Mental Health and Development: Forging the Path for Inclusion
Get insights into USAID’s groundbreaking work in mental health from Agency Mental Health and Psychosocial Coordinator Dr. Paul Bolton
To mark Mental Health Awareness Month, USAID communicator Rachael Marx sat down with Agency Mental Health and Psychosocial (MHPSS) Coordinator Paul Bolton to learn more about what USAID is doing at the intersection of mental health, inclusion, and global development.
You are USAID’s first MHPSS coordinator, and the only person to hold such a position across the U.S. Government. Can you tell us a bit more about your role?
I have four roles: to develop a mental health policy for the Agency that will guide our efforts to support and improve mental health globally; to provide technical support on mental health programming and research; to educate and train USAID staff; and to reach out and coordinate with other organizations involved in global mental health and foreign assistance inside and outside the U.S. Government. Overall, my vision is for USAID to support access to effective mental health and psychosocial support for people everywhere.
What exactly is mental health and psychosocial support, and what role does it play in helping USAID achieve its mission?
There are a lot of ways to define mental health and psychosocial support.
I find the most useful way of describing them is that psychosocial support, “PSS,” refers to actions we can take to reduce the impact of stressors such as job loss, dislocation, or insecure environments that affect mental well-being, whereas mental health care, “MH,” refers to the specific treatments for those who have developed mental health conditions — including depression, anxiety, post traumatic stress, and substance abuse.
Severe stress and these conditions affect ability to function and maintain and improve one’s situation, including ability to engage with and benefit from USAID’s programs. So while mental health is inherently good, it is also a key tool in achieving the Agency’s other objectives.
Earlier this year, Administrator Power stated: “We must offer people, not a vision merely of international development but a vision of inclusive development.” How does MHPSS fit into the Agency’s vision of inclusive development?
The Agency considers that every person is instrumental in transforming their societies. This means identifying those who are currently excluded or marginalized and enabling them to contribute. Persons with mental health conditions are among the most marginalized globally, to the point of not just being excluded but hidden by themselves, their families, and communities. This requires the Agency to be especially aware of and advocate for this forgotten and ignored population. Moreover, it is no secret that mental well-being affects how we feel, react, and are able to deal with day-to-day challenges. Mental health is a prerequisite that, among other things, helps individuals cope with adversity, contribute to their communities, and fully participate in and benefit from development efforts.
What is USAID doing in the mental health space?
For over 20 years, USAID has worked through the Victims of Torture program to respond to the needs of survivors of torture and trauma. This program has made two key contributions in the MHPSS space: the first is developing programmatic and treatment capacity for dealing with the effects of trauma. The second is development of new types of treatment. USAID has supported the development of treatments which have been found to be effective in the hands of local nonprofessional providers in at least three global regions.
USAID’s Bureau for Humanitarian Assistance has long supported MHPSS in humanitarian response. The Office of HIV/AIDS also has an extensive history of including psychosocial support in HIV programming, recognizing the links between mental conditions and HIV-related health outcomes, and USAID’s Bureau for Global Health has increased focus and investment in integrating MHPSS interventions to health programming. Other programs often include elements of psychosocial support, such as peer group support and creating safe spaces for children.
Today, USAID is in the process of developing its first-ever Mental Health and Psychosocial Support Policy, which acknowledges mental health not only as a key component of global health, but as crucial to the long-term efficacy of development programming.
What do you believe are the main challenges in advancing the issue of mental health in international development? What would you like to see change?
As human beings, we have a tendency to stigmatize persons with mental health conditions. Despite significant scientific progress, mental health is often misunderstood by both the public and health practitioners, leading many to deny, trivialize, or even blame themselves for their mental health conditions, despite the fact there are cost-effective, evidence-based treatments that work.
Suicide kills 700,000 people per year, and mental and neurological conditions directly cause one third of global disability, including the ability to access health and other services. Mental health is critical to health programming for HIV, tuberculosis, child development, and maternal, newborn, and child health. All of this is to say that mental health is a key component of global health and primary health care, and should be acknowledged as such.
This stigma and lack of understanding extends through all levels of society, including to those who make decisions about health budgets and priorities. We all need to be aware of this prejudice and to challenge it. Only then can we give the necessary attention to mental health that our public health data and our sense of justice tell us that it deserves.
About the Author
Rachael Marx is a Communications Specialist in USAID’s Bureau for Democracy, Development, and Innovation.
