Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice
In 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has bee...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/9/e002689.full |
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| author | Laurence J Kirmayer Ana Gómez-Carrillo Raphael Lencucha Neda Faregh Samuel Veissière |
| author_facet | Laurence J Kirmayer Ana Gómez-Carrillo Raphael Lencucha Neda Faregh Samuel Veissière |
| author_sort | Laurence J Kirmayer |
| collection | DOAJ |
| description | In 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has been widely implemented but also criticised for insufficient attention to cultural and social context and ethical issues. To address this issue and help overcome related barriers to scale-up, we outline a framework of questions exploring key cultural and ethical dimensions of mhGAP planning, adaptation, training, and implementation. This framework is meant to guide mhGAP activity taking place around the world. Our approach is informed by recent research on cultural formulation and adaptation, and aligned with key components of the WHO implementation research guide (Peters, D. H., Tran, N. T., & Adam, T. (2013). Implementation research in health: a practical guide. Implementation research in health: a practical guide.). The framework covers three broad domains: (1) Concepts of wellness and illness—how to examine cultural norms, knowledge, values and attitudes in relation to the “culture of the mhGAP”; (2) Systems of care—identifying formal and informal systems of care in the cultural context of practice.; and (3) Ethical space: examining issues related to power dynamics, communication, and decision-making. Systematic consideration of these issues can guide integration of cultural knowledge, structural competence, and ethics in implementation efforts. |
| format | Article |
| id | doaj-art-9403f3fb8f504cc8ab1a0b92da151b1d |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-9403f3fb8f504cc8ab1a0b92da151b1d2024-12-05T07:15:09ZengBMJ Publishing GroupBMJ Global Health2059-79082020-09-015910.1136/bmjgh-2020-002689Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practiceLaurence J Kirmayer0Ana Gómez-Carrillo1Raphael Lencucha2Neda Faregh3Samuel Veissière4Division of Social and Transcultural Psychiatry, Culture Mind and Brain Program and Global Mental Health Program, McGill University Faculty of Medicine, Montreal, Quebec, CanadaPsychiatry, McGill University, Montreal, Quebec, CanadaSchool of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDepartment of Psychology, Carleton University, Ottawa, Ontario, CanadaDivision of Social and Transcultural Psychiatry, Culture Mind and Brain Program and Global Mental Health Program, McGill University Faculty of Medicine, Montreal, Quebec, CanadaIn 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has been widely implemented but also criticised for insufficient attention to cultural and social context and ethical issues. To address this issue and help overcome related barriers to scale-up, we outline a framework of questions exploring key cultural and ethical dimensions of mhGAP planning, adaptation, training, and implementation. This framework is meant to guide mhGAP activity taking place around the world. Our approach is informed by recent research on cultural formulation and adaptation, and aligned with key components of the WHO implementation research guide (Peters, D. H., Tran, N. T., & Adam, T. (2013). Implementation research in health: a practical guide. Implementation research in health: a practical guide.). The framework covers three broad domains: (1) Concepts of wellness and illness—how to examine cultural norms, knowledge, values and attitudes in relation to the “culture of the mhGAP”; (2) Systems of care—identifying formal and informal systems of care in the cultural context of practice.; and (3) Ethical space: examining issues related to power dynamics, communication, and decision-making. Systematic consideration of these issues can guide integration of cultural knowledge, structural competence, and ethics in implementation efforts.https://gh.bmj.com/content/5/9/e002689.full |
| spellingShingle | Laurence J Kirmayer Ana Gómez-Carrillo Raphael Lencucha Neda Faregh Samuel Veissière Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice BMJ Global Health |
| title | Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice |
| title_full | Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice |
| title_fullStr | Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice |
| title_full_unstemmed | Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice |
| title_short | Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice |
| title_sort | engaging culture and context in mhgap implementation fostering reflexive deliberation in practice |
| url | https://gh.bmj.com/content/5/9/e002689.full |
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