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The biopsychosocial approach and global mental health: Synergies and opportunities


The biopsychosocial (BPS) approach proposed by Engel four decades ago was regarded as one of the most important developments in medicine and psychiatry in the late 20th century. Unlike the biomedical model, the BPS approach posits that biological, psychological, and social factors play a significant role in disease causation and treatment. This approach brought about a new way of conceptualizing mental health difficulties and engendered changes within research, medical teaching and practice. Global mental health (GMH) is a relatively new area of study and practice that seek to bridge inequities and inequality in mental healthcare services provision for people worldwide. The significance of the BPS approach for understanding mental health difficulties is being debated in the context of GMH initiatives. This paper critically evaluates strengths and weaknesses of the BPS approach to mental health difficulties and explores its relevance to GMH initiatives.
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The Biopsychosocial Approach ('BPS')
The biopsychosocial (BPS) approach was proposed as a
necessary change from the biomedical model in which
health was the result of the absence of disease, and where
illnesses and treatment options were understood within a
physiological framework.[1] Under the biomedical model
illnesses were understood as having physiological aetiologies
that were diagnosable through distinct biochemical markers,
and were to be treated via physical interventions.[2] Engel[1]
highlighted how, in order to reassert its position as a medical
discipline, psychiatry in the mid‑19th century adopted the
biomedical model, reducing mental health difculties to
brain diseases that needed treated via pharmacological
interventions targeting biological disturbances.[2,3] Engel[1]
claimed that this had culminated in a crisis developing
within medicine and psychiatry, where doctors were failing
to full their “scientic task” as well as their “social
responsibility.” In short, he argued that the “Western folk
model of disease” based on a dualistic understanding of the
mind and body had merged with the biomedical scientic
model, becoming more dogma‑like than scientic.[1] In
being myopic to the psychosocial dimensions of disease
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DOI: 10.4103/ijsp.ijsp_13_17
The biopsychosocial (BPS) approach proposed by Engel four decades ago was regarded as one of
the most important developments in medicine and psychiatry in the late 20th century. Unlike the
biomedical model, the BPS approach posits that biological, psychological, and social factors play
a signicant role in disease causation and treatment. This approach brought about a new way of
conceptualizing mental health difculties and engendered changes within research, medical teaching
and practice. Global mental health (GMH) is a relatively new area of study and practice that seek to
bridge inequities and inequality in mental healthcare services provision for people worldwide. The
signicance of the BPS approach for understanding mental health difculties is being debated in
the context of GMH initiatives. This paper critically evaluates strengths and weaknesses of the BPS
approach to mental health difculties and explores its relevance to GMH initiatives.
Key Words: biomedical model, biopsychosocial approach, global mental health, mental health
and reducing illness to somatic parameters doctors were
not only neglecting important determinants of health, but
also failing to full their social duty of care. He described
the biomedical institutions as “cold and impersonal”
and physicians who practiced biomedicine as being
“preoccupied by procedures and insensitive to the personal
problems of the patients and their relatives.”[1] Drawing
on the general systems theory from biology,[4] the BPS
approach understands illness (as well as patienthood) as
emerging from an individual who is part of a whole system
composed of “sub‑personal levels” (i.e., nervous system,
organs, tissues, cells, etc.) and “supra‑personal levels” (i.e.,
individuals living in a psychosocial context).[5] According to
the BPS, the determinants for, and the prognosis of, mental
health difculties are the result of an interaction between
biological, psychological, and social factors—with no factor
having a “monopoly” on the explanation and/or cure.[2]
For example, a person with a major depressive disorder
may have challenges at work and difculties coping within
the family. These psychosocial issues may perpetuate the
mental health condition.
Evaluating the contribution of the biopsychosocial
At the end of the 20th century the BPS approach inferred
some important advantages, e.g., in changing the way
of conceptualizing “illness,” opportunities existed for
Emmanuel Babalola1,2,
Pia Noel3,
Ross White4
1Institute of Health and Wellbeing,
University of Glasgow, Glasgow,
3University of Edinburgh, Edinburgh,
4University of Liverpool, Liverpool,
United Kingdom, 2Department of
Clinical Services, Neuropsychiatric
Hospital, Aro, Abeokuta, Ogun State,
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How to cite this article: Babalola E, Noel P, White R. The biopsychosocial
approach and global mental health: Synergies and opportunities. Indian
J Soc Psychiatry 2017;33:291-6.
The Biopsychosocial Approach and Global Mental Health: Synergies and
Address for correspondence:
Dr. Emmanuel Babalola,
Department of Clinical Services, Neuropsychiatric Hospital, Aro,
Abeokuta, Ogun State, Nigeria.
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292 Indian Journal of Social Psychiatry | Volume 33 | Issue 4 | October-December 2017
practitioners of medicine and psychiatry to be more
holistic and integrative in their approach to illness, and
humanistic in the delivery of health care. Individuals with
health challenges were now acknowledged to be active
participants in the recovery process and good health, rather
than mere passive victims of deviations in physiologic
functioning.[1] The BPS approach exerts a signicant
inuence on contemporary understanding of mental
health difculties. For example, the American Psychiatric
Association and the American Board for Psychiatry and
Neurology recommend the BPS approach.[6] The model also
features predominantly in widely used medicine textbooks
such as Human Behavior and Clinical Psychiatry, by
Stoudemire[7] attesting to the fact that the allures of the
model remain true today.[8]
It has been claimed that the BPS approach has contributed
to a reduction in the mind‑body split that has been
prominent in Western medicine. This has helped to foster
opportunities for mental health services to be integrated
into the primary care sector and for mental health
researchers to broaden the scope of their investigations.
