Fernando Lolas

This article applies the concept of normality, in both its descriptive and normative connotations, to the field of mental health, emphasizing its ethical undertones in different cultural and situational contexts. Ethics is defined as the linguistic justification of morals, and bioethics is characterized by arguments based on dialogical, discursive, and deliberative processes. Bioethical decision-making influences human relationships and has implications for diagnosis, prognosis, interventions, and evaluation of therapeutic results and outcomes. Normality in mental health should be reformulated on bioethical principles to avoid being a source of stigma and discrimination, at a time when human diversity and cultural change impose a redefinition of conceptual boundaries and depathologization of different forms of behavior and experience.

Global Issues in Mental Health: Primary Care & School Mental Health, Ethics & Culture, and Migrant & Refugee Mental Health

Co-chairs: Vincenzo Di Nicola, MD, PhD, Fernando Lolas, MD
Presenters:

1. Gabriel Ivbijaro, MD
2. Fernando Lolas, MD    
3. Vincenzo Di Nicola, MD, PhD  
4. David M. Ndetei, MD       
5. APA International Fellow & Resident: Aleema Zakers, MD, Nadia Daly, MD
Discussant: Gabriel Ivbijaro, MD

ABSTRACT:

After the information revolution produced a global village, the economic revolution with its global flows of goods and services, finance and people, produces globalization of life. While research on social determinants of health means mental health must be understood globally, we talk about mental health in local and static terms, confining mental health to the margins. Health problems are seen as entities rather processes, solutions aimed at individuals instead of communities, and we overvalue biological explanations and undervalue family, social and cultural contexts for mental and relational problems. As the WHO/World Bank conference declared, “it’s time to move mental health from the margins to the mainstream of the global development agenda.”

1. Realizing the Vision for GMH through Primary Care Transformation. Global initiatives on mental health outcomes aim to improve on current projections for global mortality and burden of disease by 2030. People with severe mental disorder die 10-20 years earlier. Primary care transformation can narrow the science-to-service gap in GMH. Primary care data is reviewed. GMH policies are part of care in their own right rather than tools to implement care.
2. The Ethics of Cultural Sensitivity and GMH. Global violence, mass migration and climate change make reflection on GMH imperative. Yet ethics is local, determined by culture and custom. Developing cultural sensitivity is a challenge. “Ethical sustainability” of policies demands strong forms of social empathy and pragmatic approaches. This offers fresh insights on the global dimension of health, a hermeneutical understanding of culture and an emphasis on new social and intellectual practices. This new conception of health permits a coherent formulation of “culture-fair” GMH.
3. Experiences of School Mental Health in Rural and Urban Settings in Kenya. A pilot study to develop school mental health in rural setting, urban and peri-urban settings in Kenya demonstrates that it is possible to engage key stakeholders, above all the children themselves. The study concluded that life skills training is a viable intervention that can be implemented in Kenyan schools with minimal extra resources and is therefore sustainable.
4. Borders and Belonging: Global Migrants and Mental Health. With over one billion global migrants, the 21st century has begun as the century of the migrant. Contentions over borders demand that our way of thinking about and dealing with migrants and borders be revised. This has implications for anthropology and geography, politics and philosophy, and not least for medicine and psychiatry. Psychiatry must redefine how we deal with migrants and refugees, their displacements and potential traumas and their place in the world. Implications for the theory and practice of psychiatry, for global mental health and for policy and service planning, as well as for therapeutics are outlined.
5. The Perspective of APA International Fellows.