Global Mental Health
We all have mental health
While there is a tendency to use a binary approach to diagnosing mental health conditions, this approach does not capture the dynamic and complex nature of mental health across individuals and populations. Mental health is experienced along a continuum, from severe to optimal/thriving.
Peoples’ mental health is largely determined by the combination of social, environmental, and structural factors, which interacts with one’s biological, physiological, and psychological processes beginning early in the life course. Recognizing the interdependent and intersectional nature of health and development, the UN Sustainable Development Goals (SDGs) includes promoting health and well-being as one of the 17 Global Goals in the 2030 Agenda for Sustainable Development.
Nearly one in ten people globally currently live with a mental health condition and an estimated one in four people globally experience a mental health condition in their lifetime. People with mental health conditions have a higher risk of developing chronic conditions, such as cardiovascular disease or diabetes. Additionally, the COVID-19 pandemic has drastically impacted the delivery of health services, and exacerbated already fragmented and fragile health care systems, increasing disparities in mental health across the globe.
The Global Alliance believes that mental health is an integral part of our health at every stage of life and a fundamental human right for all people. When systems fail to recognize this, the consequences for physical health, social and economic well-being, family functioning and society are substantial. Thus, we must reframe how we think about mental health and transform systems to focus on promoting mental health for all through an ecologically grounded, person-centered, human rights-based approach.
Our Work
Global Mental Health Task Force
Learn more about our Global Mental Health (GMH) Task Force and our focus on promoting mental health, behavioral health, and well-being across the life course.
Learn more about our work
- Check out our GMH Task Force recommendations for the new administration.
- Read our blog post Supporting Mental Health for All: The Importance of Community Engagement based on a live discussion co-sponsored by the Global Alliance, APHA Mental Health Section, and APHA Public Health Social Work Section.
Additional Resources
What can you do?
- Check out our COVID-19 topics page for resources on promoting resilience and preventing behavioral health conditions.
- Advocate and educate to reduce the stigma associated with mental health conditions.
- Strengthen community prevention, through the provision of crisis counseling, behavioral health screening, and early intervention services.
- Collaborate with community partners, academics, researchers, policy makers, and other service providers to help strengthen mental health and wellness across communities.
Research on Global Mental Health in AJO
Abstract
Homelessness is a global phenomenon that affects groups in situations of poverty and social exclusion, in both developed and developing nations. However, the scientific literature on homeless people in developing countries is scant. This work shows the difficulties defining homelessness and examines the necessary criteria for who will be deemed a homeless person in a developing country. Furthermore, the results of the Point-In-Time (PIT) count of homeless people—a measure of the number of homeless people on a specific day—done in the city of León, Nicaragua (population: 185,000). Throughout the PIT count, 82 unduplicated people living in homelessness were tallied (76% male, 23% female), of which 47 answered a questionnaire. Most of the homeless people in León are male, mestizo, of Nicaraguan nationality, with a primary level education or less, and in a situation of chronic homelessness. Results showed a mean age of 47 years for these individuals. Most of the homeless people showed a bad physical appearance, had poor personal hygiene, and wore dirty clothing. Around half of the homeless observed seemed to have problems related to mental health, alcohol, and/or drugs.
Vázquez, J. J., Berríos, A. E., Bonilla, E., & Suarez, A. C. (2018). Homeless people in León (Nicaragua): Conceptualizing and measuring homelessness in a developing country. American Journal of Orthopsychiatry. Advance online publication.
Abstract
Although adoptive families have been shown to provide a protective context for human development, some adopted children and adolescents are at increased risk for psychological adjustment problems. On the other hand, little is known about psychological adjustment of young adult adoptees. The aim of this study is to analyze the mental health and legal substance consumption (tobacco and alcohol) of young adults (n = 134) who were domestically adopted by Spanish families. Young adults showed significantly worse scores on the Symptom Check-List-90-R (Derogatis, 1975) and also more substance use than did the Spanish general population, but fewer difficulties than did the clinical population. On the Global Severity Index (GSI), 65.7% of adoptees were within the normal range, 24.6% were at risk, and 9.7% were within the clinical range. Male adoptees scored higher than expected for the general population on all subscales, whereas female adoptees did not. Age at adoption was not found to have a significant impact on adjustment.
Sánchez-Sandoval, Y., & Melero, S. (2018). Psychological adjustment in Spanish young adult domestic adoptees: Mental health and licit substance consumption. American Journal of Orthopsychiatry. Advance online publication.