Under the biomedical model, emphasis was placed on
researchers identifying potential biochemical markers of a
disorder: the dopamine hypothesis for schizophrenia,[9] and
the serotonin hypothesis for depression are widely known
examples.[10] Unfortunately, the evidence in support of
denitive biomarkers for mental health difculties remain
elusive.[11] The BPS model brought additional factors under
scrutiny including the contribution that psychological
processes (e.g., brooding) and/or social conditions (e.g.,
interpersonal difculties) made to the emergence and
maintenance of mental health difculties. The efforts were
extended from a focus on what mechanisms were underlying
the individual’s presentation (i.e., the “how”) to incorporate
explorations of the conditions that give rise to it (i.e., the
“why”) and to how these relate to each other.[1] This helped
to stimulate cross‑disciplinary avenues in mental health
research and a focus on hitherto under‑researched forms of
distress such as psychosomatic conditions.[12,13] It is claimed
that this new approach to researching mental health
difculties provided a more nuanced and comprehensive
understanding of mental health determinants.[14] This
included a specic focus on the doctor‑client relationship.
As part of the client’s social environment, the doctor needs
to develop an awareness of how his/her interaction with
the client may inuence the prognosis of the ailment,[15]
and indeed, the BPS model engendered “client‑centered”
approaches and a renewed emphasis on the importance
of the doctor‑client relationship.[16,17] It allows for a
multidisciplinary approach to treatment of mental health
difculties. It permits psychiatrists, psychologists, social
welfare ofcers, psychiatric nurses, occupational therapists,
and others in the healthcare team to participate in patient
care. This may ultimately lead to better quality of life
for the service user.[18] Unlike the biomedical model that
aims to provide “one care suits all” approach, the BPS
approach is designed to suit each individual’s needs as
his/her social and psychological environment is taken into
The conceptual inuence of the BPS model has spread
outside the realms of medicine and psychiatry, and has
highlighted that health is more than merely the absence
of disease given that the psychological and social
dimensions had to be accounted for rather than purely the
physical. This idea has been endorsed in many academic
domains such as health education, health psychology,
public health, and preventive medicine as well as in
public opinion.[20,21] The BPS approach is today the
“conceptual status quo”.[22] and underpins the World Health
Organization’s (WHO) denition of health: “A state of
complete physical, mental, and social well‑being, and not
merely the absence of disease or inrmity.”[23] With the
BPS advocating a more comprehensive understanding of
determinants of mental health, the responsibility of care has
stretched beyond the responsibility of mental healthcare
professionals alone, requiring the collaboration of
diverse professionals operating at the macro‑, meso‑, and
micro‑levels.[2] Therefore, Engel’s BPS model has allowed
for a conceptually more holistic understanding of mental
health difculties; broadening not only the awareness
of diverse determinants of mental health, but also the
responsibility towards its care. However, the model is not
without shortcomings and the extent to which Engel’s
model has succeeded in bringing about a “new medical
paradigm” has been debated.
Potential Issues with the Biopsychosocial
Criticisms have been levelled at the BPS approach with
suggestions that it is both time‑consuming and expensive
to apply. Time and cost are particularly pressing issues
in resource‑poor settings,[24] where few healthcare
professionals are available to attend to the large numbers of
people experiencing mental health difculties. It is claimed
that the holistic nature of the BPS approach makes it a
luxury many healthcare systems in low‑ and middle‑income
countries cannot afford.[25] The BPS approach requires
that more information be gathered during the assessment
procedure about an individual’s socioeconomic status,
culture, religion, as well as psychological factors that might
affect the individual’s condition. There are often insufcient
training opportunities or nancial resources available to
support the existence of multidisciplinary teams consisting
of psychiatrists, clinical psychologists, mental health nurses,
and social welfare workers to allow for a full consideration
of the biological, psychological, and social factors involved
in the mental health difculties, with responsibility instead
often falling to physicians whose expertise may be limited
to patient’s biological complaints.[26]
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293Indian Journal of Social Psychiatry | Volume 33 | Issue 4 | October-December 2017
More recently, scepticism has sprung among mental
health professionals surrounding the inuence of the BPS
approach in clinical practice.[21] Scholar‑practitioners
have accused the model’s circular nature for failing to
provide straightforward guidelines for clinical treatments
or rules for prioritization in clinical practice.[27,28] Some
contend that a lack of clarity regarding whether biological,
psychological, or social factors should be prioritized, have
resulted in eclecticism in clinical practice and this “eclectic
freedom borders on anarchy.”[21] Although clinicians may
nd the approach to be a useful heuristic[5] and helpful
for understanding clinical phenomena,[19] its relevance for
guiding clinical practice and alleviating distress remains
ambiguous.[19] There is also the lack of scientic evidence
to support the approach; McLaren described the model
as a myth as it has no theory backing it up.[29] Ghaemi[21]
opined that it is wrong to view the BPS approach as
a concept and scientic fact. It is important to have
empirical evidence of the effectiveness of the approach
before regarding it as superior to other models before and
after it. Critical voices posit the lack of implementation
of the BPS approach as being due to an unwillingness to
change among those who have power and inuence in the
mental health system.[2] Whether due to shortcomings in
the model or an unwillingness to change paradigms, the
continuous commitment towards the biomedical paradigm
within clinical practice is evidenced by the fact that the
psychological and social factors are: “Often relegated to
the role of triggers of an underlying genetic time bomb";[30]
a diagnosis is considered most accurate if symptoms can
be linked to physical anomalies and the effectiveness of
psychosocial interventions is often measured in terms of
medication adherence.[31,32] Furthermore, medical students
in the US receive very limited amount of classes in
psychosocial subjects compared to biomedical‑oriented
courses.[33] This hierarchical dichotomization between the
biological factors and the psychosocial ones, have led some
to argue the BPS model serves to mask the biomedical
model,[21,34] and is in fact a “bio‑bio‑bio model.”[30] The
mismatch between the “conceptual status quo[21]and mental
health care praxis has led to concerns being raised as to
whether the BPS approach is a fully integrative framework,
or whether it merely brings attention to three coexisting
factors affecting health.[35] The lack of BPS integration in
practice has also been noted in health psychology; empirical
and theoretical integrations of the BPS domains remain slim
despite the conceptual endorsement of the BPS approach.[36]
In addition, individualized and “intrapsychic” approaches
to particular forms of distress (such as somatization)
have been argued to reect merely a Western cultural
orientation.[37] An additional criticism made by Sulmasy[38]
highlighted concerns that the BPS approach neglects the
relational aspect a person has with transcendental factors,
and calls for a “biopsychosocial‑spiritual model” to truly
account for the whole person. The inuence that the BPS
approach has had on understanding potential determinants
of mental health has been considerable. Although Engel’s
work brought about a conceptual change surrounding
mental health difculties, in practice a dichotomization
between the biological factors and the psychosocial remains
with a bias towards treating the biomedical disturbances.
