Martha Nussbaum extended the work of Armatya Sen by exploring further the implications that the CA has for the realms of justice, social inclusion and citizenship [ 34 ].
She highlighted the strong moral and ethical credentials of the CA, with emphasis being placed on facilitating social contexts that promote and secure dignity for all members of society. In essence, the CA provides scope for reshaping the identities of individuals who have experienced mental health difficulties by providing opportunities to re-connect with society. Research investigating the narrative accounts provided by people experiencing mental health difficulties has indicated that these discourses can be characterized by experiences of exclusion [ 37 ].
The CA places emphasis on identifying sources of unfreedom such as discrimination and stigma. In short, to enhance freedom [ The CA regards the removal of sources unfreedom as being necessary, but not sufficient, to enable human development — there is also a need to foster opportunities for people to engage with what they regard as valuable ways of being and doing e. A number of researchers and theorists have applied the CA to the mental health arena, with the CA being highlighted as a way of facilitating people with a lived experience of mental health difficulties to engage with their values and priorities [ 40 ].
For example, the CA influenced the design and delivery of a community development approach to mental health promotion in a disadvantaged community in Sydney, Australia [ 41 ]. Additional research should seek to facilitate the bottom-up development of measures aimed at assessing capabilities that are tailored to particular cultural contexts. Moving forward, it may be fruitful to conduct additional research aimed at developing similar types of measures in other settings.
It has been argued that the CA provides a basis for a fuller and more dynamic view of QoL that focuses more on fulfilment i. Moving forward, there is a real need for GMH as an area of study and practice to embrace a progressive and comprehensive framework that captures what it is seeking to deliver for the global population. As a human rights informed approach that highlights the importance of respecting democracy, voice, and diversity and enhancing social citizenship [ 38 , 47 ], the CA offers great promise in guiding GMH-related initiatives.
The need for GMH-related initiatives to be inclusive of the diversity of beliefs and practices espoused by individuals living in different parts of the world has been highlighted [ 48 ]. Consistent with these calls, consideration of human diversity is central to the CA. According to Crocker and Robeyns [ 30 ], the CA takes account of human diversity in that it has an explicit focus on:.
The plurality of particular functionings and capabilities as important evaluative spaces — it recognizes that these will vary within the individual. The extent to which the personal factors e. As such, we are proposing the CA as a unifying framework for guiding Global Mental Health initiatives that can provide scope for implementing a diverse range of potential processes that are shaped by the particular contexts in which these processes are being applied.
It is widely recognized that national mental health policies have not adequately extended beyond the health system, with insufficient focus being given to related sectors such as housing, education, social care, criminal justice and employment [ 50 ]. From a CA perspective, social inequalities can be viewed as sources of unfreedom that deprive people of opportunities to develop their capabilities, and engage in valued functionings. Consistent with its origins as a welfare economics framework, the CA provides scope for recognizing the important role that efforts aimed at reducing social inequalities can have in the context of GMH.
As such, the CA provides scope for addressing factors relevant to mental health and wellbeing that are specific to the individual i. We propose that the work of BasicNeeds is consistent with the CA because of the opportunities that the organization facilitates for human development. Examples of structural violence include institutionally propagated forms of suffering such as racism and poverty [ 57 ].
It is claimed that there has been a tendency to de-socialize particular difficulties that people experience e. We proposed that the application of the CA fosters opportunities for GMH initiatives aimed at building capacity for mental health services across the globe to re-socialize mental health difficulties and address social inequalities and structural violence as forms of unfreedom that may be serving to prevent individuals from realizing their capabilities and engage in valued functionings.
Particular programmes have sought to address sources of unfreedom experienced by people with mental health difficulties in LMIC. This has historically been a widespread practice in Indonesia. The application of the CA to initiatives of this kind would mean that campaigns aimed at promoting freedom would be complemented by concerted efforts to assist individuals to engage in valued functionings.
Consistent with the CA, we propose that initiatives aimed at jointly addressing sources of unfreedom and supporting individuals to engage in value-consistent behaviours are required to enhance human development and optimize SWB. It has been suggested that these issues present challenges to mental health professionals because the particular pathological processes involved remain unclear [ 64 ].
