Vol.:(0123456789) 1 3 Community Mental Health Journal https://doi.org/10.1007/s10597-020-00720-6 FRESH FOCUS The Cultural Politics of Mental Illness: Toward a Rights‑Based Approach to Global Mental Health Lisa Cosgrove 1  · Zenobia Morrill 1  · Justin M. Karter 1  · Evan Valdes 2  · Chia‑Po Cheng 1 Received: 2 August 2020 / Accepted: 1 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract The movement for global mental health (MGMH) has raised awareness about the paucity of mental health services, particu- larly in low- and middle-income countries. In response, policies and programs have been developed by the World Health Organization and by the Lancet Commission on global mental health, among other organizations. These policy initiatives and programs, while recognizing the importance of being responsive to local needs and culture, are based on Western biomedical conceptualizations of emotional distress. In the paper, we discuss how a rights-based approach can promote the voice and participation of people with lived experience into the MGMH. We argue that a human rights framework can be enhanced by incorporating the conceptual approaches of critical inquiry and community mental health. We also discuss how rights-based approaches and service-user activism can productively reconfgure Western psychiatric conceptualizations of distress and provide both a moral and empirical justifcation for a paradigm shift within the MGMH. Keywords Global mental health · Community mental health · Rights-based approach · Community psychiatry The 2018 publication of the Lancet Commission’s Report on global mental health (GMH) and the associated forum on “Accelerating Country Action on Mental Health,” have reinvigorated interest in and debates about the movement for global mental health (MGMH). Advocates of the MGMH maintain that early detection and treatment of mental dis- orders—particularly in low- and middle-income (LMIC) countries—are pressing human rights issues (Patel et al. 2007). They argue that there is a mental health gap, and we must ‘scale-up’ the diagnosis of and treatment for mental disorders. Narrative descriptions of people with mental ill- ness being stigmatized and shunned, together with visual depictions of people being shackled, are used to emphasize the lack of mental health literacy in poor and middle-income countries (Shukla et al. 2012). Proponents also argue that there is a strong and unequivocal demand for increased access to mental health services. Critics of the MGHM, on the other hand, argue that the movement is heavily grounded in Western psychiatric taxonomy (i.e., the Diagnostic and Statistical Manual of Mental Disorders [DSM]) and Western models of treatment, particularly psychopharmaceuticals and psychotherapy (Kirmayer and Pedersen 2014; Summerfeld 2013). They point to the constructed and culturally bound nature of distress, the colonial legacy of targeting the Global South as in need of intervention, and critique the use of an economic calculus (e.g., the Disability Adjusted Life Years or DALY metric) to bring attention to the mental health gap. Further, a growing number of leaders, even from within the MGMH, have called for a “fundamental re-thinking of psy- chiatric knowledge creation and training” and have empha- sized the interdependence of mental and social health (Gard- ner and Kleinman 2019). The aim of this paper is to engender dialogue about how to develop more emancipatory and inclusive approaches and policies within the MGMH. We argue that a particular invocation of a human rights approach is needed—one that shifts attention to the socio-political determinants of men- tal health. The frst section of the paper describes a human rights approach and how it has been used by both the World Health Organization (WHO) and the Lancet Commission to support the need to scale-up the diagnosis and treatment of mental disorders, particularly in the global South. We then * Lisa Cosgrove lisa.cosgrove@umb.edu 1 Department of Counseling and School Psychology, University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA 02125, USA 2 School of Psychology, Massey University, Auckland, New Zealand