As such, a persisting focus on treating mental health
difculties within the realm of biomedicine constitutes
an egocentric and ethnocentric approach that is rooted in
Western “folk model” of personhood. The implications
this has for potentially limiting the validity, relevance, and
applicability of the BPS approach for understanding and
responding to mental health difculties worldwide is the
discussion we now turn to.
Relevance of the Biopsychosocial Approach to
Global Mental Health Initiatives
Increasingly, Global Mental Health (GMH) initiatives are
being undertaken worldwide in the hope of improving
mental health inequities and inequalities and closing the
“treatment gap” that exists between those that need mental
health services through the “scaling‑up” of evidence‑based
treatments.[39,40] International organizations such as the
World Health Organization (WHO) that endorse the BPS
approach have played a leading role in these efforts. The
multiplicity of factors that the BPS purports to be linked
to mental health difculties provides rm support for
multisectorial approaches for tackling mental health issues.
Indeed, the WHO encourages working in partnership
between the public sector (e.g., health, education,
employment, judicial, housing, etc.) and the private sector
as well as the involvement of a wide range of stakeholders
including international non‑governmental organizations
(INGOs), local NGOs, national governments, communities,
amongst other relevant stakeholders.[22] Further, the BPS
approach provides important opportunities to link mental
health outcomes to development approaches (e.g., using
micronance projects) that aim to alleviate poverty and
marginalization.[41] The INGO called Basic Needs utilizes
a development model for mental health that comprises of
ve modules that are all geared towards addressing the
biological, sociocultural, and psychological factors affecting
individuals with mental disorders.[42] The organization has
reached 640,700 people with mental health difculties,
their carers and family members in 12 countries in Africa
(Kenya, Ghana, South Sudan, Uganda, and Tanzania) and
Asia (India, Vietnam, Sri Lanka, Pakistan, Nepal, Laos).
Other programmes such as The Mental Health and Poverty
Project, designed and funded by the Department for
International Development (DFID), have succeeded in
improving access to treatment of mental disorders in Ghana,
South Africa, Uganda, and Zambia by combating poverty.[43]
Therefore, there are many examples of GMH initiatives
implicitly endorsing the BPS approach that have yielded
positive results surrounding mental health interventions
and outcomes. This approach would seem appropriate and
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294 Indian Journal of Social Psychiatry | Volume 33 | Issue 4 | October-December 2017
laudable given that 80% of people suffering from mental
health difculties live in low‑ and middle‑income countries
where social and economic inequalities are particularly
pressing issues.[44] However, rather than fully utilizing
sources of strength that may be present in social groupings
and communities, the majority of efforts have been centered
around treating individuals within the context of existing or
newly developed medical frameworks looking for example
to “improve access” to mental health services.[45‑47]
The Biopsychosocial approach and “Culture”
In articulating the BPS model Engel acknowledged “culture”
as being an important factor for understanding disease:
“The boundaries between health and disease, between
well and sick, are far from clear for they are diffused
by cultural, social, and psychological considerations.”[1]
Culture has been dened as “a set of institutional settings,
formal and informal practices, explicit and tacit rules, ways
of making sense, and presenting one’s experience in forms
that will inuence others.”[48] Indeed, DSM‑5 acknowledges
that “All forms of distress are locally shaped, including
the DSM disorders.”[49] However, in practice culture has
been relegated to the “social” factor,[36] which some have
argued largely underestimates the fundamental role culture
has on the experience and manifestation of an illness.
[50] Anthropological work has for a long time exposed
different ways of being in the world and has emphasized
the importance of culture in shaping everyday life. Keeping
in mind the danger of reductionism and essentialism when
talking about culture, it has often been noted that there
are cultures that are more individualistic and others more
collectivistic in their understanding of autonomous units.
[51,52] This observation has potential ramications for the
way distress is expressed and experienced. Along the
same line, Fernando[53] observed that the most profound
consequences in Sri Lanka after the tsunami were seen in
terms of social relationships; “social isolation and difculty
performing family roles were among the greatest concern
for survivors.”[54] These local expressions and experiences
of distress are what Nitcher[55] coined as “local idioms of
distress.” Therefore, while in the West the understanding
of psychopathology is that it is an individual intra‑psychic
phenomena,[37] it is not a universal way of expressing or
experiencing distress. Thus, despite the combined efforts of
diverse stakeholders to alleviate “mental illness,” without
the inquiry into local idioms of distress, the chances of
implementing a valid and effective intervention are curbed.
[56] GMH initiatives would benet from the BPS approach
being extended to specically include a focus on cultural
factors to maximize engagement with people in Low and
Middle Income Countries (LMIC), but there is evidence to
suggest that this could also be advantageous for engaging
underserved communities in high‑income countries (e.g.,
black and minority populations).[57,58]At the conceptual
level, the concerns voiced are around the lack of integration
of the BPS domains and the disregard of the fundamental
role culture can have on every level of the BPS approach.
[36]Ample cross‑cultural evidence has highlighted the
existence of different idioms of distress as well as
explanatory models around health and illness across the
world.[59] For instance, in addition to BPS concepts, many
individuals, especially those from non‑Western cultures,
make sense of illness within a spiritual framework.[60] In
fact, when ill, 85% of people in Sub‑Saharan Africa visit
traditional healers before seeking help elsewhere.[61,62] These
distinct explanatory models do not only indicate different
understandings of health, pathology, and “normality”
but also point at different ideas about what constitutes
personhood. The argument has been made that although the
BPS approach places the patient in a social context,[63] the
individual is still the center of analysis, interpretation, and
intervention[36] potentially curbing the appropriateness and
relevance of the model in a global context. More cautious
voices coming from medical anthropology fear that
interventions blind to local contexts are not only wasteful,
but also potentially harmful.[64‑66] Indeed, interventions
designed to alleviate distress at the level of the individual
when the damage is in fact centered at the level of social
relationships will struggle to prove relevant or useful.
