Program in Global Mental Health and Social Change

Giuseppe Raviola, MD, Program Director

Program Background
Established in 2009, the Program in Global Mental Health and Social Change serves as a conduit for implementation-based training and research in global mental health delivery, linked to expanding programmatic work at Partners In Health global sites. The Program seeks to bring together students, scholars, researchers, educators, and health care practitioners to address the global burden of mental disorders, and to develop best-practice models for global mental health delivery and implementation science.

Mental health problems impose a serious and widespread health burden, yet remain a neglected and under-resourced domain of global health. Lack of access to safe and effective services remains a significant barrier to mental health care globally. Neuropsychiatric conditions, including depression, alcohol and drug dependence, bipolar disorder, schizophrenia, dementia, and anxiety disorders comprise approximately one-third of “years lost due to disability” (YLD) among people older than 14. Depression is the leading cause of disease burden in most regions of the world; by 2030 it is predicted to be the leading single cause of disease burden globally, particularly among women. With the onset of approximately half of all adult mental health disorders occurring before the age of 14, it is estimated that 20 percent of children aged 9 to 17 have a diagnosable mental health condition that impairs their ability to function. Mental disorders significantly compound physical illness, reducing life expectancy from communicable diseases such as HIV and tuberculosis, and promote the advance of other noncommunicable health problems such as heart disease and diabetes. Stigma related to mental disorders prevents those afflicted with mental illness from seeking access to mental health care, and ultimately compromises their human rights. Globalization and broader social phenomena such as migration and access to technology serve as key forces affecting biology, psychology, and health in contemporary society. Poverty compounds the factors that perpetuate mental disorders, and leaves those particularly vulnerable to illness, and lack of safe and effective treatments, without care and support.

These problems are evident at Partners In Health global sites, where people living with untreated mental disorders suffer from significant stigma, medical co-morbidity, and vulnerability to the effects of poverty. However, the work at Partners In Health sites has innovated community- and facility-based solutions to the global mental health treatment gap, and offers an essential platform for research and learning on best practices in global mental health delivery. Over the past decade these global sites have demonstrated the feasibility of community-based programs linked to the strengthening of primary care systems that provide safe, evidence-based, culturally-adapted care in challenging and complex environments. In 2019 PIH delivered more than 32,000 facility-based mental health visits and cared for more than 8,200 people living with mental health conditions.

Innovative training fellowships housed within the Program, such as the Dr. Mario Pagenel Fellowship in Global Mental Health Delivery, have provided career development pathways for early career psychiatrists who serve as Research Fellows in the Department, interested in the academic discipline of global mental health delivery. Mental health projects nested within the HMS MMSc-GHD has brought innovative mixed methods research to build capacity at PIH global sites as well. Examples of such projects include the study of the lived experience of severe mental illness in rural Haiti, the study of the experience of caregivers of people living with mental illness in rural Malawi, and the articulation of social factors that determine interpersonal violence in households in Chiapas, Mexico.

The Program therefore draws together departmental expertise in the clinical, evaluative, and social sciences—including medical and psychological anthropology, social medicine, and history of medicine, as well as methodologies in quantitative and qualitative research—and seeks to build upon a generation of knowledge regarding service delivery and capacity-building in health services. Program research efforts focus on the innovation of models of care that bridge the preventive and the clinical, the community and the hospital, and the indigenous and the biomedical. By harnessing the resources, passion, and best practices of health care systems worldwide, the Program’s faculty and trainees aim to place the care of patients with mental health disorders squarely within the dialogue on health and human rights, and to advance he discipline of global mental health delivery.