Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa.

Journal: PLOS global public health

Volume: 4

Issue: 3

Year of Publication: 

Affiliated Institutions:  Faculty of Health, University of Canterbury New Zealand, Christchurch New Zealand and Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India. Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, New Delhi, India. Kintampo Health Research Centre, Kintampo, Ghana. Regional Institute for Population Studies, University of Ghana, Accra, Ghana. Executive Secretary, Mind Freedom, Accra, Ghana. Centre for Mental Health Law and Policy, Indian Law Society, Pune, India. Institute of Community and Public Health, Birzeit University, West Bank, Occupied Palestinian Territories. Stellenbosch University, Stellenbosch, South Africa. Centre for Rural Health, University of Kwazulu-Natal, Durban, South Africa. Centre of Society and Mental health, King's College London, London, United Kingdom. Institute for Global Health, University College London, London, United Kingdom. School of Political and Social Science, University of Edinburgh, Edinburgh, Scotland. Department of Global Health and Social Medicine and Centre for Society and Mental Health, King's College London, London, United Kingdom. Warwick Medical School, University of Warwick, Warwick, United Kingdom.

Abstract summary 

Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a 'deficit model'. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in 'informal' community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.

Authors & Co-authors:  Mathias Bunkley Pillai Ae-Ngibise Kpobi Taylor Joag Rawat Hammoudeh Mitwalli Kagee van Rensburg Bemme Burgess Jain Kienzler Read

Study Outcome 

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Statistics
Citations :  Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82[11]:858–66.
Authors :  17
Identifiers
Doi : e0002575
SSN : 2767-3375
Study Population
Male,Female
Mesh Terms
Other Terms
Study Design
Study Approach
Qualitative
Country of Study
Ghana
Publication Country
United States