[45] The globalization of the Western explanatory model
of psychopathology may not only threaten the perceived
legitimacy of alternative understandings of distress and/or
action to alleviate this distress, but also add to a perceived
tendency to increasingly pathologize life experience.[67‑71]
The exact mechanisms by which this “individualization,
biologization, and pathologization” can occur is beyond
the scope of this essay, however readers may be
interested to understand the contribution that sociological
theory can make to this understanding; for example see
Hacking’s work focusing on the “looping effect.”[70] Some
commentators have pointed to the power and interests of
the pharmaceutical industry in expanding the market for
psychotropic medications as the main force globalizing the
Western understanding of distress.[71,72] The concern here is
that social factors contributing to mental health difculties
in different parts of the globe remain unaddressed in the
context of an overmedicalization of issues such as poverty.
In conclusion, the BPS approach has contributed to an
eschewing of deeply ingrained features of the Western
“folk model” such as the mind‑body split and made an
important conceptual contribution for understanding mental
health difculties in a more all‑encompassing fashion. This
article has highlighted a need to extend the BPS approach
to include a specic acknowledgement of the central role
that cultural beliefs and practices can play in understanding
mental health difculties. This will help facilitate a focus
on particular idioms of distress that are highly relevant
for developing interventions for mental health difculties
in different sociocultural contexts. In short, for the BPS
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Babalola, et al.: Biopsychosocial approach and global mental health
295Indian Journal of Social Psychiatry | Volume 33 | Issue 4 | October-December 2017
approach to be a truly “holistic” model it will need to be
sensitive to the diversity of beliefs and practices espoused
by people across the globe. A greater focus on cultural
factors could also potentially address a criticism that
has been made to the BPS model, i.e., a lack of specic
guidance relating to how support can be operationalized
and offered to clients.[22] Increased understanding about
pertinent cultural factors could inform understanding
about the people, processes, spaces, and places in which
acceptable forms of support can be provided.
Financial support and sponsorship
Conicts of interest
There are no conicts of interest.
1. Engel GL. The need for a new medical model: A challenge for
biomedicine. Science 1977;196:129‑36.
2. Deacon BJ. The biomedical model of mental disorder: A critical
analysis of its validity, utility, and effects on psychotherapy
research. Clin Psychol Rev 2013;33:846‑61.
3. Abramowitz JS. Toward a functional analytic approach to
psychologically complex patients: A comment on Ruscio and
Holohan. Clin Psychol Sci Pract 2006;13:163‑6.
4. Von Bertanlaffy L. Perspectives on General System Theory. New
York, NY: George Braziller, Inc; 1975.
5. Asokan TV. Towards an ideal paradigm. Indian J Psychol Med
6. Tavakoli HR. A closer evaluation of current methods in
psychiatric assessments: A challenge for the biopsychosocial
model. Psychiatry (Edgmont) 2009;6:25‑9.
7. Stoudemire A. An Introduction for Medical Students. Human
Behaviour. 3rd ed. Philadelphia PA: Lippincott, Williams and
Wilkins; 2004
8. Shannon MT. Health promotion and illness prevention: A
biopsychosocial perspective. Health Soc Work 1989;14:32‑40.
9. Van Rossum JM. The signicance of dopamine‑receptor
blockade for the mechanism of action of neuroleptic drugs. Arch
Int Pharmacodyn Ther 1966;160:492‑4.
10. Kerr C. The Serotonin Theory of Depression. Jefferson J
Psychiatry 2011;12:4‑10.
11. Singh I, Rose N. Biomarkers in Psychiatry. Nature
12. Reiser MF. Implications of a biopsychosocial model for research
in psychiatry. Psychosom Med 1980;42:141‑51.
13. Novack DH, Cameron O, Epel E, Ader R, Waldstein SR,
Levenstein S, et al. Psychosomatic medicine: The scientic
foundation of the biopsychosocial model. Acad Psychiatry
14. Pies RW. Nuances, Narratives, and the ‘Chemical Imbalance’
Debate in Psychiatry. Medscape; 2011.
15. Engel GL. The clinical application of the biopsychosocial model.
J Med Philos 1981;6:101‑23.
16. Smith RC, Fortin AH, Dwamena F, Frankel RM. An
evidence‑based Patient centered method makes the
biopsychosocial model scientic. Patient Educ Couns
17. Stewart M, Belle Brown J, Wayne Weston W, McWhinney
IR, McWilliam CL, Freeman TR. Patient‑centred Medicine:
Transforming the Clinical Method. Thousand Oaks, CA:10 Sage,
18. Mclnerney S. Introducing the biopsychosocial model for good
medicine and good doctors. BMJ 2015;324:1533.
19. White R, Sashidharan P. Towards a more nuanced global mental
health. Br J Psychiatry 2014;204:415‑7.
20. Alvarez AS, Pagani M, Meucci P. The clinical application of the
biopsychosocial model in mental health: A research critique. Am
J Phys Med Rehabil 2012;91:S173‑80.
21. Alonso Y. The biopsychosocial model in medical research: The
evolution of the health concept over the last two decades. Patient
Educ Couns 2004;53:239‑44.
22. Ghaemi SN. The rise and fall of the biopsychosocial model. Br J
Psychiatry 2009;195:3‑4.
23. World Health Organization. Mental Health Action Plan
2013‑2020. Geneva: WHO; 2013.
24. Truglio J, Graziano M, Vedanthan R, Hahn S, Rios C,
Hendel ‑ Paterson B, et al. Global Health and Primary care;
Increasing Burden of Chronic Diseases and Need for Integrated
Training. Mt Sinai J Med 2012;79:464‑74.
