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Abstract
The ‘Global Mental Health’ (GMH) movement, an influential driver of transnational knowledge transfer in the field of mental health, advocates evidence-based strategies to ‘scale up’ services in low- and middle-income countries. As with debates on global and local frameworks for social work, there are concerns about marginalisation of knowledge that does not neatly fit the GMH discourse. This article analyses the professional and disciplinary structures that shape knowledge transfer in GMH and the implications for social work's engagement with the movement. Analysis of key documents and secondary literature identifies three key issues for GMH: its potentially negative impact on ‘local’ knowledge production; the challenges of accounting for culture and context; and the selective forms of evidence that are ‘allowed’ to contribute to GMH. Finding ways to encompass more ‘situated’ perspectives could reshape GMH in accord with its aspirations for participation by a wider range of stakeholders. Social work's values-based commitment to rights and empowerment, emphasis on embedded knowledge emerging from close links with practice, and theoretical engagement with social, cultural and political context, enable the profession to contribute significantly to this task. Such engagement would bring improvements in care for those suffering from mental health disorders, their families and communities.
Acknowledgements
We are grateful to the participants at the ‘Social Work without Borders’ conference (University of Lincoln, January 2014) and to colleagues in the University of Edinburgh Social Work subject area for feedback on earlier versions of this article. We also thank the anonymous reviewers for their perceptive comments.
Notes on contributors
Dr David Orr is a Lecturer in Social Work at the University of Sussex. He obtained his doctorate from University College London with research into mental health in Quechua-speaking communities in highland Peru. He has co-authored a number of research reports for the UK Social Care Institute for Excellence.
Dr Sumeet Jain is a Lecturer in Social Work at the University of Edinburgh, where he is the Co-Director of the Master of Public Policy and Director of the P.G. Cert. Mental Health Officer Award programmes. He obtained his doctorate from University College London, where he carried out ethnographic research into community mental health services in rural north India.
Notes
1. Of course, social work knowledge itself is contested, with a recent review identifying at least 10 different models of social work knowledge production (Gray & Schubert, Citation2013). Yet what all these models have in common is that they find themselves wrestling with how to reconcile different sources of knowledge, that range from disembedded RCTs and meta-analyses, to highly contextualised practitioner and service user experience. The persistence with which social work seeks to keep both sides of this equation in play is perhaps its real strength in contributing to debates over the use to which what we think we know should be put.
3. Not least among these is the issue of whether, rather than LAMICs learning from HICs about mental health care, the reverse should be the case. Although we do not treat the debate in detail here, there is some evidence that schizophrenia outcomes may be better in LAMICs, despite the ‘treatment gap’ (Jääskeläinen et al., Citation2013; Warner, Citation2009). The methodology and findings of these studies are disputed by the leaders of the MGMH and others (Burns, Citation2012; Cohen, Patel, Thara, & Gureje, Citation2008). We suspect that sweeping generalisations about the ‘developed’ and ‘developing’ worlds are unhelpful and would call for more ‘embedded’ research that engages the specific characteristics of particular settings (Burns, Citation2012), but note that this does suggest that increased access to psychiatric care may not be the only way to improve mental health in poorly resourced settings.
4. While relatively few directly specialise in mental health (WHO, Citation2011, p. 52), large numbers of non-specialists commonly work with people who have, or are at risk of, mental distress or substance abuse issues (Harrison & Melville, Citation2010, p. 99).
5. It is worth noting in passing that in seeking to explain the apparently more positive outcomes for schizophrenia in LAMICs by comparison with HICs, it is these same protective factors that have generally been suggested to be operating (see Warner, Citation2009).