The (Mis)appropriation of HIV/AIDS advocacy strategies in Global Mental Health: towards a more nuanced approach

Abstract

BackgroundMental health is increasingly finding a place on global health and international development agendas. Advocates for Global Mental Health (GMH), and international organizations such as the World Health Organization (WHO) and the World Bank, argue that treatments available in high-income countries should also be made available in low- and middle-income countries. Such arguments are often made by comparing mental health to infectious diseases, including the relative disease and economic burdens they impose, and pointing to the applicability of the right to access treatment for mental health, not only infectious diseases. HIV/AIDS advocacy in particular has been held up by GMH advocates as offering an appropriate strategy for generating global commitment.DiscussionThere is a need to assess how health issues are framed not only in relation to social goods outside of health (such as human rights, security or development), but also in relation to other health or disease models, and how health policy and practice is shaped as a result. The article debates the merits and consequences of likening mental health to HIV/AIDS, and identifies four major problems with the model for GMH advocacy being developed through these analogies: 1. An inappropriately universalizing global approach to context-specific problems; 2. A conception of human rights that focuses on the right to access treatment at the expense of the right to refuse it; 3. A tendency to treat poverty as a psychiatric issue, rather than recognizing that mental distress can be the result of poverty and other forms of inequality; 4. The prioritization of destigmatization of disease over social justice models.ConclusionThere are significant problems with the wholesale adoption of an (often simplified) version of HIV/AIDS advocacy as a model for GMH. Yet critical engagement with the important and nuanced differences between HIV/AIDS and mental health may nevertheless point to some possibilities for productive engagement and cross-fertilisation between advocates, activists and scholars in both fields.

From ‘Invisible Problem’ to Global Priority: The Inclusion of Mental Health in the Sustainable Development Goals

“…The move away from understanding mental distress as ‘illness’ is not evident in literature framing mental health as a development priority, where divergent but largely individualized and medicalized understandings tend to prevail. Similarly, much global mental health advocacy equates reduction of stigma with psycho‐education based on medicalized and psychologized understandings of distress as illness (Howell et al., ). While some argue that framing distress as ‘illness’ helps to normalize the experience and encourages people to take mental health as seriously as its physical counterpart, others claim this framing may be problematic.…”

Establishing political priority for global mental health: a qualitative policy analysis

“…Since 2008, the Movement for Global Mental Health (MGMH) has attempted to strengthen the policy community with limited results partly attributable to the limited representation of local understanding of the issue and its solutions and the limited mobilization of local activists ( Patel et al. , 2011 ; Howell et al. , 2017 ; Campbell, 2020 ; MGMH, 2021 ).…”

“…The selection of indicators risks to narrow the policy agenda by focusing on specific dimensions (e.g. mortality) ( Storeng and Béhague, 2014 ) and the adoption of simple solutions to universalize context-specific issues ( Howell et al. , 2017 ).…”

Critical reflections on the concept and impact of “scaling up” in Global Mental Health

“…GMH and the MGMH follow the perceived success of the global HIV/AIDS response, which reinforces the scalar and spatial mindset that mental health is a global problem with a universal solution. Under this view, mental health is "framed as a truly 'global' problem" demanding "an ethical case for the right to access to treatment" in LMICs (Howell et al, 2017). This approach provokes important questions: What is the nature of the content being scaled?…”