Lessons from the World of Global Health for Our Mental and Emotional Well-Being

I write here as a practitioner of mental health care who also has a foot in the world of “global health”. I’m a clinician in the US and I direct mental health for Partners In Health, an international health care delivery organization founded almost forty years ago that delivers health care across twelve countries. I’ve read the blogs here and feel deeply inspired by the personal stories of healing and survival.

The World Health Organization has defined mental health as “the capacity of thought, emotion and behaviour that enables every individual to realize their own potential in relation to their developmental stage, to cope with the normal stresses of life, to study or work productively and fruitfully, and to make a contribution to their community.” This definition is about all of us being able to reach our potential, and to cope effectively. Mental health is a much broader concept than that of mental illness, which refers to a clinically recognizable set of symptoms or behaviors associated in most cases with distress and that interferes with personal functions. Mental health is a positive concept, and prevention of the development of mental health problems, or illness, means that we address mental and emotional distress as it is happening, so that it doesn’t develop into an illness. While mental health problems are incredibly common, fortunately they are highly treatable conditions, and there is so much good that we can do with a variety of treatments that exist.

Working on our mental health in a deliberate way can lead to a virtuous cycle that enhances our happiness and well-being in all kinds of ways.

I believe firmly in formal mental health services, and yet one of the insights I’ve gathered from my life in global health, where there are often no formal services at all, is that there are many forms of care that we can build around ourselves if we create spaces to do those things, and invest in the idea that people can take care of themselves and each other in creative ways. This includes engaging with others directly by being empathic, practicing listening actively, and normalizing distressing feelings we experience. It includes skills-building, for example around: problem-solving; behavioral activation, that is, doing things that one enjoys; relaxation; exposure to stressful situations in a supportive way to reduce the reaction to those things; identifying negative thoughts and restructuring those thoughts; positive self-talk; distracting oneself; mindfulness; and knowing how to ask for support, communicate effectively, and assess one’s relationships. There are apps, there are online platforms for teens, for coaching and crisis support, and there are actual online therapy platforms that can enhance this deliberate work.

There is more formal care as well, of course, but I want to emphasize here how much we can get from practicing self-care, peer-to-peer support, and community support on our own.

Over the past few years of COVID, in my work with people, I’ve emphasized some of the following ways that people can take care of themselves every day:

1. Remember the things that you really enjoy doing, find a way to do them, and be open to new things;
2. As things open up more and more, get outside and breathe, and find spaces you like to be;
3. Limit exposure to TV and internet news;
4. Exercise and physical activity, daily if possible, and get enough sleep every night;
5. Be of service, give of yourself to others, somehow;
6. Have clear routines and a schedule, and also have unstructured time for spontaneous fun, away from the cell phone;
7. Engage in focused meditation and relaxation, and if struggling to slow the mind down, find a place and person where and with to talk about it. It need not be a professional. It can be a friend, a teacher, someone you trust. Identify what stresses you out the most and find ways to limit that stress;
8. Positive family time—work to counter negativity, and talk about what you are feeling with family members who listen. If they’re not good at listening, teach them how to listen. That goes for friends too. Find ways to be seen and heard.
9. Use technology to connect widely, and also make efforts to see people in person because technology can both connect us, while it can sometimes increase loneliness without live human contact; and
10. Enhance learning and engagement—books, reading, limited internet—and minimize distraction. Try to cut down the number of inputs that your brain is managing at once. An example is eliminating the many open screens on our phones or computers that we are attending to. This downregulates the dopamine effects on our brain’s addiction centers.

Finally, lately, I’ve been thinking a lot about grief—my own, and collectively. The layers of challenge that we’ve been experiencing through COVID has compounded our pre-existing grief. To address we need to be present and undistracted (see #10 above). When we don’t talk about our grief and put it into words, it takes a toll. I hope for all of us that we can each and collectively discuss this more and more, find ways to heal together, and in an intentional way, take care of our brains, and our hearts, at once.

 

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Dr. Giuseppe (Bepi) Raviola is a mental health pioneer and avatar. Even before the realization that the world we live in was already steeped into the age of trauma, Bepi was well ahead of his time in helping organizations and institutions tackling the root causes of what has currently escalated into a global mental health crisis. Since 2000 and later as Partners In Health Director of Mental Health by 2010, he has been instrumental in helping the organization integrate mental health into its holistic vision of healthcare and fight for global health equity.

Dr. Raviola serves also as the Director of the Program in Global Mental Health and Social Change (PGMHSC) at Harvard Medical School (HMS), and an Associate Director of the Chester M. Pierce, MD Division of Global Psychiatry at Massachusetts General Hospital (MGH). A child psychiatrist who works clinically within the Division of Child and Adolescent Psychiatry at MGH, he is also an Assistant Professor of Psychiatry, and of Global Health and Social Medicine at HMS.