25. Lane RD. Is it possible to bridge the Biopsychosocial and
Biomedical models? Biopsychosoc Med 2014;8:3.
26. Gatchel RJ, Oordt MS. Clinical health psychology and primary
care: Practical advice and clinical guidance for successful
collaboration. Washington DC: American Psychological
Association; 2012.
27. Borrell‑Carrió F, Suchman AL, Epstein RM. The biopsychosocial
model 25 years later: Principles, practice, and scientic inquiry.
Ann Fam Med 2004;2:576‑82.
28. Schwartz GE. Testing the biopsychosocial model: The ultimate
challenge facing behavioural medicine? J Consult Clin Psychol
29. McLaren N. The myth of the biopsychosocial model. Aust N Z J
Psychiatry 2002;36:701.
30. Read J. The bio‑bio‑bio model of madness’. Psychologist‑leicester
31. Rose N. Neurochemical selves. Society 2003;41:46‑59.
32. Depp CA, Moore DJ, Patterson TL, Lebowitz BD, Jeste DV.
Psychosocial interventions and medication adherence in bipolar
disorder. Dialogues Clin Neurosci 2008;10:239‑50.
33. Suls J, Rothman A. Evolution of the biopsychosocial model:
Prospects and challenges for health psychology. Health Psychol
34. Stam HJ. Theorizing health and illness: Functionalism,
subjectivity and reexivity. J Health Psychol 2000;5:273‑83.
35. Kiesler D. Beyond the disease model of mental disorders.
Greenwood Publishing Group; 1999.
36. Hatala AR. The status of the “biopsychosocial” model in health
psychology: Towards an integrated approach and a critique of
cultural conceptions. Open J Med Psychol 2012;1:51‑62.
37. Kirmayer LJ, Young A. Culture and somatization: Clinical,
epidemiological, and ethnographic perspectives. Psychosom Med
38. Sulmasy DP. A biopsychosocial‑spiritual model for the care of
patients at the end of life. Gerontologist 2002;42:24‑33.
39. Patel V, Prince M. Global mental health: A new global health
eld comes of age. JAMA 2012;303:1976‑7.
40. Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G,
Tomlinson M, et al. Scale up services for mental disorders: A
call for action. Lancet 2007;370:1241‑52.
41. Fernald LC, Hamad R, Karlan D, Ozer EJ, Zinman J. Small
[Downloaded free from on Saturday, November 18, 2017, IP:]
Babalola, et al.: Biopsychosocial approach and global mental health
296 Indian Journal of Social Psychiatry | Volume 33 | Issue 4 | October-December 2017
individual loans and mental health: A randomized controlled
trial among South African adults. BMC Public Health
42. Basic Needs. Better Mental Health, Better Lives. www.basicneeds.
org. [Last accessed on 2015 October 20].
43. Thornicroft G, Cooper S, van Bortel T. Capacity Building
in Global Mental Health Research. Harv Rev Psychiatry
44. World Health Organization. Investing in Mental Health. Geneva:
WHO; 2003.
45. Jansen S, White R, Hogwood J, Jansen A, Gishoma D,
Mukamana D, et al. The “treatment gap” in global mental health
reconsidered: Sociotherapy for collective trauma in Rwanda. Eur
J Psychotraumatol 2015;6:28706.
46. Kirmayer LJ, Pedersen D. Toward a new architecture for global
mental health. Transcult Psychiatry 2014;51:759‑76.
47. Saxena S, Thornicroft G, Knapp M, Whiteford H. Global Mental
Health Resources for mental health: Scarcity, inequity, and
inefciency, (panel 1). 2007‑6736
48. Kirmayer LJ. Beyond the ‘new cross‑cultural psychiatry’:
Cultural biology, discursive psychology and the ironies of
globalization. Transcult Psychiatry 2006;43:126‑44.
49. American Psychiatric Association. Diagnostic and statistical
manual of mental disorders(DSM‑5®). American Psychiatric
Pub; 2013
50. Burkett GL. Culture, illness, and the biopsychosocial model.
Fam Med 1990;23:287‑91.
51. Marks D. Health Psychology in Context. J Health Psychol
52. Triandis H. Collectivism V. Individualism: A Reconceptualization
of a Basic Concept in Cross – cultural social psychology. Cross
Cultural Studies of Personality, Attitude and Cognition. Verma &
Bagley Springer; 1988
53. Fernando G. Assessing mental health and psychosocial status
in communities exposed to traumatic events: Sri Lanka as an
example. Am J Orthopsychiatry 2008;78:229‑39.
54. Fernando G. Finding meaning after the tsunami: Recovery
and resilience in Sri Lanka. Traumatic Stress Points. Int Soc
Traumatic Stress Stud 2005;19:1‑12.
55. Nichter M. Idioms of distress: Alternatives in the expression of
psychosocial distress: A case study from South India. Cult Med
Psychiatry 1981;5:379‑408.
56. Fernando S, Weerackody C. Challenges in developing
community mental health services in Sri Lanka. J Health Manage
57. Rathod S, Phiri P, Harris S, Underwood C, Thagadur M,
Padmanabi U, et al. Cognitive behavioural therapy for psychosis
can be adapted for minority ethnic groups: A randomised
controlled trial. Schizophr Res 2013;143:319‑26.
58. Griner D, Smith T. Culturally adapted mental health interventions:
A meta‑analytic review. Psychotherapy 2006;43:531‑48.
59. Kirmayer LJ. Cross cultural Variation in the response to
psychiatric disorders and emotional distress. Soc Sci Med
60. Shweder R, Much K. Are moral intuitions and self‑evident
truths? Criminal Justice Ethics 1994;13:24‑31.
61. Gbodossou E, Floyd V, Katy C. The role of traditional medicine
in Africa’s ght against HIV/AIDS. Conference Proceedings on
Knowledge, Attitude and Practice Studies Dakar, Senegal; 2000.
62. Morris K. Treating HIV in South Africa – A tale of two systems.
Lancet 2001;357:1190.
