Howell Alison, Mills China, Rushton Simon
Department of Political Science, Rutgers University, Newark, USA.
School of Education, University of Sheffield, Sheffield, UK.
Global Health. 2017 Jul 1;13(1):44. doi: 10.1186/s12992-017-0263-3.
Mental health is increasingly finding a place on global health and international development agendas. Advocates for Global Mental Health (GMH), and international organizations such as the World Health Organization (WHO) and the World Bank, argue that treatments available in high-income countries should also be made available in low- and middle-income countries. Such arguments are often made by comparing mental health to infectious diseases, including the relative disease and economic burdens they impose, and pointing to the applicability of the right to access treatment for mental health, not only infectious diseases. HIV/AIDS advocacy in particular has been held up by GMH advocates as offering an appropriate strategy for generating global commitment.
There is a need to assess how health issues are framed not only in relation to social goods outside of health (such as human rights, security or development), but also in relation to other health or disease models, and how health policy and practice is shaped as a result. The article debates the merits and consequences of likening mental health to HIV/AIDS, and identifies four major problems with the model for GMH advocacy being developed through these analogies: 1. An inappropriately universalizing global approach to context-specific problems; 2. A conception of human rights that focuses on the right to access treatment at the expense of the right to refuse it; 3. A tendency to treat poverty as a psychiatric issue, rather than recognizing that mental distress can be the result of poverty and other forms of inequality; 4. The prioritization of destigmatization of disease over social justice models.
There are significant problems with the wholesale adoption of an (often simplified) version of HIV/AIDS advocacy as a model for GMH. Yet critical engagement with the important and nuanced differences between HIV/AIDS and mental health may nevertheless point to some possibilities for productive engagement and cross-fertilisation between advocates, activists and scholars in both fields.
心理健康在全球卫生和国际发展议程中越来越受到关注。全球心理健康（GMH）的倡导者以及世界卫生组织（WHO）和世界银行等国际组织认为，高收入国家现有的治疗方法也应在低收入和中等收入国家提供。提出这些观点时，人们常常将心理健康与传染病进行比较，包括它们所带来的相对疾病负担和经济负担，并指出获得心理健康治疗的权利（不仅是传染病治疗权利）的适用性。GMH倡导者尤其将艾滋病毒/艾滋病宣传视为激发全球承诺的合适策略。
有必要评估健康问题不仅是如何与健康之外的社会利益（如人权、安全或发展）相关联来构建框架的，而且是如何与其他健康或疾病模式相关联来构建框架的，以及健康政策和实践是如何因此而形成的。本文探讨了将心理健康与艾滋病毒/艾滋病相类比的优缺点，并指出了通过这些类比发展起来的GMH宣传模式存在的四个主要问题：1. 针对具体情况的问题采用了不恰当的普遍化全球方法；2. 一种人权观念，侧重于获得治疗的权利，而忽视了拒绝治疗的权利；3. 倾向于将贫困视为一个精神问题，而不是认识到精神痛苦可能是贫困和其他形式不平等的结果；4. 将消除疾病污名化置于社会正义模式之上。
全盘采用（通常是简化版的）艾滋病毒/艾滋病宣传模式作为GMH的模式存在重大问题。然而，认真对待艾滋病毒/艾滋病与心理健康之间重要而细微的差异，可能会为两个领域的倡导者、活动家和学者之间富有成效的互动和相互借鉴指明一些可能性。
