Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health

Abstract

The contentious debate on evidence-based Global Mental Health care is challenged by the primary mental health program of Jamaica. Political independence in 1962 ushered in the postcolonial Jamaican Government and the deinstitutionalization of the country’s only mental hospital along with a plethora of mental health public policy innovations. The training locally of mental health professionals catalyzed institutional change. The mental health challenge for descendants of African people enslaved in Jamaica is to reverse the psychological impact of 500 years of European racism and colonial oppression and create a blueprint for the decolonization of GMH. The core innovations were the gradual downsizing and dismantling of the colonial mental hospital and the establishment of a novel community mental health initiative. The successful management of acute psychosis in open medical wards of general hospitals and a Diversion at the Point of Arrest Programme (DAPA) resulted in the reduction of stigma and the assimilation of mental health care into medicine in Jamaica. Successful decentralization has led to unmasking underlying social psychopathology and the subsequent development of primary prevention therapeutic programs based on psychohistoriographic cultural therapy and the Dream-A-World Cultural Therapy interventions. The Jamaican experience suggests that diversity in GMH must be approached not simply as a demographic fact but with postcolonial strategies that counter the historical legacy of structural violence.

Optimizing personalized management of depression: the importance of real‐world contexts and the need for a new convergence paradigm in mental health

“…Even widely experienced processes, such as deinstitutionalization, provide context-specific lessons about leveraging political opportunities into gains for mental health 8 . In many settings, deinstitutionalization and innovations in community mental health coincided with the establishment of post-colonial governments, the end of military dictatorship, or the entry of democracy.…”

“…In many settings, deinstitutionalization and innovations in community mental health coincided with the establishment of post-colonial governments, the end of military dictatorship, or the entry of democracy. For example, the expansion of community mental health services in Jamaica after its independence developed in alignment with local cultural values, distinct from the colonial era 8 . These creative approaches to mental health care are valued, though not always widely disseminated.…”

Global Mental Health: Interdisciplinary challenges for a field in motion

“…This special issue of Transcultural Psychiatry provides a snapshot of current interdisciplinary work that reflects the complexity and ongoing evolution of GMH. The authors reflect on the histories and colonial legacies of violence inscribed in mental suffering and programming (Capella, Jadhav, & Moncrieff, 2020;Hickling, 2020;Ortega & Wenceslau, 2020), on current models of culturally responsive intervention and implementation (Bustamante Ugarte et al, 2020;Hatcher et al, 2020;Honikman, Field, & Cooper, 2020;Mascayano et al, 2020;Shehadeh et al, 2020;Verhey et al, 2020) and on the challenges to mental well-being from the impending conditions of catastrophic climate change (White, 2020). Another set of contributions challenge established narratives on psychological suffering and trauma after war (Medeiros, Nanicha Shrestha, Gaire, & Orr, 2020), natural disaster (Newnham et al, 2020), and cultural practices of female genital cutting (Omigbodun, 2020).…”

“…At times, mental health institutions have been harmful to people they are mandated to care for, whether through coercive or carceral care or, more pervasively, though what Stevenson has called ''anonymous care' ' (2014), which fails to come to grips with the life world of the people it aims to help. Practices of decolonization, Hickling (2020) writes in this issue must therefore be at the center of a postcolonial mental health practice -especially in places like Jamaica that have experienced hundreds of years of oppression and structural violence. Hickling reminds us that psychiatry's own institutions -most notably the asylum -were brought to Jamaica through British colonialism, and that ''the concept of involuntary commitment, custodialization, and compulsory detention for patients with acute mental illness is a product of modern European civilization and to this day underpins much of the contemporary European mental health agenda' ' (p. 20).…”

The The Violence of Colonization and the Importance of Decolonizing Therapeutic Relationship: The Role of Helper in Centring Indigenous Wisdom

“…What non-Indigenous mental health and health care systems identify as mental illness, chronic health conditions, and/or problematic behaviour, I interpret as suffering that is directly related to colonial violence and oppression, past and present. The context and the etiology of these states of psychological distress and disease is colonization (Brave Heart, 2003;Cole, 2006;Duran, 2006;Hickling, 2020). Violence sanctioned and executed by the state is "sick" and "crazy-making."…”