LMIC will be particularly vulnerable to the mental health related impact of climate change because of existing disadvantage in socioeconomic status and the reduced availability of services for mental health [ 60 ]. The CA has been shown to be effective for critically examining the content of policy initiatives and the worthiness of these efforts [ 33 ]. Specifically, it has been suggested that:.
This can be contrasted with a growing tendency in applied social sciences to concentrate on the means that may be used to enhance quality of life as an end itself. This addresses concerns regarding the tendency for policy initiatives to regard people as the objects of policies. The primacy that the CA gives to ethical considerations can be contrasted with a tendency to obscure ethical issues that can arise when employing technocratic approaches to address particular issues. Being an approach rather than theory, there is flexibility in how the CA can be applied to issues, and the way in which it can be employed to reframe relevant issues ibid.
Building on these observations, we propose that applying the CA to mental health policy initiatives including those linked to GMH can help highlight important opportunities that may been missed for facilitating individuals and communities to engage in valued functionings and realize their capabilities. Specifically, there is a need to be wary about the risk that:. Initiatives may at times focus predominantly on particular means for building capacity for mental health e. Policy initiatives could lapse into treating humans as the objects of policies and thereby impact adversely on human dignity.
Although EBM has many benefits, key limitations relating to the approach have been highlighted [ 67 ]. For example, evidence-based guidelines tend to map poorly onto complex multimorbidity, and statistically significant effects noted in clinical trails do not always equate to clinically significant change in practice. Specific concerns have also been raised about the way in which EBM approaches have been applied in the context of GMH e. This has led to calls for the research agenda to be broadened to incorporate more trans-disciplinary approaches [ 68 ].
There is a risk that initiatives could be overly rigid in drawing heavily on Western models of treatment e. It is claimed that policy initiatives and international networks may have served to undermine the perceived legitimacy and credibility of non-allopathic forms of support [ 69 , 70 ]. This is in spite of research from Kerala, India where diverse forms of support including allopathic medicine, Ayurveda, and religious healing were all associated with improvements in individuals experiencing severe mental disorders [ 71 ].
The CA was highlighted as a framework for fostering a more sophisticated and deeply grounded understanding of community complexities that would be valuable for creating appropriate mental health services [ 72 ]. Clearly, there is a need to extend this work and explore the exciting possibilities that exist. The CA approach provides a coherent framework that brings together the work of policy initiatives specifically aimed at mental health such as mhGAP [ 6 , 7 ], Social Determinants of Mental Health [ 73 ], Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group [ 74 ], and the Comprehensive Mental Health Action Plan — [ 14 ], whilst also allowing space to incorporate other policy initiatives e.
As such, we propose that the CA represents a framework for supporting progress by complementing, consolidating and broadening the scope of existing initiatives, whilst also constructively guiding the direction of future initiatives aimed at promoting mental health and wellbeing. In being concerned with human development, the CA approach inherently facilitates opportunities to reduce levels of mental illness whilst also working to enhance mental wellbeing.
The application of the CA to Mental Health initiatives including GMH places specific emphasis on the need to systematically assess what individuals and communities value. Particular forms of psychological intervention place a specific focus on helping individuals to clarify values. For example, Acceptance and Commitment Therapy ACT [ 76 ] aims to help individuals to explore their values, and engage in behaviours that are consistent with these values by enhancing psychological and behavioural flexibility.
Research has indicated that psychological interventions can be adapted and implemented with positive outcomes in LMIC settings [ 77 — 79 ], importantly however there is a need to ensure that this is done in a culturally appropriate way and that valid outcome measures are used [ 80 ].
Specifically, a lack of equity was highlighted in efforts to reduce levels of mental illness compared with optimizing SWB. By highlighting human development as a key issue, the CA was identified as a framework for guiding initiatives across the globe that can focus on both optimizing SWB and reducing levels of mental illness. Furthermore, the CA provides scope for addressing both micro- and macro- level factors that may have served to thwart opportunities for individuals and communities to realize their capabilities.
