at the Universities of Chile and Heidelberg (Germany). He has been Vice President for Academic and Student Affairs of the University of Chile, President of the Chilean Society of Neurology, Neurosurgery and Psychiatry, and Director of the Psychiatric Clinic of the University of Chile. He led the Bioethics Program of the Pan American Health Organization, Regional Office of the World Health Organization and was a member of the International Bioethics Committee of UNESCO. He has received Doctor Honoris Causa and Honorary Professor at numerous universities in Latin America, Europe and the United States. His scientific production has been concentrated in the areas of psychiatry, psychophysiology, bioethics and behavioural sciences. He is an Honorary Member of the Chilean Academy of Language, Chilean Academy of Medicine and numerous other institutions (Mexican National Academy of Bioethics, Iberoamerican Academy of Medical Law, World Association for Social Psychiatry) as well as Corresponding Member of the Royal Spanish Academy. He is also the editor of scientific publications in English, Spanish and German and was awarded the Alumni-Preis of the Alexander von Humboldt Foundation, Germany.

Peter Brown: Why We are Lost (ASI 2016)

Why We are Lost

Peter G. Brown, McGill University
Peter G. Brown is a Professor in the Departments of Natural Resource Sciences and Geography, and the School of Environment at McGill University. He is principal investigator of Economics for the Anthropocene, a graduate training and research partnership supported by the Social Sciences and Humanities Research Council of Canada and twenty-five international university, government, and non-governmental organizations (e4a-net.org). His most recent book is Ecological Economics for the Anthropocene: An Emerging Paradigm, written and co-edited with Peter Timmerman. He is a member of the Society of Friends (Quakers), and the Club of Rome.

Peter Victor: The Trouble with Growth (ASI 2016)

The Trouble with Growth

Peter A. Victor, York University

Economic growth is the over-arching policy objective of governments worldwide. Yet its long-term viability is increasingly questioned because of environmental impacts and impending and actual shortages of energy and material resources. Furthermore, rising incomes in rich countries bear little relation to gains in happiness and wellbeing. Some hope to ‘decouple’ economic growth from its material and energy requirements but will this be enough to allow economies to grow without limit? Others argue that the trouble with growth is not only that it is bound to be short-lived, but that its pursuit prevents the achievement of more important social objectives. These perspectives will be examined in this presentation. What can and ought to grow will be distinguished from what can’t and shouldn’t and scenarios of alternative economic futures will seed discussion of possible ways forward that will better serve humanity and all life on the planet.

Peter A. Victor is an economist who has worked on environmental issues for nearly 50 years as an academic, consultant and public servant. Dr. Victor was one of the founders of the emerging discipline of ecological economics and was the first President of the Canadian Society for Ecological Economics. His most recent books are Managing without Growth. Slower by Design, not Disaster (Edward Elgar, 2008) and The Costs of Economic Growth (ed.) (Edward Elgar, 2013). In 2011 Dr. Victor was awarded the Molson Prize from the Canada Council for the Arts for his contributions to the study of economics and the environment and in 2014 the International Society for Ecological Economics named him as the recipient of the Kenneth E. Boulding Memorial Award. He was elected to the Royal Society of Canada in 2015.

Laurence Kirmayer: Psychiatry for a Small Planet – Introduction to ASI 2016

The view of earth from space provided by the Apollo mission in 1968 offered a new way of thinking about the planet as our shared home—a beautiful blue-green orb floating in space. In recent years, climate change, urbanization, mass migration, and the violence of global geopolitics have created new challenges and a more acute sense of the vulnerability of our planet. This planetary view exists in some tension with the perspective of globalization, which tends to focus on economic growth and development. This international conference and workshop will examine the implications for global mental health of the “anthropocene” in which our context of adaptation is dominated by human effects on the environment. Questions to be discussed include: What ways of thinking about current global or planetary issues can promote empathy, equity and effective action? Does the notion of “planetarization” offer an alternative to globalization for thinking about geopolitical and ecological crises? What are the links between care of the planet and care of the self? What cultural values and practices can contribute to adaptation, flourishing and well-being in the face of the massive environmental and social changes that are on the horizon? Sessions will explore topics related to four themes: (1) rethinking the ethics, politics, and governance of global mental health “from the bottom up” to ensure the voice of diverse communities and stakeholders in addressing global health inequities; (2) the impacts of migration and urbanization on mental health; (3) the effects of climate change on the mental health of populations and communities; and (4) ecosocial approaches to mental health promotion of populations and communities. These interconnected processes are changing the configuration of social worlds, presenting new challenges to mental health and affording new possibilities for intervention. Presenters will examine the ways that ecosocial and ecosystemic approaches to health and illness can inform policies and practices that contribute to the treatment and prevention of mental disorders and the promotion of mental health and well-being.
Laurence J. Kirmayer, MD, FRCPC, FCAHS, FRSC is James McGill Professor and Director, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University and Co-director of the McGill Global Mental Health Program. He is Editor-in-Chief of Transcultural Psychiatry, and Director of the Culture & Mental Health Research Unit at the Institute of Community and Family Psychiatry, Jewish General Hospital in Montreal, where he conducts research on culturally responsive mental health services, the mental health of Indigenous peoples, and the anthropology of psychiatry. He founded and directs the annual Summer Program and Advanced Study Institute in Cultural Psychiatry at McGill. His current research includes studies on: culturally based, family centered mental health promotion for Indigenous youth; the use of cultural formulation in cultural consultation; and the place of culture in global mental health. He co-edited the volumes, Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives (Cambridge University Press), Healing Traditions: The Mental Health of Aboriginal Peoples in Canada (University of British Columbia Press), Cultural Consultation: Encountering the Other in Mental Health Care (Springer), DSM-5 Handbook for the Cultural Formulation Interview (APPI), and Re-Visioning Psychiatry: Cultural Phenomenology, Critical Neuroscience and Global Mental Health (Cambridge). He is a Fellow of the Canadian Academy of Health Sciences and of the Royal Society of Canada (Academy of Social Sciences).

Duncan Pedersen: Dream-A-World Cultural Therapy as an innovative approach in Global Mental Health (ASI 2015)

Dream-A-World Cultural Therapy as an innovative approach in Global Mental Health.

Duncan Pedersen, Douglas Mental Health University Institute, McGill University

Much work is being conducted in countries around the world to systematically influence the knowledge and practice around mental health and service provision. Current propositions in GMH seek to scale-up western biomedical psychiatric models, in order to improve access to services and treatment, thus reducing the ‘mental health gap’ and best meeting the needs of users. Others, like Dream-A-World (DAW) Cultural Therapy, focus their work outside-the-box, that is outside the realms of the health sector and depart from a different paradigm which has been called “user/survivor-ledapproach.” DAW chooses their subjects among the most troubled young children, school drop-outs, living in inner-city garrison settlements of Kingston, Jamaica, and uses creative arts to promote social well-being, resilience and improved academic performance; increasing self-control; reducing antisocial behaviour and promoting ‘wholesome’ identity. My contention here is that creativity is the ‘key’ ingredient of DAW Cultural Therapy. Creativity is as important in education as literacy and numeracy, and we should treat it with the same status. However, schools are replicating the same hierarchical model all over the world. Our education system has been designed to kill creativity or to make it a subordinate of mathematics, physics or natural sciences, thus mining our minds in the way that for the future globalized world won’t serve us much. DAW has contributed not only to foster the mind and mental health of vulnerable young children in Jamaica, but above all has made us rethink the
fundamental principles on which we are educating our children, as well as how should we conduct global mental health interventions inspired by equity and social justice, that are both effective and ethically sound.

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