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I agree with others about the Global Mental Health movement. I would actually not only challenge the medication treatment model GMH is flogging to poorer countries
but also the Cognitive Behavioural Therapeutic approach too, that no doubt will follow quickly after the tablets!! Indigenous peoples have managed without rearranging their brains (temporarily) with an American idea of what they really need (reference Aaron
Beck). What makes me more concerned is how governments of countries like India seem to want to accept the Western Model of Psychiatry so easily when the Ayurvedic Medicine and philosophy, that has lasted for thousands of years before pharmaceutical products
were even thought about, is so effective for many people there. I suppose some of their politicians and bureacrats may want to receive some of the profits the pharmaceuticals will generate.
I do agree with Suman’s idea that the pharmaceuticals are looking for new markets since the Western Health Services have been so badly hit with budget cuts
and their populations are beginning to realise tablets aren’t everything they have been purported to be!
What frankly can be done to stop GMH rolling out? Does anyone have any idea? I doubt if any of us can stop it from happening. Vikram Patel was very convincing
in his radio broadcast last week…
Neil
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]]
On Behalf Of Kim Robinson
Sent: 04 March 2014 15:08
To: [log in to unmask]
Subject: Re: 'Global' Mental health
Hi all,
Yes – I agree. This is an interesting discussion following on from the programme this morning.
It reminds me of working in East Timor after the UN referendum when psychiatrists were flown from ‘Western’ countries in to administer medication to traumatised
and distressed people (despite no secure ongoing provision of drugs or healthcare). The support local healthcare workers needed was to rebuild their community based services, and develop skills and not to be ‘seduced’ by pharmaceutical companies offering
quick fixes and a limited view of mental health. NGOs with experience on the ground have lots to offer, but are often undermined by those powerful interests.
Kim Robinson
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]]
On Behalf Of Suman Fernando
Sent: 04 March 2014 14:36
To: [log in to unmask]
Subject: Re: 'Global' Mental health
It is remarkable that just when there is mounting evidence that medications for ‘mental illness’ such as ‘depression’ are no different to placebos, there is a drive (the global mental health movement) to promote
their use in low and middle income countries (I still prefer the term ‘Third World’!). One wonders whether part of the reason for this is that Big Pharma detects a drop in sales in the West and is now looking for markets in the Third World (much as happened
in the case of cigarettes).
Suman
From: Health of minority ethnic communities in the UK [mailto:[log in to unmask]]
On Behalf Of Ingleby, J.D.
Sent: 04 March 2014 14:27
To: [log in to unmask]
Subject: Re: 'Global' Mental health
........yes, Christine - as well as solid scientific evidence that reported success rates for pharmaceutical treatments have for many years been grossly inflated by "publication bias" and other techniques of distortion.
Making allowance for such biases results in a level of effectiveness scarcely different from placebo effects.
However, we're not so backward as to want to deny the benefit of these expensive placebo effects to the inhabitants of low- and middle-income countries, are we?
Best wishes,
David
Some references:
Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R: Selective publication of antidepressant trials and its influence on apparent efficacy.
N Engl J Med 2008; 358:252–260
http://www.nejm.org/doi/full/10.1056/NEJMsa065779
Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT: Initial severity and antidepressant benefits: a meta-analysis of data
submitted to the Food and Drug Administration. PLoS Med 2008; 5:e45
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045
"These findings suggest that, compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression
in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo,
rather than increased responsiveness to medication."
For more such studies visit http://www.criticalpsychiatry.co.uk/
and search for (e.g.) "placebo".
Van: Health of minority ethnic communities
in the UK [[log in to unmask]] namens McCourt, Christine [[log in to unmask]]
Verzonden: dinsdag 4 maart 2014 14:41
Aan: [log in to unmask]
Onderwerp: Re: 'Global' Mental health
I heard this and was also worried by the assumption that the only or best treatment for depression is medication, while there is solid scientific evidence to support other types of therapy.
From:
Suman Fernando <[log in to unmask]>
Reply-To: Suman Fernando <[log in to unmask]>
Date: Tuesday, 4 March 2014 13:35
To: "[log in to unmask]" <[log in to unmask]>
Subject: 'Global' Mental health
Vikram’s apparent conversion to American-type thinking (in the topic of mental health’) is well-known but why and how and why this occurred may not be exactly as Vikram himself says! But the objection
to the ‘global’ MH movement is not a personal one.
The ‘Global Mental Health’ movements began quite recently and is the subject of much criticism from transcultural-academic and political-ethical (i.e. ethics of development) standpoints. My personal
view from studying the politics of this movement are given in short on the appended article in
Openmind. The critiques are varied and in depth and not easy to reduce to a few lines.
Derek Summerfield an eminent critique of applying western diagnoses and ‘treatments’ has described ‘global mental health’ as an oxymoron. ‘Mental health’ is not a ‘global’ concept but one that emerges locally - it is largely
determined by context - especially social and cultural. What is ‘mental’ is variable and certainly remedies for what we in the West call ‘mental illness’ is culturally diverse. For anyone interested:
There was a major meeting in Montreal in 2012 where some aspects of what is behind the MGMH were thrashed out
http://somatosphere.net/2012/07/global-mental-health-and-its-discontents.html. Videos of some of the talks there are
available on line-
http://www.mcgill.ca/tcpsych/training/advanced/previous/2012-asi/asi-lectures
Relevant books: Decolonizing Global Mental Health; The psychiatrization of the majority world’ by China Mills (Routledge, 2014),
Crazy Like Us The globalization of the American psyche by Ethan Watters (PBK 2011). Although I thought I had finished with writing books the political nature of the ‘Movement for global mental health’ stimulated me into writing
Mental Health Worldwide; Culture, Globalization and Development due out in April -
http://www.palgrave.com/products/title.aspx?pid=669016
Some aspects of MGMH are very worrying. For example, An MSc course run by the people who started the MGMH is supported by Janssens (the pharmaceutical company)
http://www.lshtm.ac.uk/newsevents/news/2013/nine_new_scholarships.html. I think it is obvious that MGMH plays into marketing of pharmaceuticals in the Third World. The new mental health care bill (apparently drawn up by psychiatrists) mentioned by Vikram
has been severely criticised by community workers in India as has the GMH movement. It seems, community clinics in India merely dole out medications.
Suman
Suman Fernando
WEBSITE:
http://www.sumanfernando.com
Visiting Professor, Faculty of Social Sciences & Humanities
London Metropolitan University
Formerly
Senior Lecturer in Mental Health, European Centre for Migration & Social Care (MASC)
University of Kent
Consultant Psychiatrist, Chase Farm Hospital, Enfield, Middlesex
From: Health of minority ethnic communities
in the UK [mailto:[log in to unmask]]
On Behalf Of Richard
Sent: 04 March 2014 09:49
To:
[log in to unmask]
Subject: Interview with Prof. Vikram Patel
Hi everyone
Being retired gives me more time to listen to the radio. Just heard the The Life Scientific interview in which Prof Jim Al-Khalili discusses with Prof. Vikram Patel issues of global mental health and
the application of Western medical diagnoses and responses. Might be something network members may wish to comment on / discuss after listening to it.
It's repeated tonight on BBC Radio 4 at 9.30pm.
More info on the BBC website at:
http://www.bbc.co.uk/programmes/b03wphhj
Kind regards
Richard
Richard Bryant-Jefferies
@richardbj