63. Duncan G. Mind Body Dualism and the biopsychosocial
model of pain: What did Descartes really say? J Med Philos
64. Fernando S. Mental health worldwide: Culture, globalization and
development. Palgrave Macmillan; 2014.
65. Mills C. Psychotropic Childhoods: Global Mental Health and
Pharmaceutical Children. Children Soc 2013;28:194‑204.
66. Roman MW. Anatomy of an epidemic: Magic bullets, psychiatric
drugs, and the astonishing rise of mental illness in America.
Issues Ment Health Nurs 2012;33:707‑11.
67. Timimi S. The McDonaldization of childhood: Children’s mental
health in neo‑liberal market cultures. Transcult Psychiatry
68. Davars B. Globalising Psychiatry and the case of “vanishing”
alternatives in a neo‑colonial state. Disability and the Global
South 2014;1:266‑84.
69. Mills C, Fernando S. Globalising Mental Health or Pathologising
the Global South? Mapping the Ethics, Theory and Practice of
Global Mental Health. Open Access 2014;1:188‑202.
70. Hacking I. The looping effects of human kinds: Causal cognition.
A multidisciplinary debate; 1995.
71. Applbaum K. Educating for global mental health. Global
Pharmaceuticals: Ethics, markets, practices 2006;85‑110.
72. Kirmayer LJ, Raikhel E. Editorial: From Amrita to Substance D:
Psychopharmacology, Political Economy, and Technologies of
the Self. Transcult Psychiatry 2009;46:5‑15.
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... 133), arguing that a similar question may be asked regarding schizophrenia or diabetes. The persuasive nature of Engel's arguments can be seen in how the biopsychosocial model of disease was adopted vigorously in mental health-care discourse in both the Global North and the Global South (Babalola et al., 2017;Thornicroft et al., 2012). The terms 'Global North' and 'Global South' here are to be understood beyond narrow geographical notions, but in terms of global unequal power relations between centres/metropoles ('norths') and peripheries ('souths') de Sousa Santos, 2014;Ndlovu-Gatsheni, 2013b). ...
... Rhetoric and frameworks on the biopsychosocial nature of illness have however not easily translated into practice. Criticism levelled at the biopsychosocial approach has not only focussed on it being time-consuming and costly (Babalola et al., 2017;Truglio et al., 2012) but also on its inability to provide clear guidelines for clinical practice (Ghaemi et al., 2012). Building on criticism that the biopsychosocial model has failed to shed its Western Eurocentric baggage in that it remains individualistic, Babalola et al. (2017) also point to its insufficient attention to the role of culture. ...
... Criticism levelled at the biopsychosocial approach has not only focussed on it being time-consuming and costly (Babalola et al., 2017;Truglio et al., 2012) but also on its inability to provide clear guidelines for clinical practice (Ghaemi et al., 2012). Building on criticism that the biopsychosocial model has failed to shed its Western Eurocentric baggage in that it remains individualistic, Babalola et al. (2017) also point to its insufficient attention to the role of culture. Noting that Engel (1977), in his original conceptualisation of the model, highlighted the importance of culture, these authors argue that this aspect was lost in how it was bound up with the notion: social. ...
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Community psychology is deeply committed to the liberation and wellbeing of communities. Seemingly missing from the discipline, however, is an explicit interrogation of coloniality. In keeping with the decolonial process, one paradigm that allows for the disruption of hegemonic knowledge is Participatory Action Research (PAR). PAR facilitates opportunities for critical consciousness, self and collective determination, shared decision-making, and social change as defined by communities. This chapter engages two questions: What does it mean to decolonise PAR within community psychology? What are key elements toward the development of a decolonial PAR praxis? Pursuing these questions requires centering decolonial Global South and Indigenous cosmologies in relation to a PAR paradigm. PAR in community psychology must disrupt the coloniality of power. Thus, to engage with elements of decoloniality this chapter proposes ten axioms toward a decolonial PAR praxis in community psychology that align with the decolonial turn.
... The study analysed the views of 19 mental health professionals working in primary health care Thirdly, with the partial exception of Hamdani et al. (2015Hamdani et al. ( , 2017 and Humayun et al., (2017), the studies reviewed do not appear to reflect an ecological or developmental approach to CAMH. There was also no evidence of attempts to broaden the scope of mhGAP-IG implementation to include participatory mental health care planning, community mobilisation, and other complementary interventions recommended by the programme (Babalola et al., 2017), which characterises the mainstreaming of mhGAP approaches to adult mental health in some settings (Breuer et al., 2014;Kohrt et al., 2019). Despite schools having been identified as some of the most conducive environments for mental health prevention and promotion (Klasen & Crombag, 2013), in the studies selected for this review, only Lasisi et al. (2017) investigated implementation in an educational setting. ...
... Despite schools having been identified as some of the most conducive environments for mental health prevention and promotion (Klasen & Crombag, 2013), in the studies selected for this review, only Lasisi et al. (2017) investigated implementation in an educational setting. Most of the studies were conducted in the context of facility-based service provision, suggesting an overall bias towards clinical approaches to child mental health care that is not in line with the inspiring principles of the mhGAP programme (Babalola et al., 2017;WHO, 2008b), or indeed of the GMH agenda more generally (Patel, 2014). And whilst the Intervention Guide recommends collaborative case management including family, school, and social welfare systems, the studies reviewed provide very limited examples of actual implementation of this model. ...
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Background The Mental Health Gap Action Programme (mhGAP) supports engagement of non-specialists in mental health services in Low- and Middle-Income countries. Given this aim, assessment of the effectiveness of approaches under its remit is warranted. Aims We evaluated mhGAP approaches relating to child and adolescent mental health, focusing on provider / child outcomes, and barriers / facilitators of implementation. Methods Thirteen databases were searched for reviews and primary research on mhGAP roll out for child and adolescent mental health. Results Twelve studies were reviewed. Provider-level outcomes were restricted to knowledge gains, with limited evidence of other effects. Child-level outcomes included improved access to care, enhanced functioning and socio-emotional well-being. Organisational factors, clients and providers? attitudes and expectations, and transcultural considerations were barriers. Conclusions Further attention to the practical and methodological aspects of implementation of evaluation may improve the quality of evidence of the effectiveness of approaches under its remit.
