Rebalancing power in global mental health

Global Mental Health has become clearly defined as a distinct academic discipline and area of practice since the 1990s, and has gained increasing prominence. Its roots lie in international and cultural psychiatry, but it has taken a clear direction of focusing on effective real-world change through application of evidence-based health interventions in a scientific psychiatric paradigm, strongly influenced by social psychiatry. While culture is acknowledged as important, it is seen as an overlay, presuming a common scientific paradigm for mental health globally. One example of this is the use of local adaptation of international guidelines like the WHO’s mhGAP. While a growth in investment, prioritization, and application of knowledge has the potential to positively impact on lives of people affected by mental ill health, there is a risk of causing harm by inappropriate application of ideas not well-suited to local needs. Global frameworks for mental health and human rights already advocate a human rights approach with participation of people affected, but it is only by rebalancing power towards local actors that national authorities can be held to account, and potential benefits of Global Mental Health be realized.