I’ll never forget the intense and electrifying global mental health debates during McGill’s Advanced Study Institute in the Summer of 2012 between Vikram Patel, Derek Summerfield Suman Fernando, and Frederick Hickling in particular (you can read Somatosphere’s summary, Global Mental Health and Its Discontents, here). Frederick Hickling later referred to the debate in his 2019 article “Owning Our Madness: Contributions of Jamaican Psychiatry to Decolonizing Global Mental Health” for Transcultural Psychiatry.
The contentious debate on evidence-based Global Mental Health care is challenged by the primary mental health program of Jamaica. Political independence in 1962 ushered in the postcolonial Jamaican Government and the deinstitutionalization of the country’s only mental hospital along with a plethora of mental health public policy innovations. The training locally of mental health professionals catalyzed institutional change. The mental health challenge for descendants of African people enslaved in Jamaica is to reverse the psychological impact of 500 years of European racism and colonial oppression and create a blueprint for the decolonization of GMH. The core innovations were the gradual downsizing and dismantling of the colonial mental hospital and the establishment of a novel community mental health initiative. The successful management of acute psychosis in open medical wards of general hospitals and a Diversion at the Point of Arrest Programme (DAPA) resulted in the reduction of stigma and the assimilation of mental health care into medicine in Jamaica. Successful decentralization has led to unmasking underlying social psychopathology and the subsequent development of primary prevention therapeutic programs based on psychohistoriographic cultural therapy and the Dream-A-World Cultural Therapy interventions. The Jamaican experience suggests that diversity in GMH must be approached not simply as a demographic fact but with postcolonial strategies that counter the historical legacy of structural violence.
Keywords: Community Mental Health, decolonization, European-American psychosis, Global Mental Health, psychiatric deinstitutionalization, psychohistoriographic cultural therapy, stigma
Dr. Hickling, who died on May 7 “after a sudden illness . . . was a giant in the global movements for deinstitutionalization, community mental health and cultural psychiatry,” according to McGill CMB program co-director Laurence Kirmayer and McGill cultural psychiatrist Jazwant Guzder.
You can read the rest of their tribute here.