Global Mental Health from the Margins- Reframe 2024 | MHI

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EDITOR’S NOTE

RAJ MARIWALA

This is the sixth edition of ReFrame, though it is, by all accounts, late by a year. As editor, I had decided the theme for this issue well ahead of time, but was unable to write a call letter for well over a year. At the time, after seeing me struggle for many months, my colleague, and MHI CEO, told me that it was okay to not publish at all that year. This allowed me to completely stop thinking about ReFrame for months. Much later, I was able to write with the support of teammates, but I continue to struggle to reach the pace of thought or work I’ve maintained in years past. 

It is important for me to start this off with such a ‘personal’ conversation because, despite regular access to a psychiatrist and counsellor, I was unable to do this work. In fact, it is due to accommodations, and due to enabling environments, that I manage to work at all. However, according to the 2018 Lancet Commission on Global Mental Health (GMH) and Sustainable Development, critiques of the dominant biomedical narrative are a threat to Global Mental Health. How is the GMH field fit for purpose if there is an overwhelming need to uphold Western psychiatric frameworks?

Additionally, deemed problematic by the Lancet Commission was the idea of diverse constituencies fragmenting advocacy particularly by foregrounding discrimination. Thus, it isn’t surprising that conversations around mental health at work, or around depression, anxiety, or burnout, don’t consider how neurodivergent folx experience burnout. This is why I prefaced this note with a personal example. 

However, even when one looks at the knowledge or advocacy around experiences of neurodivergence, they are not inclusive of those marginalised by race, caste, ethnicity, class religion, gender, and sexuality. While my experience is valid, I have many advantages in my corner – being at the top of the organisational chart, not having to factor in monetary concerns, not having to continuously prove myself due to caste privilege, etc. But how does one work towards access for all or universal health care when certain narratives, communities, and knowledge are excluded from GMH? If these omissions remain unquestioned in GMH and health equity discourse, psy-institutions will continue to reproduce systemic violence that is embedded in “everyday practices of a well-intentioned liberal society” (Iris Marion Young).

Of course, this is not new; the mental health industry has always colluded with power,  particularly the colonial matrix of power. However, since GMH aims to focus on low and middle-income countries (LMICs) contexts, should it not foreground decolonisation and decoloniality? The lack of visible engagement on this has propelled my work for this issue of ReFrame. There is anger and rage as one watches the mental health industry be silent or become active participants in the dehumanisation of certain communities and nations over the last eight months. 

This is very clear in the way we saw the psy-complex allying with Ukraine, versus the lack of humanity being accorded to Palestine, as well as Congo and Sudan. On the contrary, a few major psychiatric associations, such as the American Psychiatric Association (APA) and the American Academy of Child & Adolescent Psychiatry (AACAP), wrote statements against acts of terror against Israel. How is it that all the voices and clamour around youth mental health don’t extend to Palestinian youth? Or maternal mental health extend to Palestinian mothers? I wonder how many formal bodies within the psy-disciplines have shown any solidarity at all for the long ongoing and current acute atrocities against Palestinians. 

I often speak (and write) of the violence of clinical legacies in the psy-disciplines, but the last eight months have made me question whether to call it a violent clinical legacy, for the violence and weaponising of the psy-discipline under the garb of scientific neutrality is well and truly alive. Mental health cannot overlook the collective impact of colonialism and oppression on people’s well-being.. As Ursula K. Le Guin writes, “It was easy to share when there was enough, even barely enough, to go round. But when there was not enough? Then force entered in; might making right; power, and its tool, violence, and its most devoted ally, the averted eye.”

With this issue of ReFrame, we hope to address the averted eye in psy-disciplines, featuring scholarship from feminists from Turkish, Kenyan and Dalit movements; Mental health professionals from Palestine, Malawi, and Kashmir; and from indigenous communities across the world – Quichua, Naga, Roma community, and the Murrup Bung’allambee Indigenous Psychology group. Voices from peer support providers, trafficking survivors, and social workers in this issue detail how we can gain practical on-ground understanding of interrupting power and disenfranchisement. 

