‘Global Mental Health Spreads Like Bush Fire in the Global South’: Efforts to Scale Up Mental Health Services in Low- and Middle-Income Countries

‘Scaling up access to mental health services globally, and particularly in low- and middle-income countries (LMIC), is a central priority within current global mental health advocacy. This chapter asks a number of pertinent questions aimed at facilitating critical reflection and exploration of the complexities of efforts to scale-up mental health services in LMIC. The questions to be considered include: Is the validity of psychiatric diagnosis being over-emphasised? Is a preoccupation with eliminating symptoms of illness obscuring understanding about what constitutes ‘positive outcomes’ for individuals experiencing mental health difficulties? Is the ‘treatment gap’ in LMICs as large as it is reported to be? Are alternative forms of support being neglected? Are social determinants of mental health being sufficiently considered? Is the evidence base for GMH sufficiently broad, and has the efficacy of ‘task-shifting’ been sufficiently demonstrated?

Using these questions as a lens through which to explore scaling-up, the chapter contends that while laudably drawing attention to the much neglected arena of mental health, efforts to scale up may also serve to divert attention away from the need to reform the underlying assumptions of mental health services in HIC, and the need to rethink the role of psychiatry in promoting wellbeing worldwide. The chapter concludes with a call for reciprocity between high-income countries and LMIC in how mental health services are designed and delivered, and greater recognition of the differing worldviews that inform knowledge about mental distress’.