So this is a timely moment to reflect on one of the most pressing of those challenges – the fact that indigenous peoples are significantly more likely to experience mental health problems than majority populations.
The vulnerability of indigenous peoples in relation to mental ill-health was highlighted in a recent report by the UN Special Rapporteur on the Right to Health, Dr. Darius Pūras. He emphasised how for indigenous peoples, the ‘political, economic and cultural structures’ that give rise to mental health problems can intersect in particularly harmful ways.
This attention to the political determinants of mental ill-health is forcefully expressed in Dr. Pūras’s summing up of the implications of his research: ‘measures to address inequality and discrimination would be far more effective in combatting mental illness than the emphasis over the past 30 years on medication and therapy.’
Research into the experience of Aboriginal people provides a stark vindication of the Special Rapporteur’s analysis. Over 30% of Aboriginal people were suffering some form of psychological distress, compared to 20% of the overall population; and 12.4% of Aboriginal people aged over 45 had dementia, compared to 2.6% of the overall population. Researchers also found dramatic increases in Aboriginal rates of youth suicide, anxiety and depression, as well as cognitive disability and mental health problems among offenders, and perinatal mental health problems.
This recognition of the need to address the political and economic causes of mental ill-health is becoming increasingly prominent in debates about the ‘global mental health crisis’ confronting us today. In particular, a number of commentators have drawn attention to how core features of neoliberalism are damaging to mental health.
William Davies, for example, has argued that ‘the meritocratic ethos of contemporary capitalism […] states that social class is no longer relevant, and therefore everybody ends up with the socio-economic position they deserve. This produces a chronic sense of self-blame, unease, anxiety and self-recrimination’.
And for Ruth Cain, ‘there is growing concern that the conditions and effects of neoliberalism – the enervating whirl of relentless privatisation, spiralling inequality, withdrawal of basic state support and benefits, ever-increasing and pointless work demands, fake news, unemployment and precarious work’ are partly to blame for the rise in mental ill-health.
One of the main ways in which the legacy of colonialism continues to infiltrate global mental health discourse and practice is through the perceived universal applicability of Western assumptions
Importantly, the Special Rapporteur’s report also identifies a perhaps less-recognised political determinant of mental ill-health, but one which is especially relevant in the experience of indigenous peoples: the fact that mental health is ‘also deeply influenced by scars of the past, such as historical injustices, the legacy of colonialism, racism, slavery and land appropriation’.
One of the main ways in which the legacy of colonialism continues to infiltrate global mental health discourse and practice is through the perceived universal applicability of Western assumptions and explanatory models, such as an approach to ‘treatment’ that is heavily based on pharmacology. This globalisation of Western approaches has the effect of sidelining the articulation of local understandings of mental distress in indigenous languages (which, given that the theme of this year’s ‘Indigenous Peoples Day’ is Indigenous Peoples’ Languages, makes a focus on mental health even more apropos).
Another crucial feature of Western mental health approaches is an individualistic view of self. The reductionist neoliberal scientiﬁc method favoured by the West tends to reduce phenomena into parts, including how human beings are perceived. Individualism and the scientiﬁc approach are coupled with ideologies of consumerism, individual choice and individual fulﬁlment. This reductionist approach is in marked contrast to that of many non-Western cultures, including those of indigenous peoples.
In these cultures, children are socialised into a different sense of self where priority is given to connections and interrelationship with others as the basis of psychological well-being. The health of individuals is dependent on, and not separate from, healthy relationships with the wider social, cultural and natural environments – ancestors, the community and the land.
In past few years we have seen a very welcome, if long-overdue, recognition that a far higher priority needs to be attached to promoting global mental health than has been the case hitherto. In this context, a reflection on the experiences of indigenous peoples’, and on the political, economic and cultural reasons for those experiences, provides a very clear message: if the aspirations of the global mental health movement are to be realised, then the much-needed increase in mental health funding must be underpinned by a commitment to culturally appropriate approaches.