You will find these essays interspersed throughout ReFrame, with section 1, ‘Re-vision’, featuring advocacy, perspectives, and research on livable lives, colonial trauma, and cultural negligence, neoliberal well-being, and neurodiversity. The “Contexts” section details lived experience that challenges mainstream constructs around Post-traumatic Stress Disorder, maternal mental health, stigma and discrimination, cultural sensitivity, and colonialism. Finally, “Engage” shares on-the-ground examples of research, service delivery, law, and policy on incarceration, collective healing, trauma-informed approaches from marginalised communities, health equity, and digital medicine. 

With this issue, I hope that we all continuously confront suffering in ways that are intersectional and collective, while also centring context, resistance, compassion, and solidarity.

FOUNDER’S NOTE

HARSH MARIWALA

In the last edition of ReFrame, I wrote about the need to break out of the ‘business as usual’ mode. The challenges facing humankind are increasingly complex,  interconnected, and deep rooted. Temperatures continue to shatter records locally, regionally and globally. Conflict continues unchallenged in Gaza, Manipur, Congo and Sudan. The failure of international government bodies, courts of justice and civil society as the world watches attacks on hospitals, aid workers, schools, watches ethnic cleansing whether in Gaza or Sudan – tells me that the system is broken. 

Continuously reminding ourselves of this is necessary for philanthropy to engage with polycrises. As a starting point, there is a need to question multiple assumptions in our approach to philanthropy and international development. To enable systems change we cannot think in terms of months, quarters, or years – these mainstream ideas around time horizons of funding will not result in lasting progress. Long-term funding of individuals, collectives, and communities is essential to create lasting impact. If the philanthropic vision is long-term, then it is necessary to think beyond immediate and tangible results. By ensuring that funding allows stakeholders to focus on the future, philanthropists can help lay the groundwork for environments where lasting progress is possible. 

Linked to this is the focus on impacts, outcomes, and metrics, which are not fit for purpose. Such narrow indicators may help with measuring incremental change, but the world needs transformational change. The top-down expert-led frameworks of Monitoring, Evaluation, and Learning (MEL) are part of the same problem because they are based on the assumption that “we know what success looks like.” 

Perhaps, the most dangerous assumption of all is that philanthropists “find solutions,” “build solutions,” or “solve for” – it is crucial to recognize that the philanthropy cannot discover, evaluate,  or own the answers. Philanthropists must be willing to listen to and learn from the communities they aim to serve, rather than making choices on their behalf. The biggest hurdle in this process is often ego; effective philanthropy requires humility and a genuine desire to empower others rather than seek personal recognition or legacy. 

Finally, the assumption that funding or financing is a pivotal factor needs to be questioned. It is only one of many variables, for no matter how much money is thrown at climate change or mental health, they will continue to be long-term problems. Whether it is very popular giving pledges or recent commitments around health and climate, how we give possibly matters more than how much we give. I urge philanthrophy to be reflexive and ask of ourselves: how accurate are we in providing funds to the right people, and how efficiently do we make funds and resources accessible to them?

Re-Vision

  • ADVOCACY |
  • PERSPECTIVE |
  • RESEARCH

With embedded biases in knowledge systems themselves, what are the ways and measures that need to beHow do we critique the agenda of treatment of mental, neurological, and substance use conditions in LMICs juxtaposed with the aim of equitable mental health for all? How has the Global Mental Health (GMH) field reacted to critique regarding its relevance in tackling mental health issues worldwide? How can we reimagine frameworks to be intersectional and foreground liberation, social justice and psy-activism, and acknowledge both the risks and resilience in resistance?How do we understand resilience when it comes to oppression that is both historical, intergenerational and day-to-day?