... Although there are various studies examining burnout, there is a lack of a holistic view-including whether biological, psychological, and socio-environmental factors (based on the established health and disease model) are sufficient to describe the onset of the syndrome. and leisure environment, etc.)], as well as cultural and spiritual aspects as supplementary dimensions (Sulmasy, 2002;Suls and Rothman, 2004;McGee and Torosian, 2006;Esch, 2008aEsch, , 2011Esch, , 2019Havelka et al., 2009;Babalola et al., 2017;Berry et al., 2017;Listopad et al., 2021). There is preliminary evidence that spirituality, meaningfulness, faith, and trust are pain-and stressreducing and essential within a holistic model of health and disease (Sulmasy, 2002;McGee and Torosian, 2006;Esch, 2008aEsch, , 2011Esch, , 2019Saad et al., 2017;Listopad et al., 2021). ...
... The bio-psycho-social model of health and disease was postulated more than four decades ago by Engel (1977). According to the model, biological, psychological, and socio-environmental aspects play an important role in the development of health and disease and should therefore be considered in the description, prevention, and treatment of diseases (Engel, 1977;Egger, 2008;Havelka et al., 2009;Babalola et al., 2017;Lehman et al., 2017). In general, the (i) biological dimension refers to the physical elements of the body that influence and determine mental and physical health (Havelka et al., 2009;Lehman et al., 2017). ...
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Background: Burnout is a widespread, multifactorial, and mainly psychological phenomenon. The pathogenesis of burnout is commonly described within the bio-psycho-social model of health and disease. Recent literature suggests that the phenomenon of burnout may be broader so that the three dimensions might not reflect the multifaceted and complex nature of the syndrome. Consequently, this review aims to identify the diversity of factors related to burnout, to define overarching categories based on these, and to clarify whether the bio-psycho-social model adequately describes the pathogenesis of burnout—holistically and sufficiently. Method: Five online databases (PubMed, PubPsych, PsychARTICLES, Psychology and Behavioral Sciences Collection, and Google Scholar) were systematically searched using defined search terms to identify relevant studies. The publication date was set between January 1981 and November 2020. Based on the selected literature, we identified factors related to burnout. We aggregated these factors into a comprehensible list and assigned them to overarching categories. Then, we assigned the factors to the dimensions of an extended model of health and disease. Results: We identified a total of 40 burnout-related factors and 10 overarching categories. Our results show that in addition to biological, psychological, and socio-environmental factors, various factors that can be assigned to a spiritual and work cultural dimension also play an important role in the onset of burnout. Conclusion: An extended bio-psycho-socio-spirito-cultural model is necessary to describe the pathogenesis of burnout. Therefore, future studies should also focus on spiritual and work cultural factors when investigating burnout. Furthermore, these factors should not be neglected in future developments of diagnosis, treatment, and prevention options.
... Overall, our results are compatible with the biopsychosocial model used to generate the hypotheses and build the questionnaire. Indeed, Lebanese mental well-being was related to biological characteristics (chronic disease and family history of COVID-19), behavioral/psychological factors (health beliefs such as the fear of COVID-19), and social conditions (family relationships, education, economic status, and social support) (Babalola et al., 2017). ...
Objective: This study aimed to examine the outcomes of COVID-19 and a collapsing economy on the mental well-being (MWB) of the general Lebanese population. Methods: A cross-sectional study was conducted online in May 2020 and enrolled 502 adults. Results: MWB had a mean of 14.80[14.37;15.24]. A lower MWB was associated with female gender (beta=-1.533[-2.324;-0.743]), university education (beta=-2.119[-3.353;-0.885]), fear of COVID-19 (beta=-0.131[-0.199;-0.063]), fear of poverty (beta=-0.232[-0.402;-0.063]), verbal violence at home (beta=-3.464[-5.137;-1.790]), and chronic disease (beta=-1.307[-2.283;-0.330]). Better family satisfaction (beta=0.380[0.235;0.525]) and better financial situation (beta=0.029[0.003;0.055]) were significantly correlated with better MWB. In the subsample of workers/looking for a job, additional factors affected MWB: physical exercise (beta=1.318[0.370;2.265]) was associated with better QOL, while being a previous waterpipe smoker, being self-employed before the crisis (beta=-1.22[-2.208;-0.231]), working from home since the economic crisis (-1.853[-3.692;-0.013]), and worrying about the long-term effects of the crisis on one's employment status (beta=-0.433[-0.650;-0.216]) were associated lower MWB. It is noteworthy that closure of the institution yielded a borderline result (B=-1.2; p=0.094), while the fear of COVID-19 was not significantly associated with MWB (B=-0.054; p=0.192). Conclusion: This study showed that, during the pandemic, economic and other factors, directly or indirectly related to COVID-19, significantly affected quality of life. The fear of COVID-19 and fear of poverty mainly impacted the MWB of the general population. However, the fear of COVID-19 lost its significance among workers, who reported that factors negatively affecting their MWB are directly related to their employment and the already collapsing economy in Lebanon.
... In severe cases, infection can even lead to serious breathing difficulties [7]. The COVID-19 pandemic has not only caused physical illnesses but also led to global socioeconomic problems [8], and the biopsychosocial impact of COVID-19 is leading to serious mental health problems [9]. ...
