Leadership Needed to Forward Culturally-Responsive Global Mental Health Policies

Support has grown for Global Mental Health over the past decade, but political tensions and the lack of a shared vision continue to get in the way of new policies.


An article written by Valentina Iemmi, published in Health Policy and Planning, examines the political tensions that influence the development and implementation of global mental health policies.

Global political priority for mental health–the degree to which international programs, organizations, and leaders pay attention to and put resources toward an issue–has risen in the past decade, according to Iemmi’s research. However, the absence of guiding institutions and the presence of ideological friction create barriers that must be overcome before mental health can be prioritized effectively.

Iemmi highlights some critical messages at the beginning of the article:

“Global mental health has gained political attention, especially over the past decade, yet support remains limited. Advocates face several challenges, including a fragmented policy community, a divided public portrayal, a lack of a strong global governance structure, and few credible indicators. Opportunities are arising, including an increasing number of leaders and grassroots organizations, multiple arguments for action, widening political support, and an expanding evidence base on cost-effective interventions.”

The field of Global Mental Health (GMH) is not without its critics, as many scholars, activists, and service users have raised concerns. Not only is the field’s search for universality hindered by varying vested interests and differing viewpoints, but GMH also struggles to reckon with issues of racism and colonialism.

Valentina Iemmi of the London School of Economics is clear on GMH’s drawbacks in her article and seeks to identify, via qualitative policy analysis, where the field is significantly fragmented. Perhaps with an understanding of GMH’s fragmentation, we can better understand how to ethically move forward with policies that improve access to culturally appropriate services.

Utilizing a case study methodology, Iemmi sought to produce an in-depth analysis of a generation of political priorities for global mental health. Interviews were conducted over 11 months in 2018. After data collection, the Shiffman and Smith framework was used to organize all data into four themes (actor power, ideas, political contexts, issue characteristics) and 11 sub-themes (policy community cohesion, leadership, guiding institutions, civil society mobilization, internal frame, external frame, policy windows, global governance structure, credible indicators, severity, and effective interventions).

“Thirty-five participants from 12 countries in three regions (Africa, the Americas, and Europe) and two LMICs [low- and middle-income countries] were interviewed. Most individuals who have worked in global mental health over the past three decades come from high-income countries where most of the interviewees were based. Results show that global mental health has gained political attention, especially over the past decade, yet support remains limited. Over the past three decades, all factors analyzed became more favorable except one for which change was negligible: guiding institutions.”

Guiding institutions are organizations that coordinate and manage the mechanisms and tools needed to roll out and maintain the progress of an initiative sponsored by global leaders and international organizations. Iemmi, notes:

“The absence of a single guiding institution or coordination mechanism has hampered the coordination of efforts to elevate mental health at the global level. However, multiple institutions have held prominent roles, including international and civil society organizations.”

The creation and maintenance of a single guiding institution is not an easy task. Friction between factions was common throughout Iemmi’s analysis. And, despite growing popularity, a lack of agreement amongst stakeholders makes meaningful progress challenging.

Stakeholders from the biomedical side of global mental health, alongside stakeholders from the rights-based side of global mental health, both struggle to find and warrant credible indicators, cost-effective, scalable solutions, and a consensus on the definitions and causes of mental illness and ill-health.

“However, opportunities are arising, including an increasing number of leaders and grassroots organizations, multiple arguments for action and integrated solutions resonating with broader audiences, widening political support at the national level, an emerging global governance structure, and an expanding evidence base on the scale of the problem and available solutions.”

In particular, the author notes that both formal and informal unifying international groups such as United Global Mental Health (UGMH) and the Global Mental Health Action Network (GMHAN) may have a unique platform to solve disagreements and mediate arguments—only after these arguments are mediated and convergence of common understanding might meaningful change occur, not only in mental health’s political standing and priority but also in the field of GMH, in general.




Iemmi, V. (2022). Establishing political priority for global mental health: a qualitative policy analysis. Health Policy and Planning. (Link)


  1. You write…

    “Support has grown for Global Mental Health over the past decade, but political tensions and the lack of a shared vision continue to get in the way of new policies.”

    I say…

    But do we need “a shared vision?”. Why not “share” our differences of vision? Why not have diversity of vision?

    Vision is a word that can stand in for “own opinion”. But if this has to be “shared opinion” what happens if it is not “your opinion”? Are you then antithetical to the “shared vision”. When such a vast shared vision is rolling in tanks down a deprived area you may not want to share anything more.

    Animals do not share. Animals do not cause wars.

    I write this from my stay as an inpatient in a psychiatric hospital whose shared vision has been a huge blight in the past but not so much now. Today I dined on vegetable casserole that tasted delicious. As an ill person I am glad to have three hot meals a days in here and lots of caring people to speak to. People who have just saved my life in their opinon and my opinion.

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    • https://youtu.be/OgAMh7s-q_k

      This song says…

      “We will do as you say…God has left us anyway”.

      Schizophrenics and brothel residents have often been in bed with clients.

      Christain missonaries are ever waxing lyrical to save both. None ask if the persecuted can save themselves thank you very much.

