Lecture 12: Global Mental Health

Question 1

Why did Hans become interested in psychiatry in the non-Western world? What field of research did he undertake?

Answer 1

Hans became interested in psychiatry of the non-Western world because his Mother was born in Indonesia and he had many connections there. He conducted research on colonial psychiatry.

Question 2

What was the ARC project (and what was its full title)?

Answer 2

The ARC project: Imagining Indonesian Psychiatry: Past, Present Future was conducted by Hans and two anthropologists from Harvard over four years (2014-2017). It involved interviews with mental health practitioners in Indonesia.

Question 3

There are (approximately) 270 million people in Indonesia, and how many psychiatrists?

Answer 3

Less than 1000.

Question 4

If Indonesia were to have the same percentage/density of psychiatrists as Australia, how many would they need?

Answer 4

Indonesia would need 175,000 psychiatrists, compared to the less than 1000 currently practicing.

Question 5

Why are the mentally ill placed in wooden locks? What are some consequences for those individuals?

Answer 5

The severely mentally unwell (such as those with schizophrenia) can become violent sometimes, so their feet are placed in wooden locks – sometimes for decades. Their feet sometimes with atrophy to a point where they aren’t functional.

Question 6

What is the practice of putting people’s feet into wooden blocks called? And what is the “anti practice/movement” called?

Answer 6

“Pasung” – the practice of locking people’s feet, and “Bebas Pasung” is the anti-movement.

Question 7

Apart from locking people’s feet into wooden locks, what is another practice for managing the mentally unwell in Indonesia?

Answer 7

Locking people up.

Question 8

What are some of the advantages of locking people in mental hospitals in Indonesia? How does Australia differ?

Answer 8

Well, even though the mental hospitals are not pleasant places to be, they still ensure a place to live, food, and some medical attention. Whereas in Australia, people aren’t locked up but they live on the streets. It could be debated as to which is worse.

Question 9

What is the repetitive history of Australia’s royal commissions into mental health care?

Answer 9

That, every four years there is a new royal commission on mental health care in Australia, and yet nothing is ever done.

Question 10

There are five areas that are measured by public health physicians to understand health? What are they?

Answer 10

Life expectancy, life expectancy at 1, quality of life measurements, disease burden (economic, psychological, etc.), & DALY (disability adjusted life years).

Question 11

Why are there two measurements for life expectancy?

Answer 11

Because in many countries, infant mortality causes their life expectancy to be lower than what is actually occurring. So children who die before the age of 1 are excluded from the life expectancy measurement.

Question 12

What is the problem with the mainstream measurements of health, in terms of how they reflect mental health?

Answer 12

Well, mental health is (generally) poorly reflected in the measurements of health – particularly as few people die as a result from their severe mental illness, they often die from other health complications.

Question 13

What is the DALY?

Answer 13

DALY’s measure “disability adjusted life years”, by subtracting the number of years someone lives with a disability from their life expectancy.

Question 14

Why are DALY measurements so important?

Answer 14

Because they indicate the prevalence of mental illness, and how mental illness may impact on someone’s life.

Question 15

There are large disparities in life expectancy between countries, what do the disparities reflect?

Answer 15

The disparity between counties reflects social issues and inequality.

Question 16

What is the leading cause of death in the age bracket of 15 to 44 in Australia?

Answer 16

Suicide (although, this is because there are less causes of death here than in older age).

Question 17

Why is life expectancy in the US falling?

Answer 17

Mainly because of the opioid crises, but also because of “unexplained deaths” in men with low education levels around 50 years.

Question 18

In Russia, why is there a decrease in life expectancy?

Answer 18

Apparently because of a spike in accidents and unexplained deaths.

Question 19

What is the leading cause of death worldwide?

Answer 19

Malaria.

Question 20

What is the leading cause of death in Africa?

Answer 20

Malaria and AIDS – mainly because AIDS medication doesn’t reach people in Africa because there is no value for pharmaceutical companies in a country with poor people.

Question 21

In global mental health, what is the “treatment gap”?

Answer 21

The difference between the incidence of a mental illness, and its treatment is stark. But this is true in the West too.

Question 22

In global mental health, what are some barriers to treatment for the mentally ill?

Answer 22

lack of physicians, lack of education in psychiatry, lack of medication, lack of medical infrastructure, stigma, and lack of mental health literacy.

Question 23

Life expectancy measurements are not good for understanding mental illness, but DALYs are. With the introduction of DALYs, what happened to the 10 leading disabilities in the world? And what did WHO do afterwards?

Answer 23

With the introduction of DALYs, 5 of the 10 leading disabilities in the world were changed to mental illnesses, and so WHO finally took notice of mental illness as something that needs combatting.

Question 24

What was the name of the pamphlet that started the global mental health movement – particularly in LMIC (lower and middle income countries)?

Answer 24

“Where there is no doctor”

Question 25

Why are there not enough doctors in developing countries?

Answer 25

Partly because educating physicians is expensive and takes a long time. To address the shortage of doctors is a long term solution.

Question 26

Although there are not enough doctors in developing countries to help treat mental illness, what are two other solutions?

Answer 26

An increase in nurses, who can make a huge difference. Also, health volunteers who can do household checks, etc.

Question 27

Who was Vikram Patel, and what was his pamphlet?

Answer 27

Vikram Patel is a leader in the global mental health movement, he created the pamphlet (as a spin on the WHO pamphlet): “where there is no psychiatrist”.

Question 28

What work did Vikram Patel do for communities?

Answer 28

Vikram Patel trained lay people in CBT for the treatment of depression. He discovered it works well IF there is adequate training and supervision.

Question 29

In the attempt to tackle global mental health issues, researchers, advocates and physicians often focus on “resilience”, why is that?

Answer 29

Because “resilience” helps local people to have mental health strategies that align with cultural repertoires.

Question 30

There are ways that communities can support their own mental health in the wake of a crises (the tsunami, 9/11), is this enough?

Answer 30

Yes, it is true that communities can come together to support each other through tough times, and mental health workers should not get in the way of this, but it is not enough for some really acute mental illnesses.

Question 31

What is the alternative approach to global mental health, known as “planetary health”?

Answer 31

Planetary mental health focuses on public health and the structural/social factors that prevent illness. The movement focuses on issues such as inequality, poverty, climate change and overpopulation.

Question 32

What is the difference between “global mental health” and “planetary health”?

Answer 32

“Global mental health” focuses on how to provide more mental health services to more people, whereas “planetary health” focuses on prevention and social change.

Question 33

Why is the “planetary health” movement so important?

Answer 33

Because ‘an ounce of prevention is worth more than a pound of cure’ and addressing the social issues that plague people is really, really important.

Question 34

In conclusion, there are many mental health challenges facing today’s societies, what are the two main solutions? AND the biggest point about global mental health solutions?

Answer 34

The two main solutions are global mental health strategies (treatments) and preventative strategies. The biggest point to remember about mental health solutions is that one solution does not fit all.