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Objective: Healthcare workers and disaster service workers have been reported to be vulnerable to mental health problems during outbreaks of infectious diseases such as the COVID-19 pandemic. This study aimed to investigate the psychosocial characteristics of disaster service workers in charge of COVID-19-related work and also identify the factors affecting their quality of life. Methods: From June 2020 to June 2021, a survey was conducted of 526 disaster service workers in charge of COVID-19-related work. This included those working in public health care centers (PHC), 119 rescue and emergency medical services (119 REMS), public servants of city hall (PS), and police officers. The Korean version of the Fear of COVID-19 Scale, Patient Health Questionnaire-15, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Connor-Davidson Resilience Scale, and World Health Organization quality of life assessment instrument brief form were used. A one-way ANOVA was conducted, and a stepwise regression analysis was carried out to determine the factors affecting quality of life. Results: Regarding quality of life, 119 REMS (180.64 ± 26.20) scored significantly higher than PHC (165.76 ± 23.73) and PS (163.90 ± 23.60), while police officers (176.87 ± 23.17) scored significantly higher than PS (163.90 ± 23.60) (F = 12.373, p < 0.001). Resilience (β = 0.897, p < 0.01) was the most significant explanatory variable, and together with insomnia (β = 0.154, p < 0.01), depression (β = -0.152, p < 0.01), and COVID-19 anxiety (β = -0.057, p < 0.01) accounted for 91.8% of the explanatory variance with regard to quality of life. Discussion: Quality of life was found to be negatively correlated with insomnia, depression, and COVID-19 anxiety while being positively correlated with resilience. Therefore, active interventions are needed to improve the resilience of disaster service workers.
Purpose The purpose of this paper is to test a mental wellness intervention, Mood Lifters (ML), that addresses significant barriers to mental health care. ML includes adults over 18 struggling with mental wellness or any life difficulties, except those with active suicidality, mania and psychosis, and addresses barriers to care using peer leaders in a manualized group format with a gamified point system. Design/methodology/approach Participants were recruited using online postings. Those eligible (76% female, 80% white) were randomly assigned to professional-led groups ( N = 30), peer-led groups ( N = 33) or a waitlist ( N = 22; i.e. attended assigned condition if available). Participants completed pre- and postgroup measures (including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Perceived Stress Scale), attended 15 weekly meetings and tracked “points” or at-home skills practice. Multiple imputation was used to account for attrition. Linear regressions were analyzed to determine the program’s impact on anxiety and depressive symptoms and perceived stress. Further analyses included comparisons between peer- and professional-led groups. Findings Participants in ML experienced significant reductions in anxiety symptoms. Completing more homework across the program led to significant reductions in anxiety and perceived stress. Finally, there were no significant differences in attendance, homework completed or outcomes between peer- and professional-led groups. Practical implications Overall, participation in the ML program led to reduced anxiety symptoms, and for those who completed more homework, reduced perceived stress. More accessible programs can make a significant impact on symptoms and are critical to address the overburdened care system. Additionally, there were no differences between leader types indicating that peers may be an effective way to address accessibility concerns. Originality/value ML is unique for three reasons: it takes a biopsychosocial/Research Domain Criteria approach to mental wellness (i.e. incorporates many areas relevant to mental health, does not focus on a specific diagnosis), overcomes major barriers to mental health care and uses a peer-delivery model. These attributes, taken together with the results of this study, present a care alternative for those with less access.
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Smoking cessation is a major public health goal today as smoking has threatened the safety, health, and lives of millions of people in the global community. Therefore, the purpose of this study is to identify the role of biopsychosocial and spiritual factors towards the readiness to quit smoking and smoking cessation. The results of the study found that smoking behaviour adversely affects not only the biological aspects but also the psychological, social, and spiritual aspects. Apart from that, this study also found that the biological, psychological, social, and spiritual aspects also play an important role in determining the motivation of smokers to quit smoking holistically. Therefore, research and empirical evidence on the biopsychosocial and spiritual aspects are needed to help healthcare teams to identify the barriers and motivating factors to quit smoking.
The burden of disease has quadrupled in much of the world population, affecting the Global South, particularly indigenous populations, the most. This chapter delves into what may explain the failure to translate good intentions behind health promotion, a global strategy towards better population health, into every day health practice and research. The role of biomedicine, and why it remains the dominant discourse in both health care and research is outlined. To address the global failure in delivering on the most progressive thinking about health and society in the history of humanity, the chapter argues for a decolonial shift in both discourse and praxis, illustrating how this shift often necessitates disobedience within disciplines or professions such as psychology and occupational therapy.
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The global mental health movement has the mission to reduce the gap between the burden of mental illness and the availability of effective mental health services. This mission entails advocating for increased funding for mental health services and personnel, expanding research to develop evidence‐based practices for low‐resource settings. It has been proposed that this can be accomplished by advocating for increased funding for mental health services and personnel, expanding research to determine evidence‐based mental health treatments, development of government mental health policies, and advancing the human rights of persons with mental illness. Key topics from medical anthropology related to global mental health include universalism versus cultural relativism in psychopathology; culture‐bound syndromes and cultural concepts of distress; healing, belief, and meaning in ethnomedical traditions; critique of psychiatry and social–political–economic construction of labels; social suffering and structural violence; humanitarian disasters, complex emergencies, and the mental health and psychosocial support movement; and definitions of culture.
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Offers a perceptive critique of the universalized model of psychiatry and its apparent exportation from the West to the developing world. Rooted in detailed analysis of the problems this causes, the book proposes new suggestions for advancing the field of mental health and wellbeing in a way that is ethical, sustainable and culturally sensitive.
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Background: The "treatment gap" (TG) for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda. Objective: The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which "community" has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs), "community" should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress. Conclusions: Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being.
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Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused on developing, implementing, and evaluating evidence-based practices that can be scaled up through task-shifting and other methods to improve access to services or interventions and reduce the global treatment gap for mental disorders. Recent debates on global mental health have raised questions about the goals and consequences of current approaches. Some of these critiques emphasize the difficulties and potential dangers of applying Western categories, concepts, and interventions given the ways that culture shapes illness experience. The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes. More fundamentally, exclusive attention to mental disorders identified by psychiatric nosologies may shift attention from social structural determinants of health that are among the root causes of global health disparities. This paper addresses these critiques and suggests how the GMH movement can respond through appropriate modes of community-based practice and ongoing research, while continuing to work for greater equity and social justice in access to effective, socially relevant, culturally safe and appropriate mental health care on a global scale.