Context

  • PERSPECTIVE |
  • HUMAN RIGHTS |
  • LIVED EXPERIENCE |
  • SERVICE DELIVERY |
  • ADVOCACY

How does the Global Mental Health (GMH) field engage with mental health issues related to global humanitarian crises? How is the GMH field complicit in upholding colonial, racialized, casteist and Eurocentric power dynamics? How does the GMH field engage with mental health distress in conflict zones, and does it decry the systemic forces that cause this distress? How has lived experience within the GMH field been defined, and does it fit LMIC contexts? How does the GMH field treat identities of race, caste, nationality, ethnicity, religion, gender, ability, occupation and class across countries? 

Engage

  • ADVOCACY |
  • PERSPECTIVE |
  • RESEARCH

Who commissions research in the GMH field, and how much of academic publishing involves collaboration with local communities, survivors/service users? Where and how are recent digital solutions being put forth to address mental health concerns? What specific mental health conditions do these solutions address, and how effectively do they do so? How does the GMH field engage with the carceral system? How does the GMH field position social and environmental factors such as poverty and food insecurity in the context of mental health issues? How does the GMH field address the health issues of communities marginalised by colonisation that reside within Western nations? 

MHI’s Work Innovation | Insights | Philanthropy | Challenges | Lived Realities

We work with multiple stakeholders – including non-profit organisations (NGOs), governments, mental health professionals, and activists – in the pursuit of an INCLUSIVE mental health ecosystem. Our core strategies include ADVOCACY, CAPACITY BUILDING, and GRANTMAKING.

About MHI

MHI provides grants and strategic support to organisations and collectives working within communities to provide greater access to mental health services for all.

About ReFrame

ReFrame, a journal by the Mariwala Health Initiative is a platform to challenge existing norms and explore diverse voices within the mental health space — expanding horizons for who gets to participate in such conversations in an effort to firmly ground mental health in a contextual, intersectional, rights-based, intersectoral framework. It is envisioned as a tool for mental health practitioners, advocates, activists, scholars, students, experts, funders, government officials, and non-profit organizations — and those from closely allied sectors.

PERMISSIONS Copyright © 2024, Publisher: Mariwala Health Foundation CONTENT WARNING: Readers to note that this edition has an article discussing the ongoing Palestinian genocide. Additional content warning for: authoritarianism, colonisation, colonial extractivism, war, forced displacement, forced migration, dispossession, apartheid, civilian killings, torture, oppression, violence perpetrated by armed forces, life in conflict regions, cultural erasure, enslavement, serfdom, coercive sterilisation, communal conflict, casteism and caste violence, ableism, transphobia, queerphobia, conversion therapy, rape, molestation, sexual violence, extra-judicial murder, torture, human rights violations, human trafficking, racism, systemic discrimination, social exclusion, stigma, Roma Holocaust, incarceration, isolation, suicide, post-partum suicide, suicidal ideation, parasuicide (thoughts of self-harm), environmental exploitation, climate change, depression, stress, anxiety, PTSD, adjustment disorder, psychosis, trauma, historical and collective trauma, generational trauma, non-affirming therapeutic practices, physical abuse, verbal abuse, sexual abuse, polyvictimisation, misogyny, domestic violence, gender-based violence, abortion, miscarriages, reproductive violence, substance abuse, poverty, loss In the case of material being triggering or upsetting, you can reach out to iCall at +91 9152987821 or icall@tiss.edu

EDITORIAL TEAM

Raj Mariwala
Ruby Hembrom 
Manali Roy 
Anugraha Hadke 
Saniya Rizwan
Amalina Sengupta

COPY EDITOR

Janani Ganesan 
Shraddha Mahilkar

ILLUSTRATIONS

Deepti Megh 
Keisha Leon 
Lina Jadarat 
Rishabh Pinapotu
Canato Jimo 
Rose Kibara
Axel Rogel 
Samyak Prajapati

IMAGES

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ICONS

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