Savulescu, J. and McConnell, D., (2020), 'Welfarist Psychiatry Goes Global'. in D. Stein and I. Singh, (Eds.) Global Mental Health and Neuroethics. (Elsevier) [NBK559850]
Mental health problems represent a significant proportion of the global burden of disease (~10% disability-adjusted life years) yet receive a disproportionately low level of funding (less than 1% of most countries’ healthcare budget). The situation is especially fraught in low- and middle-income countries (LMICs). Between 76% and 85% of people with severe mental disorders receive no treatment for their mental health problem in LMICs and untreated mental health problems account for 25.3% and 33.5% of all years lived with a disability in LMICs, respectively. Governments from LMICs spend the lowest percentages on mental health worldwide and receive very little support from international aid and NGOs for mental health. Clinical trials are rarely conducted in low-income countries so the effectiveness of treatments in culturally diverse, low-income settings is largely unknown. Furthermore, a lack of appropriately trained health professionals in LMICs undermines the feasibility of a range of therapeutic approaches developed in the Western context.
This situation has motivated a concerted effort to address global mental health by the WHO, the US National Institute of Mental Health, and the Global Alliance for Chronic Diseases, among others. We argue that a welfarist approach to psychiatry will support this effort better than the dominant Western approach to psychiatry because it provides better tools to negotiate a variety of challenges. These challenges include the risk of entrenching flawed aspects of Western psychiatry in new populations, the neo-colonial imposition of Western mental health norms, reducing stigma towards mental illness, and preventing the use of psychiatry for immoral or political ends. Welfarist psychiatry corrects these significant flaws in the Western psychiatric model, avoids neo-colonialism by indexing aspects of patient welfare to the local sociocultural context, reduces stigma by abandoning the concept of ‘normal’ mental health, and provides grounds to restrict the misuse of psychiatry by appealing to objective aspects of personal and social well-being.
We begin by describing welfarist psychiatry before outlining the relevant challenges to improving global mental health and explaining how welfarist psychiatry meets those challenges.
This paper has been made Open Access under Wellcome Trust grant WT203132 (click link to see more OA papers on this grant).
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