Abstract
Internationally adopted adolescents are at increased risk for mental health problems. However, little is known about problematic alcohol and drug use, which are important indicators of maladjustment. The aim of this study was to examine the level of problematic alcohol and drug use in internationally adopted adolescents compared to their nonadopted peers. The study is based on data from the youth@hordaland-survey, which was conducted in Hordaland County, Norway, in the spring of 2012. All adolescents born from 1993 to 1995 residing in Hordaland at the time of the study were invited to participate. Information on adoption was obtained from the Central Adoption Registry and linked to self-report data from the youth@hordaland-survey. Among 10,200 participants, 45 were identified as internationally adopted. No significant differences were found between international adoptees and their peers regarding whether or not they had tried alcohol or illicit drugs or their patterns of drinking behavior. However, adopted adolescents had a higher mean score on a measure of problematic alcohol and drug use compared to their nonadopted peers. The difference was attenuated and no longer significant when adjusting for measures of depression and attention-deficit/hyperactivity disorder. Results from a structural equation model indicated a full mediation effect of mental health problems on the association between adoption status and problematic alcohol and drug use. Our findings indicate that internationally adopted adolescents experience more problematic alcohol and drug use than their nonadopted peers, and the difference can largely be explained by mental health problems.
Askeland, K. G., Sivertsen, B., Skogen, J. C., La Greca, A. M., Tell, G. S., Aarø, L. E., & Hysing, M. (2018). Alcohol and drug use among internationally adopted adolescents: Results from a Norwegian population-based study. American Journal of Orthopsychiatry, 88(2), 226-235.
Abstract
Despite the growing population of Mainland Chinese students at the local government-funded universities in Hong Kong, little is known about their acculturation experiences and psychosocial adjustment. Drawing on an acculturation framework (Berry, 2003) and theories of coping (Folkman, 1984), resilience (Masten, 2001), and socioecological processes (Bronfenbrenner & Morris, 2006), this article provides an in-depth account of acculturative stress and coping behaviors experienced by Mainland Chinese university students in Hong Kong. Using qualitative research methods, we conducted seven focus groups with a total of 32 Mainland Chinese students from a public university in Hong Kong over a 3-month period. Analytic strategy included identifying the unit of analysis, coding, sorting code, checking code, and creating salient themes. Findings suggested that Mainland Chinese university students faced acculturative stress stemming from “language barriers,” “prejudice and discrimination,” “cultural differences,” and “transport, food, and accommodation.” The study also found that the participants used a number of adaptive and maladaptive coping strategies in the face of acculturative stress. As an extension of this research, future studies should examine the subtle difference between a subculture (Hong Kong) and its mother culture (Mainland China) and how that affects acculturative stress. Implications of these findings are discussed at the levels of theory, policy, and practice.
Bhowmik, M. K., Cheung, R. Y. M., & Hue, M. T. (2018). Acculturative stress and coping strategies among Mainland Chinese university students in Hong Kong: A qualitative inquiry. American Journal of Orthopsychiatry, 88(5), 550-562.
Abstract
We tested a trauma-focused, cognitive–behavior therapy treatment (TF-CBT-anger) for intermittent explosive disorder (IED) and related dimensions of anger adapted to the local culture in postconflict Timor-Leste. The intention-to-treat sample (n = 78) comprised Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and wait-list (WL). Assessments were made at 1 week prior to therapy, immediately at posttreatment, and at 1 month follow-up. Primary measures included an IED diagnosis made according to the East Timor explosive anger measure and the directionality of expression and control of anger assessed by 4 dimensions of the State–Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler scale and an index of posttraumatic stress disorder (PTSD) assessed using the Harvard Trauma Questionnaire. In the TG, there was a decline in IED from 100% to zero at follow-up. In the WL, more than 70% (of the 100% at baseline) showed persisting IED at second and third assessments. The TG alone showed significant (p< .05) improvements on all STAXI-2 scales, the effect sizes for the intervention being uniformly large (>0.80). Psychological distress and PTSD showed substantial reductions in the TG but not the WL group. Although based on a modest-sized sample, our findings provide the first evidence in support of the efficacy of TF-CBT-anger for IED in a culturally diverse, postconflict setting.
Hewage, K., Steel, Z., Mohsin, M., Tay, A. K., De Oliveira, J. C., Da Piedade, M., . . . Silove, D. (2018). A wait-list controlled study of a trauma-focused cognitive behavioral treatment for intermittent explosive disorder in Timor-Leste. American Journal of Orthopsychiatry, 88(3), 282-294.
Abstract
There has been a plethora of outcomes associated with child trafficking for commercial sexual exploitation; however little attention has been paid to how outcomes are addressed for children who are placed into residential aftercare recovery programs following their identification as victims. Field-based qualitative research was undertaken in South and Southeast Asia, and involved interviews with 213 representatives from U.N. and governmental agencies, nongovernmental organizations, and residential aftercare recovery programs. Findings highlight the mental health needs of child victims of trafficking for commercial sexual exploitation, describe the availability and quality of mental health services and supports in aftercare programs to address prevailing needs and repair the psychological damage caused by trafficking, and report on lessons learned pertaining to elements of good practice and related challenges associated with the availability and quality of mental health services and supports. It concludes by highlighting the implications of the findings for mental health policy and practice and offers suggestions for further research.
