Faruk Md Omar
Department of Clinical Psychology, University of Dhaka, Dhaka, 1000, Bangladesh.
Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA.
Glob Ment Health (Camb). 2025 May 22;12:e52. doi: 10.1017/gmh.2025.10008. eCollection 2025.
Indigenous peoples across the world are at disproportionate risk of mental health problems. Colonial hegemony, cultural infiltration, language loss, land grabbing, limited access to healthcare services, including mental health, and geographical isolation - all in synergy - contribute to the heightened risk of developing mental health problems. Epistemic injustice, apparently unrelated, yet another major determinant - can also contribute to the higher prevalence of mental health problems among Indigenous peoples. Systemic exclusion and marginalization of Indigenous people from the generation, dissemination, and validation of knowledge - the central concept of epistemic injustice - provides an opportunity to reflect on the disproportionate rates of mental health problems. If epistemic injustice is left unaddressed, the impetus for Indigenous peoples to participate in conventional health practices would be greatly impeded. In this article, I present the case of Bangladesh, where the conventional mental healthcare system has historically been ignorant of the inclusion of Indigenous people's perspectives and lived experiences, eventually perpetuating epistemic injustice. Finally, I provide a framework to address epistemic injustices to reform mental healthcare in Bangladesh that can inform a system equipped with equitability, accessibility, cultural sensitivity, human rights, social justice, and collaborative alliance - key tenets of global mental health.
世界各地的原住民面临心理健康问题的风险极高。殖民霸权、文化渗透、语言丧失、土地掠夺、获得包括心理健康服务在内的医疗保健服务的机会有限以及地理隔离——所有这些因素相互作用——导致心理健康问题的风险增加。认知不公正,表面上看似无关,但也是另一个主要决定因素——也可能导致原住民心理健康问题的患病率更高。原住民在知识的产生、传播和验证方面受到系统性排斥和边缘化——这是认知不公正的核心概念——为反思心理健康问题的高比例提供了契机。如果认知不公正得不到解决,原住民参与传统健康实践的动力将受到极大阻碍。在本文中,我以孟加拉国为例,该国传统的心理保健系统历来忽视纳入原住民的观点和生活经历,最终使认知不公正长期存在。最后,我提供了一个解决认知不公正问题的框架,以改革孟加拉国的心理保健,这可以为一个具备公平性、可及性、文化敏感性、人权、社会正义和合作联盟——全球心理健康的关键原则——的系统提供参考。