Reprising the work of Vanessa Rose and colleagues , we propose that the CA represents an important platform for considering factors related to people, spaces and places that can facilitate opportunities for enhancing mental health and wellbeing. We believe that this will provide opportunities for consolidating existing complementary mental health initiatives with a global focus, whilst also facilitating opportunities to extend into other non-health sectors.
Importantly, the application of the CA can also provide opportunities to critically reflect on ways in which GMH initiatives could inadvertently hinder efforts to develop capabilities by: 1 Narrowly focusing on mental illness rather than also addressing subjective wellbeing, and 2 Relying too heavily on a restricted range of epistemologies and research methodologies to design and evaluate interventions. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study Resources for mental health: scarcity, inequity, and inefficiency.
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Transcult Psychiatr. Mills C. Decolonizing Global Mental Health: The psychiatrization of the majority world. London, UK: Routledge; Summerfield D. Afterword: against Global Mental Health. Global Mental Health and its discontents. Accessed 18 April Santayana G. Life of reason: reason in common sense. Mental illness and mental health: the two continua model across the lifespan. J Adult Dev. Comprehensive mental health action plan — Subjective well-being: three decades of progress. Psychol Bull. Inner wellbeing: concept and validation of a new approach to subjective perceptions of wellbeing—India.
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Nussbaum M. Frontiers of justice. Disability, nationality, species membership. Dreze J, Sen AK. India: development and participation. London: Oxford University Press; Robeyn I. The capability approach: a theoretical survey. Brown W, Kandirikirira N. Recovering mental health in Scotland.
The Capability Approach: Concepts, Measures and Applications - Google книги
Report on narrative investigation of mental health recovery. Glasgow: Scottish Recovery Network; Accessed 18 Apr Carpenter M. The CA, and critical social policy: lessons from the majority world? Is functioning an adequate proxy for capability? Is a list of context free capabilities to be generated? This is particularly evident when considering his writings on the topics of freedom and justice e.
Sen, , Some of the philosophical preoccupations of social researchers seem to be absent from his work, however. He seems to show little interest in the polarised debates between positivism and anti-positivism, and between interpretivist and objectivist positions in the social sciences.
This may reflect his grounding in economics, a discipline that is strongly quantitative, abstract e. Sen, , and largely traditionnal in its approach to the social sciences such that these debates may not be salient. More pertinent to this discussion, he has been equally critical of the use of subjective psychological measures of well-being, chiefly because people can adapt or become resigned to their circumstances.
He appears to see such indices as crude, and offering a very partial picture, but recognises they have some value. He is pragmatic about using whatever indices are available Qizilbash, Sen seems reluctant to list capabilities so as not to constrain their local application to specific situations.
Others notably Nussbaum, e. It is difficult to see how the capability to feed oneself is not universally desirable. The researcher therefore must seek a philosophical approach that transcends these dichotomies. A solution is offered by the critical realism of Bhaskar e.
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He stresses the distinction between ontology and epistemology, a distinction that is often conflated in new paradigm social research. It adopts an epistemology that is relativist and interpretivist, recognising that knowledge of reality is always partial and local. Not all explanations may be equivalent in their ability to describe reality, and reality can be understood as complex and stratified, with different depths of explanation possible. Whilst new paradigm approaches may agree that knowledge is constructed and always from a specific perspective, they disagree about the ontological implications, i.
Career researchers assert not just that they can understand events through the lens of post-modernism, but also that the world is post-modern. The ontological implications of these positions are not made fully explicit, but instability in the labour market is used as a justification for an interpretivist world view.
Different perspectives are associated with different levels of analysis. These include macro-level perspective e. Intermediate, or meso-level positions are also possible e. With few exceptions most notably the systems theory framework of career development, e. Its level of analysis tends to be at micro level.
Quantitative measures are important in research in psychology. This means that they are likely to be characterised by narrowness of focus. This is a concept of central importance for the CA, with its focus on choice and autonomy. In psychology there have been several attempts by psychologists to narrow down the notion of personal agency for the purposes of measurement, the most successful being the construct of self-efficacy Bandura, Self-efficacy relates to a confidence in the ability to achieve goals and belief in the ability to have some impact on the world.
