A WORLD OF GOOD FOR MENTAL HEALTH By Christina Hernandez Sherwood Illustration by Alex Nabaum
A South African woman, who is HIV positive and a survivor of sexual trauma, clutches a cloth bag heavy with orange and purple painted pebbles. As the woman removes one pebble after another—each, depending on the color, represents a changeable or unchangeable stressor—the bag lightens, as does her metaphorical burden. She divides her “coping pebbles” into two piles, then works with a counselor to develop strategies to help her handle each stressor. Researchers from the Columbia University Mailman School of Public Health, in partnership with colleagues at the University of Cape Town, are studying whether the women who receive this therapy will better adhere to their HIV medication regimen. Kathleen Sikkema, PhD, Stephen Smith Professor and chair of Sociomedical Sciences, developed this therapeutic intervention two decades ago for a population of American HIV patients and adapted it specifically for women in South Africa. Her theory is that addressing social determinants of mental health—in this case, the stress resulting from violence—will help the women stay engaged in their care and wellbeing, improving their clinical outcomes. This type of global mental health work is more urgent than ever. Worldwide mental health disparities were brought into sharp focus by the COVID-19 pandemic. Climate change both poses an existential crisis and threatens livelihoods and health. It is likely to displace even more populations, a situation that brings with it a host of mental health effects. More than 75 percent of people with mental health disorders living in low- and middle-income countries do not
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