This study will pursue three specific aims: 1) to refine a conceptual framework and methodological approach for clarifying the relationships between mental health services and global trade; 2) to assess the decisions and actions of major groups concerning globalization and mental health services: U.S. government agencies, multinational banking and trade organizations, international and national health organizations, multinational corporations, and advocacy groups; and 3) to present policy recommendations that link globalization and mental health services. The application addresses the priorities of the NIMH Small Grants Program since it proposes an exploratory study that represents a significant change in research direction for an experienced, NIMH-supported investigator. Economic globalization raises fundamental issues concerning mental health services. The World Bank and other international lending agencies have fostered reduction and privatization of health and public health services, including mental health services, previously provided in the public sector; this intensely debated orientation has affected policies of the World Health Organization, the Pan American Health Organization, and the U.S. National Institutes of Health. Expansion of multinational corporations (managed care organizations, consulting firms, pharmaceutical and medical equipment firms, and industrial corporations) has accompanied the increasing privatization of mental health services in the United States and other countries. Growing from previous research on the exportation of managed care and the implementation of Medicaid managed care for medical and mental health services, the proposed work includes an analysis of the research and archival literature on globalization and mental health services; interviews with representatives of government agencies, multinational banking and trade organizations, international and national health and mental health organizations, multinational corporations, and advocacy groups; and assessment of these organizations' reports available in the public sphere. This project will lead to several products: two journal articles; op-ed and similar articles for newspapers and magazines; a book; and a curriculum module for mental health services, policy studies, public health, social sciences, and management. ? ?
