The Lancet: The moral case for global mental health delivery

10 January, 2020

Citation and extracts below from HIFA member Vikram Patel and Paul Farmer in the new print issue of The Lancet (11 January 2020).

CITATION: Perspectives|the art of medicine| volume 395, issue 10218, p108-109, january 11, 2020

The moral case for global mental health delivery

Vikram Patel, Paul E Farmer

Published:January 11, 2020

DOI:https://doi.org/10.1016/S0140-6736(19)33149-6

Poor people die much earlier than rich people. Objection to this injustice is the foundation of global health equity that seeks to redress disparities of risk and outcome within and between populations. Many strategies are needed to address this injustice, and many of them target the structural violence that is committed on people who wield less power and wealth. This essay concerns not actions targeting these structural determinants, as crucial as they are. Instead, we explore the risks of potential collusion of the global health community with this injustice, played out on both global and local stages...

The moral driver of global health delivery is simple: the benefits of high-quality health care must be made available and accessible to all people, irrespective of their social station or where they live... [*see note below]

We will need to reframe the appalling fact that most people with severe mental disorders and disabilities die earlier than they should simply because they do not have access to quality and person-centred care as a moral outrage, no less an insult to our basic humanity than the arguments that people with HIV in Africa could be left to die because their countries' health systems were weak or the interventions unaffordable. To do so, global health delivery practitioners will need to adopt a rights-based approach to health care.

People with severe mental disorders and disabilities were subjected to horrific forms of torture and violence under the guise of mental health care for centuries and were among the first victims of the Nazi gas chambers. In our times, these individuals have been cast aside to sleep on the streets of cities of unimaginable wealth, or to be incarcerated in prisons, or kept in captivity in colonial-era asylums and religious healing shrines. Our collective failure to respond to the needs of one of the most vulnerable groups of people in society is a catastrophic failure of humanity...

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*Note (Neil PW): This moral driver - the benefits of high-quality health care must be made available and accessible to all people, irrespective of their social station or where they live - is the driver for HIFA. To realise these benefits requires health workers (and the public, and policymakers) to have access to reliable, relevant healthcare information (as well as skills, equipment, systems support, medicines, incentives and communication). For mental health in primary care, I would highlight Vikram Patel's Where There is No Psychiatrist, 2nd edition, which, thanks to HIFA's advocacy, is freely available for download: https://www.cambridge.org/core/books/where-there-is-no-psychiatrist/4757...

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org