Rafferty, Y. (2018). Mental health services as a vital component of psychosocial recovery for victims of child trafficking for commercial sexual exploitation. American Journal of Orthopsychiatry, 88(3), 249-260.
Abstract
The prevention of child maltreatment has become a global health concern because child maltreatment is a violation of children’s rights. Across the world, a variety of parenting programs have been developed to address this problem. However, no such parenting program currently exists in Suriname. This pilot study aimed to implement Lobi Mi Pikin (LMP) parenting program in Suriname and to evaluate its effects on corporal punishment (CP) and child behavioral problems. Parents–caregivers (N = 70) of children (ages 3–12 years) with externalizing behavioral problems participated in a protocoled parenting program. The child’s behavioral problems and the parenting style of the parent–caregiver were assessed using the Strengths and Difficulties Questionnaire and the Parental Behavior Scale, pretreatment and posttreatment. Five-week follow-up measures revealed significant positive effects of LMP on all outcome measures. Follow-up comparisons demonstrated (a) a large reduction of total child difficulties and conduct problems, (b) a moderate reduction of hyperactivity and emotional problems, (c) a moderate to large increase in the self-reported positive behavior of the parent, and (d) a small decrease in the use of CP. This study provides preliminary evidence that LMP may be an effective model of parent training in Suriname. Moreover, it can help guide efforts to reduce the use of CP and encourage positive parenting, thereby preventing child maltreatment.
van der Kooij, I. W., Bipat, S., Boer, F., Lindauer, R. J. L., & Graafsma, T. L. G. (2018). Implementation and evaluation of a parenting program to prevent child maltreatment in Suriname. American Journal of Orthopsychiatry, 88(3), 295-305.
Abstract
Recent years have brought a growing social and public commitment to the promotion of children’s rights and children’s well-being around the world, and these have become important goals of all those striving to improve children’s lives. In spite of the intimate ideological connection between the concepts of children’s rights and children’s well-being, they have evolved separately both theoretically and empirically. In the current article, we present a study exploring the empirical association between these 2 concepts based on data from the International Survey on Children’s Well-Being. This unique survey explores children’s own perspectives on their well-being (subjective well-being), their perceptions and knowledge of their rights, and their reports on their right to participation. It includes data from more than 54,000 children aged 8–12 from 16 countries around the world. Our results showed clear cross-national differences between children’s knowledge and perceptions of their rights and their reports on participation. Also, children’s participation in different contexts in their lives showed an association with their subjective well-being; a weaker association was found between children’s knowledge and perceptions of their rights. These results indicate that children’s right to participation and, to some degree, their knowledge and thinking about their rights is an indicator of their well-being.
Kosher, H., & Ben-Arieh, A. (2017). What children think about their rights and their well-being: A cross-national comparison. American Journal of Orthopsychiatry, 87(3), 256–273.
Abstract
As the number of children without parental care continues to increase in resource-poor countries, it is important not to discount institutional care as an option before conclusively assessing whether these structures have systematic negative impacts on the millions of children for which they provide care. An almost universal emphasis and focus on deinstitutionalizing children in the face of the urgent necessity for large-scale measures to care for the global orphaned population puts millions of children at risk of deprivation, degradation, and early death. Deinstitutionalizing children in underresourced countries without alternate systems in place could leave many children behind. This article proposes an equal assessment of suitability and necessity of all alternative care options, without relegating institutions as a last resort. Institutional care should be considered as no less suitable in certain cases and for certain children than other options, especially when there is a serious need for such an option in some parts of the world. In addition, recent research challenges early conclusions, shows variability in international institutions, and also documents positive effects of interventions seeking to improve institutions. The Convention of the Rights of the Child and its implicit “last resort” language, as well as subsequent global policies that also use this language, do not create a constructive way of approaching alternative care solutions for any children without parental care. Instead, policymakers and practitioners should establish individualized care plans for all children without parental care, regulate their admission to institutions with periodic reviews of the necessity and appropriateness of their placement, and develop standards for “suitability” of institutions to improve conditions.
Huynh, Hy V. (2014). New directions in orphan and vulnerable children policy and research: A focus on supporting “suitable” institutions when placement is “necessary” for a child. American Journal of Orthopsychiatry, 84(4), 387-394.
