What’s in the ‘Treatment Gap’? Ethnographic Perspectives on Addiction and Global Mental Health from China, Russia, and the United States

Abstract

Recent years have seen the emergence of a 'global mental health' agenda, focused on providing evidence-based interventions for mental illnesses in low- and middle-income countries. Anthropologists and cultural psychiatrists have engaged in vigorous debates about the appropriateness of this agenda. In this article, we reflect on these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia, and the United States. We argue that the logic of 'treatment gaps,' which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges, and actors framing and managing addiction (as well as other mental health issues) in any particular setting.

Postsocialism, the psy-ences and mental health

“…This includes historical work emphasizing the circulation of expertise and medical technologies within the Second World War (not all of which radiated out from Moscow), and from the Second to the First and Third Worlds (Marks & Savelli, 2015;Rogers, 2010). More recently, countries such as Russia and China have sought to exert influence over global health and drug policy beyond their borders, with priorities that do not necessarily align with those of the WHO or the central organizations of international health (Bartlett, Garriott, & Raikhel, 2014;Dirlikov, 2015;Harmer & Buse, 2014). In short, lines of difference are no longer predominantly drawn between an Eastern/Western legacy, but rather shifted towards the dichotomy between "local" versus "global" forms of psy-interventions, and towards the study of their encounter, renegotiation, and effect within concrete, situated settings.…”

Sociopolitical contexts for addiction recovery: Anexos in U.S. Latino communities

“…This case study of anexos highlights the importance, within substance abuse treatment research, of considering variations in sociopolitical context and how these impact service delivery and characteristics of established recovery models. While some cross-cultural studies of addiction treatment attend to this need (Bartlett, Garriott, & Raikhel, 2014; Garcia, 2010; Makela et al, 1996), they are in the minority.…”

Conceptualizing globalization for mental health research

“…Such efforts partly aim to address and intervene on mental health stigma; however, systematic underfunding of mental health services, and the asymmetric way in which people with mental health problems are affected by society problems, such as community violence, socioeconomic inequality and service provision, have not been formalized in frameworks to date. For example, as a focus for policy development, observational research, treatment and service evaluation and qualitative study, a narrow focus on the treatment gap could risk leaving important details out, about actors, institutions, processes and thinking that is relevant to understanding mental health in a given community (Bartlett, Garriott, & Raikhel, 2014).…”