Career scholars have found the concept of self-efficacy to be very useful in developing theory and in research, where it has been extensively and successfully applied e. For example, an immigrant lacking legal rights to work or study, may find that confidence is not a sufficient condition for career success. Nonetheless, through the lens of the CA, narrowness in focus essentially means discarding information unwisely.
This problem can to some extent be managed by use of multiple, hybrid or aggregate indices. Individualism is a charge that has also been made against the CA. Sen promotes the notion of the capability of the individual agent to critically reflect and make worthwhile life choices from the alternatives available to her. Both interventions and research efforts may be targeted at an individual, group or community level.
From the CA perspective, the individual remains the ultimate focus of concern across all these activities.
The choice between quantitative and qualitative methods is a fundamental one in social research. Will it be lists of capabilities? If so, then what purpose do they serve? Ibrahim stresses that there is no agreement as to what domains of life to include in a list of capabilities, but suggests some characteristics of a good list.
Alkire , approaches these problems from a different angle, suggesting methods to identify capabilities that are participatory. Whilst accepting that pre-existing data and evidence, and expert analysis have a role to play, Alkire suggests involving stakeholders in ongoing participatory process that elicit their perspectives and values. Capabilities may attain some degree of local political legitimacy if a public consensus is sought on their selection.
This would seem very much within the spirit of the CA , but it is not necessarily straightforward. One concern is that the concept is too abstract, and that this may be an obstacle to involving participants in research processes to identify capabilities. Al-Janabi et al. In summary, this study illustrates that individuals can understand and respond to questions about their capabilities. Qualitative research is desirable to identify capabilities, which perhaps will then be measured and quantified. It is no surprise that they have been the dominant group of interest to those involved with career development.
Of particular concern are those young people who experience difficulty in the transition to adult life, encountering periods of exclusion from work and learning. The substantial growth in youth unemployment in Europe following the banking crisis of has only intensified the perennial concern about the effects of exclusion on young people, and its implications for wider society e. Key publications emerging from this project include Otto et al.
They studied two brief work activation programmes for young people in Scotland. They found evidence that participants were offered some genuine choice of work placement experiences during their programme, and what to do after their programme, thus to some extent they were empowered. This demonstrates that such an approach is viable. The CA points to ways of supporting NEET young people that place their own preferences, objectives and aspirations as central, not peripheral considerations.
These studies also illustrate that this is not straightforward and unproblematic to implement in a context shaped by funding and policy constraints. Whilst acknowledging the importance of the higher levels of analysis, and the wider socio-economic and politic environment, this approach takes the individual and their experiences as the focus of concern. This is intended to identify career capabilities appropriate to this key target group. This avoids discussing the notion of capabilities as an abstract concept.
IPA requires participants to engage in reflection, recollection, and articulation of past and present experiences, and seeking to understand them, in so far as it is possible, through their eyes. To this extent it can contribute to our understanding of career capabilities. This may subsequently inform interventions to promote career capability. It appears that through a variety of confidence building activities, the programme enables participants to reconnect with their life-career goals, and to redeploy unused but pre-existing resources at their disposal, including skills, qualification, experience and vocational preferences.
It defines social justice as basic capability equality Arneson, This challenge presents the researcher with difficult problems. These are problems to which there is no single correct or final answer. Rather the researcher has choices to make, which must be defensible. Arguably a feature of the CA is that it allows heterogeneous approaches to research and capability assessment.
Attempts at measurement are best informed by involving or consulting people in identifying capabilities, and those factors or experiences that empower them. It follows from this that qualitative approaches are particularly well suited to this kind of question. Once capabilities have been identified they can later be converted to quantitative measuring instruments. The promotion of social justice means viewing young people not solely in terms of their potential contribute to the labour market or skills development to move them closer to this point.
It means supporting young people to conceive of and implement lifestyles and identities that are personally meaningful. Al-Janabi H. Alkire S. Anand P. Arneson A. Arthur N. Bandura A.
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