The Beauty of Global Mental Health

The Beauty of Global Mental Health

The Beauty of Global Mental Health

By Bryan Wright 0 Comment October 12, 2019


It’s 1998 and I’m visiting Lisutu, a Southern African country surrounded
by South Africa where I happened to be living at the time. Presidential elections have recently
occurred and people are not happy with the outcomes. I’m in a car with colleagues
driving through the Capitol
after a long weekend in the mountains. As we drive,
the crowd around us thickens. We see angry expressions on faces in
this crowd as people shouted us and believing that we would pass
quickly through. We drove on. In a minute our car is surrounded, young men sit down in the
road in front of the car. People with cinderblocks pick up the
cinderblocks and bring them crashing down on the doors of our car and a baseball
bat crashes the back windshield. We are terrified. Some friendly bystanders on the side of
the road beckoned us and we somehow pull off the road. We abandoned our car. An ambulance drives through moments after
this and drives us to the border with South Africa. Back in Johannesburg
hours after the event. Our goal is to stay together to deal
with the shock and the pain of this event and we try talking. We try alcohol, but the sensation of distress, something like the pain of an
incision actually lingers for days, but I was fortunate I did not
develop a severe anxiety disorder. I was not one of the 1.5 billion people
who lives in areas affected by conflict, by fragility or large scale organized
criminal violence who are more likely to have been repeatedly
exposed to traumatic events, nor was I someone consistently exposed
to the traumas of forced migration or other adversities in childhood,
increasing my risk for disorder. I have not lived in
settings of deprivation into my knowledge. I do not have the
hyperactive HIPAA Campbell circuitry, that little area in my brain where anxiety
and fear arise that might increase my vulnerability to post
traumatic stress disorder and I was not a child. This did not happen to me during one
of the sensitive periods of development during late childhood
or early adolescence, which is the time during which the
majority of mental disorders present in adulthood begin to emerge and I had
access to safety and I had the ability to find resources to manage my own emotions, but childhood trauma is one of the
risk factors for mental disorders in adulthood and mental disorders are about
a billion people around the world live with a mental disorder that’s
16% of the global population. That means about one in six people are
living with a mental disorder and we think of depression as the most
prevalent but anxiety disorders, schizophrenia, substance use disorders, these affect hundreds
of millions of people. Much of my research has focused on people
living with severe mental illnesses and these are conditions that have reached
the later stages of illness on this continuum from wellbeing all the way
to lasting symptoms and chronicity. They include things like psychotic
disorders or schizophrenia, but also severe bipolar disorder and
sometimes severe major depression. They are accompanied often
by incur paired functioning, sometimes repeated psychiatric
hospitalizations as well
as social problems like unemployment, poor social
support, and even homelessness. Adults with severe mental illnesses
are more likely to have experienced childhood trauma and are also more
likely to experience adult victimization. This cumulative exposure to multiple
kinds of childhood trauma increases the risk for victimization and adulthood
and high rates of childhood adversity. Seen among people with severe mental
disorders is strongly related to psychiatric problems including depression,
post traumatic stress disorder, suicidal thinking as well as
repeated psychiatric hospitalization. This has a gender component as well
for women with severe mental illness. Violence, all too often accompanies relationships
with partners and families. One in three women with
severe mental illness, experienced violence and
intimate relationships and
these women experience a 13 to 19 fold greater risk of violence
than the general population. And importantly, this has consequences
for their mental health and wellbeing, but also for other significant
health risks like HIV. The global HIV pandemic is one of the
most challenging public health problems of our time for women with
severe mental illnesses. The psychosocial context in which they
live frequently increases risk for HIV infection. Now in the United States you can see
that we have a HIV prevalence in the general population of
around 0.5% half a percent, but there is an estimated four to 10
fold difference in HIV prevalence between the general population and people living
with severe mental health conditions. But this is a global problem as well. This is not just a United States
problem among Ugandan women. HIV prevalence is almost twice as high
among women with serious mental illness than in the general population. So the solutions to these kinds
of problems must also be global. How do we approach complex problems
that must address mental health, other medical conditions like HIV and
the social contexts in which they arise? Well, the university of Washington global mental
health program faculty and staff work to do precisely this to develop test, build capacity to deliver contextually
appropriate and sustainable models for mental health intervention with local
and global partners because we recognize that addressing the challenges
of mental illnesses, whether childhood trauma
or the complexities of
depression in HIV or perinatal mental health can be done creatively
when we work across borders, across cultural contexts to
solve these kinds of problems. In fact, solutions from the global South can be
applied in the global North and this is one example. You’re seeing an image
of the friendship bench. This intervention delivered on an
ordinary bench instead of in a therapist office provides an evidence
based psychological therapy
adapted for the delivery by trained community health workers in
Zimbabwe and they’re typically grandmas. It’s effective in reducing symptoms of
depression for people who are living in considerable adversity. The name of the therapy is
called problem solving therapy. It’s also being analyzed now for how well
it improves adherence to HIV treatment for people who are managing both
mental health problems and HIV. Interestingly, New York city has also adopted this and
adapted it for use by peers across their boroughs. And the bench has also been set on
by the Duke and Duchess of Cambridge. So imagine when some
of the mental effects, mental health effects of childhood trauma
and adversity can be mitigated by non specialist providers in the global
South and in the global North. And imagine if we can actually begin
to test some of these innovative global approaches to our comprehensive
responses to challenging local problems. And I’ll give you just one example.
And this is already happening, and this is the beauty of
global mental health. Thank you. [inaudible].

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