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Monday November 27, 2017

Mental Health Inclusion is a Human Right: The Case of Grameen PrimaCare

By Sara Wetzler

Nobel Peace Prize Laureate Muhammad Yunus was first to argue that access to financial credit is a natural human right, establishing the pioneering Grameen Bank in Bangladesh in 1982 to offer ultra-poor individuals small business microloans. Since then, Grameen has worked tirelessly to open cashflow to the poorest people in underdeveloped countries, guided by the belief that entrepreneurs with access to seed funding to start small enterprises can propel  themselves out of poverty.

In 2008, Yunus exported these microfinance principles to developed countries by establishing Grameen America, which launched the so-called “third wave” of microfinance. A primary focus of this third wave is health inclusion: not only because access to health care is as fundamental a human right as financial inclusion, but also because health and economic development are inextricably linked. People cannot achieve financial stability if they are unhealthy or lack access to affordable medical care. One needs to look no further than the United States, where medical bills are the leading cause of bankruptcy.

Grameen

The health-focused offshoot of Grameen America, Grameen PrimaCare (GPC), is a paragon of the health inclusion model, providing health care and health education to underserved communities. Its first clinic launched in Jackson Heights, Queens, in 2008. Through its Grameen VidaSana (GVS) initiative the clinic provides immigrant women – many undocumented, all who lack health insurance – with a community in which they can receive quality primary care and comprehensive health education services in group-based settings. GVS provides support to navigate the complicated health system through a primary care team, health conversation groups led, as well as weekly activities like exercise classes, cooking demonstrations, and relaxation activities. Similarly, the Grameen Promotoras initiative is entering  its second phase this year, a community health workers program based in the South Bronx that offers health education workshops and stress reduction and relaxation sessions. The main focus of these fifteen-minute workshops is to improve the overall health and wellness of the women and family who have health insurance but still face many barriers to getting the care they need.

The above services bolster mental health as much as physical health; the provision of comprehensive services offers comfort, community, and support to this under-resourced community. Additionally, the clinics are gradually improving capacity to provide direct mental health services in the primary care setting. Doctors and health coaches at GVS use conversations, both individual and group, to help patients navigate their many life stresses. The GVS staff takes an extensive social history of patients in order to determine the level of risk for mental health problems and the best means of psychosocial support. Patients may also be referred to local psychiatrists in the community, but GVS supports the patient and family in navigating the process. Anxiety is the most commonly diagnosed disorder, though some patients present with psychotic or paranoid symptoms.

As GPC grows, the staff will continue to find new, effective ways to help their patients with their mental health issues, according to GVS medical director Dr. Diana Ramirez-Baron. “The clinic truly understands the importance of health inclusion, that access to health care is a human right, and that health includes mental health care.”

A sophomore at Harvard College, Sara Wetzler was a 2017 Summer Intern at the Global Mental Health Program.