Abstract
A mixed-methodological study conducted in the aftermath of the 2010 Haiti earthquake assessed experiences of 8 lay mental health workers (earthquake survivors themselves) implementing a psychosocial intervention for residents of camps for displaced people in Port-au-Prince. Quantitative results revealed decreased posttraumatic stress disorder symptoms, consistently high compassion satisfaction, low burnout, moderate secondary trauma, and high levels of posttraumatic growth measured over 18 months. Qualitative accounts from lay mental health workers revealed enhanced sense of self-worth, purpose, social connection, and satisfaction associated with helping others. Results support the viability of utilizing local lay disaster survivors as implementers of psychosocial intervention.
James, L. E., Noel, J. R., & Roche Jean Pierre, Y. M. (2014). A mixed-methods assessment of the experiences of lay mental health workers in postearthquake Haiti. American Journal of Orthopsychiatry, 84(2), 152-163.
Abstract
Child trafficking, including commercial sexual exploitation (CSE), is one of the fastest growing and most lucrative criminal activities in the world. The global enslavement of children affects countless numbers of victims who are trafficked within their home countries or transported away from their homes and treated as commodities to be bought, sold, and resold for labor or sexual exploitation. All over the world, girls are particularly likely to be trafficked into the sex trade: Girls and women constitute 98% of those who are trafficked for CSE. Health and safety standards in exploitative settings are generally extremely low, and the degree of experienced violence has been linked with adverse physical, psychological, and social‐emotional development. The human‐rights‐based approach to child trafficking provides a comprehensive conceptual framework whereby victim‐focused and law enforcement responses can be developed, implemented, and evaluated. This article highlights promising policies and programs designed to prevent child trafficking and CSE by combating demand for sex with children, reducing supply, and strengthening communities. The literature reviewed includes academic publications as well as international and governmental and nongovernmental reports. Implications for social policy and future research are presented.
Rafferty, Yvonne. (2013). Child trafficking and commercial sexual exploitation: A review of promising prevention policies and programs. American Journal of Orthopsychiatry, 83(4), 559-575.
Abstract
Consisting of a preamble and 30 articles, the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) is a wide-ranging bill of rights for women. The 186 national governments that are parties to CEDAW have pledged to take all appropriate measures to protect women from discrimination in commerce, employment, and property ownership and in cultural life, education, family life (including reproductive decision making), and politics. The publication launched a global movement to improve women’s mental health and to address behavioral issues in their physical health. To reduce or eliminate persisting gender disparities that continue to prevent full enjoyment of human rights (including the right to health), a high-priority, conceptually coherent plan of action is needed to enhance respect for the human rights of women and girls. CEDAW can serve as a blueprint with which to frame a comprehensive legal policy that guarantees political, civil, and economic rights for all women. At the core of the treaty is the fundamental principle that women’s rights are human rights.
Sianko, Natallia. (2011). Gender equality and women’s mental health: What’s on the agenda? American Journal of Orthopsychiatry, 81(2), 167-171.
Abstract
In Angola, a former child soldier expressed fear and stress because the spirit of a man he killed visited him at night. The community viewed the boy as contaminated and feared retaliation by the spirit. Humanitarian workers consulted traditional healers and learned that the spirit could be expelled by the healer in a cleansing ritual. According to the Inter-Agency Standing Committee (IASC), an international nongovernmental organization (INGO) provided the necessary food and animal for a sacrifice so that the healer could purify the boy and protect the community. Inter-Agency Standing Committee reported that a year after the tsunami in Southeast Asia, a community of 50 families in northern Sri Lanka identified 27 different INGOs offering or providing help. One interviewee lamented, “We never had leaders here. Most people are relatives. When someone faced a problem, neighbors came to help. But now some people act as if they are leaders, to negotiate donations. Relatives do not help each other anymore.” These examples show the various roles that INGOs play in promoting mental health and psychosocial support in developing and transitional societies. Two contemporary programs or initiatives are especially noteworthy models for mental health services in developing and transitional communities, particularly in emergency situations. Recognizing the broad variation in mental health issues among both individuals and communities, the IASC guidelines suggest that a key way to organize mental health services is to develop a layered system of complementary supports, all of which should be implemented concurrently when possible. The guidelines emphasize that most mental health problems can be managed through simple measures to assist the entire displaced community. In particular, the guidelines provide for the promotion of community partnerships that draw on existing social capital. Preventing stigma, local volunteers, and village health workers or healers can be trained to perform screenings, monitoring, and followup. With due attention to the rights of people with mental health problems, Ortho can and should participate in advocacy for community-based services and resources for mental health, especially in places where mental health policy has yet to be articulated and mental health services are rare.
McLeigh, Jill & Sianko, Natallia. (2011). What should be done to promote mental health around the world? American Journal of Orthopsychiatry, 81(1), 83-89.