Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories,and South Africa

Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a ‘deficit model’. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in ‘informal’ community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.

全球心理健康（GMH）的奖学金与实践通常关注社区在心理健康方面的未满足需求与障碍，并针对此需求开发生物医学和心理社会干预措施，以融入正式的医疗保健平台。在本文中，我们分析了四个不同的环境，旨在打破对健康体系薄弱环节、治疗缺口和障碍的强调，这些因素可能加剧有害的等级制度、殖民和医学假设，或所谓的‘缺陷模式’。我们借鉴了在加纳、印度、被占领的巴勒斯坦领土和南非工作的社区心理健康实践者和研究者的经验知识，描述了存在于‘非正式’社区心理健康保健系统中的关键资产及其在社政环境中的形成方式。这些定性案例研究源自于39位来自24个国家的学术和社区合作者之间的在线互学过程，他们探讨关键原则，以形成一个全球心理健康的社交范式。汇集来自专业实践和研究领域的多元化专业知识，我们的子小组通过比较不同国家的案例研究，探讨了社区心理健康系统在GMH中的作用，描述了社区护理在医疗保健和社会保健体系之外的特性。我们发现，全球经济结构的社会政治健康决定因素对四个国家的当地社区健康体系产生了显著影响。我们确定了各地点的关键资产包括：家庭和社区护理，以及来自非营利组织、宗教和基于信仰的组织的支持。加强社区资产可能促进正式和非正式部门之间的互惠关系，为社区提供支持与培训资源，同时社区在基于当地专业知识的干预措施的设计与实施中协作。本文强调了非正式护理的价值、每个地方独特的社交结构以及当地社区资源作为心理健康现有关键资产的重要性。