Decolonising mental health, aid and fundraising

In recent years, decolonisation has gained attention within the development and humanitarian sector as a key concept, and many actors are either considering applying it to their respective scope of work or are discussing it.

I was unsurprised recently when members of Bond’s Mental Health and Psychosocial Disability (MHPSD) subgroup selected “Decolonisation, aid and fundraising” on the list of topics they wanted to have a session on during this year’s series of seminars, of which I was honored to speak at the opening last month. Having just completed a consultation process on a related theme, “renaming aid”, I had a few points of view to share with members, which I shall echo here.

In many communities across the world, decolonisation is a constant struggle where people unrelentingly organise to defend themselves against foreign control and campaign for the return of ancestral lands. They push for the revival of critical customs and ways of life, which have been abandoned or decimated by colonial systems –this is what decolonisation entails. However, in recent times the understanding of decolonisation is being expanded and used widely as a metaphor for those who want to critique and dismantle processes, structures and matrixes of power that stem from colonialism and its legacies.

According to the World Health Organization, there are huge discrepancies in mental health outcomes across cultures and countries. For instance, a young man with a mental health condition in a Minority World is more likely to receive help and thrive, than one with same conditions in a deprived former colonial country like Burkina Faso, where they areunlikely to have attended school, and may have ended up homeless or institutionalised in facilities, without access to their basic needs and rights.

In the Majority World, informal-, faith- or traditional-based strategies have the highest chance of increasing access and usage of mental healthcare services because they adopt more culturally and socially appropriate and sensitive methods that have proven to increase both the readiness and willingness to seek and adhere to treatments. However, these treatments remain out of reach to many people, because they lack financial support, and instead more attention and funding are paid to colonial-rooted biomedical approaches.

When the global ramifications of ideas such as “scaling up mental health services” pops-up for discussion or considerations in policy fora or in programming, people forget that more often than not, it is these colonial-rooted biomedical approaches that are under consideration. Besides building oncolonial memories of suppression, these ideas are likely to come into conflict with a range of local truths that underpin mental wellbeing. It’s on this basis that decolonising becomes a critical tool for analysis and strategy.

The key challenge for aid agencies, donors and fundraisers is how to support the decolonisation of mental health services. As is the recognition that aid agencies, donors and fundraising initiatives themselves may need decolonising.

Although more is to be known, there is sufficient evidence indicating coloniality is rife among many actors and practices within the sector, from the way fundraising is conducted to the way donor institutions operate. There is no denying the presence of inherent power imbalance when a Western donor dictates the size of the grant, frames the problem and sets the terms, including the kind of intervention. As innocent as it may seem, this practice is akin to imposing a worldview on others.

Likewise, when a fundraising campaign fails to describe the root causes of the issue that needs funding, and instead insinuates that communities need the help of international organisations, the campaign plays into an age-old colonial narrative of dependency.

Primarily, the challenge for aid agencies and fundraisers is to reflect on their own operations with the aim of refining how aid resources can be best utilised to shift power towards approaches that have a higher chance of eliminating disparities in mental health outcomes across the board. This would entail supporting policies that end institutionalisation and that address, holistically, all of the factors that contribute to the rise of mental health conditions.

Aid agencies and fundraisers should also invest in non-harmful home-grown methods; and promote active participation of people with lived experiences, and their families, which may include building networks of users, care givers and support systems – all of which are required for healing, advocacy, and programming.

There may not be a manual already in place to decolonise mental health, aid and fundraising, but it’s always important to start by acknowledging there’s a problem and taking that first step.
Finally, the language around “aid” needs to be ditched and replaced with one that brings into perspective structural causes of global inequalities in health generally such as historical legacies and current injustices in trade and climate policies.