Academic journal article Journal of Marital and Family Therapy

Global Mental Health in Action: Reducing Disparities One Community at a Time

Academic journal article Journal of Marital and Family Therapy

Global Mental Health in Action: Reducing Disparities One Community at a Time

Article excerpt

The discipline of Marriage and Family Therapy (MFT) arose out of innovation. Rather than treating problems as individual processes, pioneers of the field connected what was going on with individuals to couple, family, community, and sociocultural processes, and developed models for intervening at these levels. While marriage and family therapists (MFTs) and other mental health providers today may see couple and family interventions as conventional best practices, at the time they were unconventional and bold because they defied the dominant psychotherapy practices of the time (Bischoff, 2011). With their focus on the functioning and influence of systems, MFTs continue to be innovators today. Examples are the leadership MFTs have played in the development of models of collaborative and integrative care (e.g., Hodgson, Lamson, Mendenhall & Crane, 2014; McDaniel, Doherty & Hepworth, 2013) and models of participatory research and community engagement (e.g., Doherty, Mendenhall, & Berge, 2010; Esmiol, Knudson-Martin, & Delgado, 2012; Piercy & Thomas, 1998), both of which address mental health care disparities. As attention increasingly turns to disparities in mental health care around the world (World Health Organization, 2013), the MFT's expertise with systems and role as an innovator is particularly needed.

Global mental health refers to research and practices designed to improve the mental health for all people around the world through: (a) local access to mental health services; (b) equity in distribution of resources that support mental health across communities; and (c) mental health treatment outcomes (Patel, 2014; Patel & Prince, 2010). Whether it entails research, practice, or both, it must be action-oriented and contextualized to the cultural and social circumstances of the country and community (Patel & Prince, 2010). Global mental health research can range from addressing questions related to mental health on a world-wide multinational scale, such as the Global Burden of Disease Study (Whiteford et al., 2013), to questions related to local issues, but always has implications for advocacy at the local, national, and global level (Horton, 2015). Global mental health practices are informed by and inform local initiatives or policies that improve the local access, equity and efficiency of mental health care (World Health Organization, 2015). It is in these local initiatives and local solutions that global models are developed and adapted according to cultural and social circumstances.

SCOPE OF THE PROBLEM

Mental health encompasses cognitive, emotional, behavioral, and relational functioning (American Psychiatric Association, 2013; World Health Organization, 1992). To determine the scope of the global mental health problem one must consider both (a) the prevalence of mental health problems; and (b) disparities in access to treatment. But, our understanding of the scope of the problem worldwide is limited by the quality of the available data, which is dependent on reliability and validity of measurement and uniformity in data collection. As it relates to the profession of MFT, there are two noteworthy challenges in measurement and data collection. First, the WHO and other international organizations tend to rely on the traditional psychiatric diagnostic categories that emphasize individual disease processes to determine the prevalence of mental health problems worldwide (Whiteford et al., 2013; World Health Organization, 2003, 2013). While there may be growing recognition of behavioral and relational problems (World Health Organization, 2013), data on the prevalence of these problems around the world does not exist. Second, the most reliable data about disparities in access to care relates to the number of mental health care providers. However, the mental health care workforce is largely unregulated worldwide. The exception is the medical profession of psychiatry. Consequently, our current understanding of access to care and the state of the world-wide mental health care workforce are the number of psychiatrists in a geopolitical region, country, or city. …

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