A patchwork of good intentions: a critical look at different perspectives regarding ethics-based mental health care in under-resourced settings

Abstract

Currently, there is an overall focus on mental health as a global health priority in the United Nations (Sustainable developmental Goals), World Health Organization (WHO), and Global Mental Health (movement and study field). As “mental disorder” is constructed as universal, the consequence is that the focus is on the treatment gap as a result of the huge inequalities regarding access to mental health care and treatment (Mills and Fernando, Disability and the Global South 1:188–202, 2014). UN’s Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (UN Human Rights Council, https://reliefweb.int/sites/reliefweb.int/files/resources/G1707604.pdf, 2017) urges the promotion of mental health for all ages in all settings as a general human right. In the historical basis for Global Mental Health, we find efforts to improve mental health for people living in under-resourced settings. According to mainstream, this means that the Global South should get better access to staff trained after standards and evidence-based treatment from the Global North. Critics rebut this approach since evidence-based practices developed in a Western setting transferred to different contexts might have unethical consequences, due to the ruling idea of a universal human, by pathologizing individuals rather than their sociopolitical-economic conditions. Attempts have been made to bypass or solve the discussion on the possibility of combining culture and the notion of a universal human which is implicit in Western evidence-based practice. Human rights and ethics-based practices are the ideals of all approaches, but all seem to have unforeseen consequences that go against these ideals. In this chapter, we take a critical look at different perspectives and the debate around ethics-based practice in mental health care in under-resourced settings.