      I must curb my tendency to think that articles are posted especially for me. As if each article is a veiled rebuke. A personal message. I must curb thinking each article is a set up since schizophrenia of the sort I have often thinks messages are being masterminded and broadcast to me. Like my telly talks only to me. Like antipsychiatry is there to confound only me, or wrestle with only me. Thinking this way is how my illness causes me to get tangled in skirmishes that frankly I have no interest in.

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      • I think these are important insights. It took me a long time to realize that someone else disagreeing with me had to do with them, not with me. I mean, I understood that intellectually, but to get so I accepted that fact emotionally took a long time.

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        • Better yet is to WANT people to disagree with you and make it all YOUR fault. A disagreement is like a puppy. It rips rag rugs and pukes on the sofa and gnaws television umbilical cords.

          A disagreement is not his problem, nor your problem. It is NOT a problem. It is LIFE.

          Imagine a world where there were no disagreements anywhere, ever. Sounds good. But for how long, a week, a month, a year? Disagreements are healthy signs of prioritizing the freedom to be different and have different freedom of own choices. But when disagreements are infiltrated by bullying, which is not the same as celebrating difference, then the bullying takeover that insists you “have to” change must not be accepted.

          In brief….

          Disagreements offer the cherishing of differences.
          If there is pressure by any bully to accept the customs of their party, if going from mere bickering to persecution of differences, this pushy bossy drive highlights a “contamination” of sportive disagreement, one that minus the toxicity and instead left to be in simple form often brought fond feelings of solidarity and even swimmy passion.

          There is danger in the idea we are all the same.

          Yes, you arrived at that conclusion. Good on you. But the iffy word fact, and your being obliged to accept it could be from a caring respect of other peoples “no” boundaries, such that the boundary looks as robust as the HOOVER DAM. But another version of having to tolerate someone’s giving you a fact can sometimes be about “their” need to bully your feelings via the rose prunners of scholarly discource.

          See it like enrichment in zoos. The captive animals sleep to death unless they get their pen messed up on Thursday then tidied up on Monday then strange blankets, big as manta rays gallumph down over the fence to cause outrage, intrigue, stress, excitement and happenings. Commotion is healthy for humans. Disagreements channel into the creating of new paintings and songs.

          We are engirdled by disagreements all our lives. They enrobe who we are. To the extent that a compliment feels like a strip that will reveal within that the pillar of rags held an invisible man nowhere in sight.

          A house is made of boundary walls. When the walls come down is the empty air in that cube of a house still tall and grand? Disagreements are bricks defining who we are not and who we are. But there is a way in which bullying seeps in through the gaps and infects the resident with a sense they must not have emotions or wishy washy sentiments, instead they must do a good performance of handling facts by agreeing with such facts.

          One NEVER has to agree with external facts if one does not want to. Other peoples boundaries must be respected. But when they come over their boundary and toss healing into your boundary they are being disagreeable in their sharing of disagreement.

          Disagreeing is fine and healthy.
          Being disagreeable is what bullies do. A person does have the right to be a truculant mocker who disagrees and does not love you. Nobody is perfect.

          But…if the bully becomes actually criminal or they start foisting conversion therapy then this ought not be allowed to pass without some comment. You cannot accept being treated like less than.

          ALL ARE EQUAL.

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          • I agree. Embracing disagreement teaches us to be bigger people. Fighting to be “right” makes us smaller. My biggest challenge comes when I’m trying to be big and encounter those who want me to be small again. It is tricky to handle that without lowering oneself to the “make them wrong” viewpoint.

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  2. I have to say that being made to be small and belittled is what bullies try to do, and add a rosette for good measure. This causes a reactivity to want to be big and make the bully just as small.

    But what people seldom reach is the cosmic superpower inherent in all small things. A small electric snap makes your ventricles run as smoothly as a kitchen flip top bin with swing lid, flip flap flip flap. It is the small things in life that make all the difference.

    If someone makes you feel small, and actually that is not possible as a flight path since no person can deliver their feeling into the closed vehicle of your body, that sense of being made to feel small is a feeling that is not even a feeling. It is a mental mind based overlay interpretation of a buried authentic feeling. Feeling small would be feeling sad, or feeling frustrated. And since you architect all your feelings without knowing it consciously they seem like dozens of escaped guinea pigs running and wriggling all over your house. They seem unmanageable and so you stress at having no intrinsic control of them. Instead it feels easier to say that so and so made me feel small.

    But what is small? when we feel feelings deeply and completely we become giants for braving staying with all our feelings, even if crying makes us look small.

    Small is massive.

    Everything you see right now as you gaze out of a window came from “a universe cake mix” thinned with an explosive. The Big Bang quantity was no bigger than a bag of sugar.

    Everything you touch and hold and sniff and balance on and see and even say comes out of a small detonated sugar bag.

    Not even feeling small will let you fit snugly right back into that lightyears away sugar bag. The sugar bag needs the small stuff to help make the big stuff. Now we know why I am in hospital.

    My angels say that you were a seafairing man who was captain of your own ship. You were poisoned there.

    Time I call the nurse for a biscuit embossed jigsaw puzzle.

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