Can Mental Health Nurses Help Localize Global Mental Health?

The pandemic has provided an opportunity to develop culturally sensitive global mental health reforms.

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In a new article published in the Journal of Psychiatric and Mental Health Nursing, Paul Illingworth argues that reforming global mental health should be at the center of any Covid-19 pandemic response. According to Illingworth, the pandemic has thrust mental health into an unprecedented global spotlight and given the psy-disciplines a chance to repackage their initiatives to better appeal to the global community.

Illingworth argues that the best way to achieve this is by training global mental health nurses (MHN) to understand local cultures and political agendas better. This move would not significantly increase the cost of training but could reduce the frequency of costly medical and pharmacological interventions that have historically not worked well in the global community. Illingworth writes:

“The knowledge and skills MHN offer needs to be central to any emergency risk reduction and management strategy. There are numerically more MHN than other mental health professionals. Therefore there is a greater opportunity to involve them in any response. Further, MHNs are in an ideal position to ensure they are better placed to engage with global communities.”

Many authors have argued that the Westernized version of mental health does not translate well to the global stage. This view of mental health tends to ignore socio-cultural determinants in favor of biological ones and thereby offers interventions that cannot address the structural causes of psychological suffering.

The World Health Organization has recently called for a radical restructuring of the global mental health movement to emphasize more sociocultural determinants. Many researchers have also called for more emphasis on structural competency within the psy-disciplines, focusing on how social issues like racism affect mental health. Similarly, the current research argues that our global health policies need to be more open to structural causes and solutions to mental health issues.

According to Illingworth, Covid-19 has placed a global emphasis on mental health we have never seen before. While everyone will find recovery difficult, low- and middle-income countries are likely to see the most problems due to a lack of infrastructure. The author argues that with many people dealing with financial ruin and bereavement issues, access to proper, culturally sensitive mental health resources are of paramount importance.

Illingworth believes the psy-disciplines could use the pandemic recovery to change world mental health policies for the better by placing more emphasis on structural factors and local cultures’ influence on mental health. According to the author, this is an opportunity for the countries that normally lead the discussions around mental health to acknowledge that other countries and cultures understand mental health very differently.

To achieve this, Illingworth argues that the psy-disciplines need to concentrate on MHN training for several reasons. MHNs are the most numerous of mental health workers and therefore are more likely to be involved in any intervention. MHN education involves cultural sensitivity training, and most already work in multi-cultural societies. As a result, MHNs tend to be well-trained and culturally sensitive communicators who are perfectly placed to change the way the psy-disciplines respond to psychological suffering on the global stage.

By adding “global citizenship” and local “political agenda” training to MHN education, Illingworth believes MHN will be in a much better position to advocate for their patients. Additionally, the sheer number of MHNs means they are in the best position to influence how organizations like the United Nations and the World Health Organization create policies around mental health.

Illingworth concludes:

“Mental health needs to be prioritized, but there needs to be a focus on culturally sensitive, localized person-centered mental health care, which achieves the Universal Health Care everyone is calling for. MHNs need to influence the construction of global mental health policies rather than just the implementation of them. After all, they are ideally placed to do so.”

Illingworth argues that by training MHN in local cultures, psychologists will be better able to offer non-drug interventions to service users in low- and middle-income countries.

However, recent research has also shown that psychotherapy is less effective for people living in poverty. Additionally, giving impoverished people money tremendously improves their mental health in ways that therapy simply cannot. Lastly, several researchers have pointed to the dangers of exporting mental health concepts into the global south, where they are out of context and can even be harmful.

Illingworth sees an opportunity in the Covid-19 pandemic recovery for the psy-disciplines to better address the mental suffering of low- and middle-income countries. To achieve this, he champions re-training MHNs in local culture and politics and calls on MHN to use that training to create better policy and advocate for their patients.

 

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Illingworth, P. (2021). Culturally Sensitive, Localised, Universal Mental Health Care. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12774

4 COMMENTS

  1. “According to the author, this is an opportunity for the countries that normally lead the discussions around mental health to acknowledge that other countries and cultures understand mental health very differently.”

    Of course, the real problem with Western exportation of psychiatry is the assumption that what the West is doing is working for the West. It’s not like what we have is working for us but doesn’t export well as this position would assume. In reality, the approach of the West isn’t working for us, either. And so maybe what global mental health needs is for high income countries to take a look at what middle and low income countries do differently that works better as those countries have historically had much higher rates of recovery before implementing the biomedical approaches that dominate Western psychiatric practice and theory.

    • “Illingworth argues that the best way to achieve this is by training global mental health nurses (MHN) to understand local cultures and political agendas better. This move would not significantly increase the cost of training but could reduce the frequency of costly medical and pharmacological interventions that have historically not worked well in the global community.”

      Well and you cannot “reform” it from the inside.
      And who “trains” these people to “culturally understand”? It really means to train in old ways of psychiatry but with a new twist.
      It sounds a lot better than it is. Actually to me it sounds like infiltrating cultures more gently at the start. There is absolutely nothing we need to teach other countries.

      • I agree. A truly culturally aware approach would START by trying to learn from the culture we are encountering, and being humble enough to understand that they have much to teach us. The “schizophrenia” recovery rate is 10 times better in the “developing” world. Our “thought leaders” have tried their best to explain this away, instead of finding out what they’re doing right and what we’re doing wrong. That’s the real problem. However gently it is framed, we Westerners believe our culture is superior and that these “primitive” people need to learn how to do it our way.

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