Summary
In this analysis, we argue that the ‘treatment gap’ for common mental disorders often reflects lack of demand, arising because services fail to address the needs of disadvantaged communities. We propose a route forward for global mental health, with explicit focus on action on the socioeconomic determinants of psychological suffering.
In northern Uganda, more than 50,000 people were recruited by the Lord’s Resistance Army (LRA) between the late 1980s and 2004, mostly by force. Around half of those taken were children (under 18 years old). A large number were never seen by their families again, but more than 20,000 returned through aid-financed reception centres. Endeavours were made to reunite them with their relatives, who were mostly living in insecure displacement camps. Relatively few were subsequently visited, even after the fighting ended in 2006. Thousands of vulnerable children were largely left to their own devices. This article draws on research carried out in 2004–06 and from 2012 to 2018, and compares findings with other publications on reintegration in the region. It argues that implementing best-practice guidelines for relocating displaced children with their immediate relatives had negative consequences. The majority of children who passed through a reception centre are now settled as young adults on ancestral land, where they are commonly abused because of their LRA past. With few exceptions, it is only those who spent a long period with the LRA and who are not living on ancestral land who have managed to avoid such experiences.
A well‐known medical journal, The Lancet, recently published an important systematic review and meta‐analysis of mental disorder estimates in conflict settings, advocating for the scaling up of mental health interventions in such contexts. However, there is an assumption that the introduction of such treatments has no significant impact, except from a therapeutic one, in the settings they have been imported to. The authors' research in post‐conflict northern Uganda analyzed the social impact of mental health interventions addressing post‐traumatic stress disorder (PTSD) and showed that promoting trauma has had considerable socio‐economic ramifications on the wider society. The introduction of trauma narratives has created a market where some are able to thrive, but many deeply troubled individuals remain invisible. The authors found no social benefits from promoting trauma, and few positive effects for individuals. Arguments for urgently upscaling mental health interventions of the kinds highlighted by the review in The Lancet, and which the authors have observed on the ground, should be treated with caution.
Achieving high rates of COVID-19 vaccination has become central to a return to normalcy in a post-pandemic world. Accordingly, exceptional measures, such as the regulation of immunity through vaccine passports and restrictions that distinguished between vaccinated and unvaccinated individuals, became a feature of vaccination campaigns in certain G7 countries. Such policies stand in tension with recent supranational European Union policies that seek to build inclusion and trust through engaging minoritised groups in vaccine campaigns. To explore this tension, we present novel ethnographic data produced with migrant and Roma communities in Italy. Our evidence suggests that under restrictive measures, many within these groups initially described as ‘vaccine hesitant’ have accepted a vaccine. Yet, rather than indicating successful civic engagement, we find that vaccine acceptance was tied to deepening mistrust in science and the state. Considering the structural socioeconomic, historical and cultural elements informing people’s vaccination choices, we propose a shift in emphasis towards equitable principles of engagement.
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