Beyond Western Psychiatry: Rethinking Global Mental Health

The global mental health movement has faced criticism for its promotion of standardized interventions that lack cultural relevance and its tendency to replace local understandings of psychological distress with a westernized disease model. A new commentary published in Culture, Medicine, and Psychiatry argues that Western models of mental health and recovery are most helpful when they incorporate and honor local traditions and understandings of psychological distress. This commentary, by Augustus Osborne from the Institute for Development in Sierra Leone, covers the success of several pluralistic interventions as well as the risks of the global export of Western psychiatric models. Osborne writes:

Harms Associated with the Global Mental Health Movement

Research has found that the global mental health movement has not helped in reducing the global burden of psychiatric disorders. A 2004 study from 100 countries found that the introduction of mental health initiatives and more access to psychiatric drugs increased suicide rates. In Nepal, Western psychiatric models reframed social obstacles as mental health problems, shifting the focus from improving systemic problems to treating individual mental “illness” and reinforcing existing inequalities. Westernized psychiatric interventions in Africa, South Asia, and Latin America replaced local treatments for psychological distress that emphasized integration within communities with clinical categories that separated “patients” from the larger community, likely complicating long-term recovery. Experts have criticized the global mental health movement for creating new illness categories which can cause reinterpretations of distress and chronic, intensified symptoms, paving the way for exploitation by the pharmaceutical industry, and scaling up interventions with little thought for adapting them to local cultures resulting in inappropriate diagnoses and worse outcomes.

Key Critiques of the Global Mental Health Movement

The current work presents three main critiques of the global mental health movement. First, cultural mismatch in the understanding, classification, and treatment of psychological distress is common with psychiatric models exported from the west. Osborne gives the example of South Asia and Africa, where distress is commonly felt in the body and described in terms such as “burning in the head” or “pressure in the heart.” Western psychiatric models often overlook such markers of distress, classifying them instead as “medically unexplained symptoms.” This cultural mismatch can also lead to the classification of normal cultural experiences, such as hearing the voice of a deceased loved one, as pathological.

Second, the medicalization of social suffering threatens to obscure social determinants of distress. Western psychiatric models tend to locate mental “illness” within individuals, often neglecting the systemic causes of distress. This can lead to policy and funding decisions that prioritize drugs and therapy at the expense of implementing social and structural changes.

Third, Western psychiatric models often take a dismissive or even adversarial position with respect to local healing systems. While Western models frame these practices as “unscientific” and “superstitious,” they are embedded in local understandings, cultural practices, and social networks. Despite the success of these local models in treating psychological distress, the imposition of Western psychiatry threatens to displace or even replace them.

Pluralistic Implementation of Psychiatric Interventions

Osborne presents several interventions that combine Western psychiatric practices with local realities, social structures, and healing practices. Task-shifting describes a practice in which mental healthcare is delivered by community members rather than mental health professionals. While this practice was born from a lack of psy-professionals in many low- and middle-income countries, Osborne argues that the promising results challenge the idea that experts are necessary in the delivery of mental health interventions.

One example of a successful task-shifting program is the Friendship Bench Project in Zimbabwe. This program trains grandmothers, who are respected community members with strong social ties, to facilitate problem-solving therapy sessions in the local language using metaphors familiar to people from Zimbabwe. A randomized controlled trial found participants in this program had a greater reduction in both depression and anxiety compared to treatment as usual. This improvement was sustained over at least six months.

Partnerships between local practitioners and biomedical clinicians have shown some promise in treating mental health issues. In Uganda, traditional healers have partnered with biomedical providers resulting in increased access to mental healthcare, reduced harmful practices, and less resistance to psychiatric drugs. Similarly, partnerships between faith-based organizations and biomedical providers in Nigeria have increased community acceptance and reduced stigma around mental health struggles.

Osborne notes that while combined approaches have shown promising results, randomized controlled trials are likely not able to capture the true efficacy of local forms of healing and recovery. When Western ideas of evidence and efficacy dominate, these practices are often sidelined. It is also worth noting that while Osborne classifies reduced resistance to psychiatric drugs as a positive aspect of biomedical and traditional healer partnerships, other experts have argued that recruiting locals to talk people into taking psychiatric drugs is a negative aspect of the global mental health movement.

Hybrid models that combine aspects of both local forms of healing and Western psychiatric practices have also shown promise. For example, In Nepal, providers have pioneered a type of narrative exposure therapy embedded in local rituals and storytelling practices. Participants were more engaged with this hybrid intervention, and also showed significant clinical improvement. South Africa has implemented a system that involves traditional healers in mental health referral systems which has increased the reach of community care. While Osborne points to these interventions as successful pluralistic experiments combining local healing with Western psychiatry, he warns that “the unchecked dissemination of Western psychiatric approaches continues to pose significant risks to cultural context and community well-being.”

Risks of Exporting Western Psychiatry

Osborne points to three main risks of exporting Western psychiatric models. First, this practice threatens the loss of cultural context around psychological distress and recovery. Diagnosis, categorizations of mental “illness,” and treatment protocols can alter local framing of suffering and healing. Research has found that psychiatric labels can be destructive of existing social networks and coping strategies. These labels can even alter the course of “illness.” One such example comes from Sri Lanka, where the imposition Western psychiatric labels resulted in the increased stigma and social exclusion.

This kind of increased stigma around psychological suffering is the second main risk of exporting Western psychiatric models according to Osborne. Research has shown that the biomedical model of mental “illness” increases stigma. As with the above example from Sri Lanka, research from China found that the medicalizing depression resulted in increased stigma, social distancing, and discrimination in rural areas.

Third, the global mental health movement tends to prioritize drug treatments, which can create an over-reliance on pharmaceuticals. According to Osborne, psychiatric drugs are prescribed in many low- and middle-income countries without proper monitoring, follow-up, or informed consent. The pharmaceutical industry also aggressively markets its products, leading to concerns of overdiagnosis.

To overcome these risks, Osborne believes that global mental health must embrace pluralism rather than a universal or one-size-fits-all approach to mental healthcare. This would involve mental health care that is adapted to local cultures and co-designed with local communities. Leadership positions should be filled by local professionals and service users, and research funding should prioritize innovations and input from various stakeholders with differing points of view and beliefs about mental health. Osborne concludes:

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Osborne, A. (2026). Embracing pluralism: Rethinking western psychiatric models for equitable global mental health. Culture, Medicine, and Psychiatry, 50(1). (Link)