Ideas & Insights Mental health, agency, and voice

Mental health, agency, and voice


Jun 11th 2018


Note: This is the fourth blog of a six-part blog series

This week’s IEI takes a look at the role of mental health and psychotherapy in improving both economic and overall well-being, understanding how government interventions intersect with activating agency, and amplifying unheard voices.

The effects of psychotherapy-trained health workers in Pakistan.

Cognitive behavioral therapy, focusing on psychological affirmation makes a difference to poor Pakistani women – both psychologically and financially.

Making mental health a top priority in India.

The government’s National Mental Health Survey, published last year, reported that about one in 10 adults in India was experiencing a clinically significant mental health problem (I suspect the prevalence would be similar in children), meaning that at least 100 million people in this country are currently affected (and tens of millions more if one counts family members affected by mental health problems in a relative). But, what is even more disturbing is that the vast majority of these persons, up to 90 per cent for some types of mental health problems, had not received any treatment or care for their suffering. This is despite the fact that we have highly effective remedies, ranging from medicines to psychological therapies and social interventions, and mounting evidence that these can be delivered by community health workers.

Vikram Patel is a psychiatrist and professor at Harvard, and founder of Sangath, an NGO in Goa. More about his research on epidemiology and sociocultural determinants and treatment of mental disorders in impoverished parts of India and other countries (see his TED talk below).


Freedom-loving reasons for government interventions.

[…] if you want to take freedom seriously, you need to take seriously the accumulating science on the necessary conditions for freedom. There is no excuse today for not appreciating the importance of two things for the ability to exercise free choice. First, the “choice structure” — the determinants of the menus from which our choices have to be picked and the relative costs they attach to them — which is not God-given or natural but a function of our social and economic order, including policies. Second, the physiological and psychological bases for deliberate decision making.

[…] Promoting freedom in such contexts must involve reducing the costs of rational decision making, which will often require state intervention.

To read more about nudging and activating agency, see Michael’s blogpost.

Promoting the development project and missing voices. World Bank lead economist Vijayendra Rao talks about “the role that anthropology and ethnography could play in helping poor or disempowered people engage with powerful institutions” and cultures of development: “the faddishness of ideas, the reliance on scale and quantification, the bureaucratic inertia, and the ways that ordinary people–their cultures, struggles, and aspirations–can be missing from the picture.”

Land laws and economic opportunity lost. Speaking of engaging with powerful institutions, the Council on Foreign relations recently highlighted efforts at national and international levels to reform land laws that disenfranchise women around the world. This too often neglected element of access to pivotal resources is one of a many tiered approach that could improve women’s economic opportunity and the well-being of their families and communities.

An Ethiopian women holds a land certificate.
Photo credit: USAID

“A woman’s income can increase up to 380 percent when she has a right to own and inherit property. In Rwanda, women who own land are 12 percent more likely to take out loans to build businesses, and in India, secure land rights yield an 11 percent increase in women moving from subsistence farming to selling crops from their land. Secure land rights for female farmers are also related to higher agricultural productivity and food security, important drivers of development.”

But as the article points out, this requires not only advocacy for legal reform, but also the challenging and incremental process of cultural shifts. As we’ve seen in so many different areas, one approach alone can’t open new sustainable pathways to economic prosperity and opportunity for women around the world.