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Panel: Ecosocial Approaches to Global Mental Health (ASI 2016)

Chair:
Jaswant Guzder, McGill University

Participants:
Ashlee Cunsolo, Labrador Institute of Memorial University
Sandra Hyde, McGill University
Frederick Hickling, University of the West Indies
Ross White, University of Glasgow
David Ndetei, University of Nairobi

 

Ross White: Creating personal and socio-environmental contexts for enhancing human development (ASI 2016)

 

 

Creating personal and socio-environmental contexts for enhancing human development

Ross White, University of Glasgow

Efforts to build capacity for mental health services across the globe have progressed in the absence of consensus about what the principal aim of these services should be. Contention exists, for example, about the priority that should be given to getting rid of symptoms of mental illness compared to facilitating people to live full and meaningful lives. To help address this contention, this presentation explores the implications that adopting a ‘human development’ approach might have for Global Mental Health (GMH) initiatives. Consideration is given to the potential utility that the Capabilities Approach (CA) offers for creating personal and social-environmental contexts for enhancing mental health and wellbeing. This includes an analysis of micro- and macro-level factors that may have served to thwart opportunities for individuals and communities to realize their capabilities. The presentation discusses how applying the CA to GMH initiatives can serve to highlight the importance of developing a nuanced understanding about: 1) What individuals in particular settings value as being important to how they want to live their lives, and 2) The personal and structural factors that can promote, or hinder, individuals’ freedom to realize their capabilities and engage in valued functioning. As such, the CA approach provides a platform for considering factors related to people, spaces and places that can enhance mental health and wellbeing. So, in addition to providing a framework for considering the merits/demerits of existing GMH initiatives, the CA provides an opportunity to extend the focus to important issues such as climate change and food security that are relevant for human development. Consideration is also given to the way in which the CA can provide opportunities to critically reflect on how GMH initiatives might inadvertently thwart efforts to develop capabilities by: 1) Narrowly focusing on mental illness, and 2) Relying too heavily on a restricted range of epistemologies and research methodologies for evaluating forms of support.

Ross White, PhD, is the Director of the MSc Global Mental Health programme at the University of Glasgow. His research interests relate to psychological mechanisms involved in complex mental health difficulties such as psychosis. His focus has been on using this research to develop psychotherapeutic interventions aimed at addressing these mechanisms. In recent years, he has conducted randomised controlled trials to determine the effectiveness of psychotherapeutic interventions for complex mental health difficulties. His particular interests relate to the application of mindfulness-based treatments and Acceptance and Commitment Therapy for these populations. Dr. White is engaged in scholarly activity that investigates the role that socio-cultural factors play in the manifestation of mental health difficulties, and explores how psychological interventions can be adapted to accommodate cultural beliefs and practices. He is a co-editor of the upcoming Palgrave Handbook for Global Mental Health: Socio-cultural Perspectives. Dr. White also has an honorary contract as a Principal Clinical Psychologist with Greater Glasgow and Clyde NHS.

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

Panellists:
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.

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