Suman Fernando - Challenges for Mental Health Dev't in Low- and Middle-income Countries скачать в хорошем качестве

Suman Fernando - Challenges for Mental Health Dev't in Low- and Middle-income Countries

Community mental health services everywhere in the world should: aim to meet the mental health and social care needs of people as perceived by people themselves; be relevant and sensitive to local conditions and cultures; involve all stakeholders including marginalised groups; and be culturally and economically sustainable. In planning services in LMI countries, cross-cultural psychiatric research carried out using psychiatric diagnostic categories are of limited use, but there are some pointers that may help. "Mental illness" identified in a psychiatric model, during the 1960s and 1970s, had better outcomes in LMI countries (compared to that in the (then) industrially-developed countries) although this "better outcome" may no longer be as evident, since the spread of westernisation. It seems that attendance at healing centres in South India may provide as much benefit for people diagnosed as "schizophrenic' as psychiatric treatment, and that the best system may be one where people suffering psychological distress and their relatives have a choice as to what system they access for help. The "global mental health" movement being pursued by the US NIMH requires considerable modifications if it is to be ethically acceptable in a post-colonial world. Otherwise, the result will be the imposition of Euro-American psychiatry en masse, amounting to cultural imperialism. The present priorities for alleviating mental distress in LMI countries include: developing social support and community development -- for example, to re-build communities disrupted by the effects of war, civil conflict and natural disasters; addressing breakdown of social systems resulting from rapid industrialization and urbanization; counteracting the effects of poverty and oppression; and providing human-rights sensitive ways of controlling people who are behaviorally disturbed. Also, there is an urgent need for regulating the marketing of psychoactive drugs in order to prevent the exploitation of vulnerable people in LMI countries.