Social Work on a Global Scale: Expanding Access to High-Quality, Equitable, and Culturally-Relevant Mental Health Care with Dr. Flora Cohen
The School of Social Work’s International Committee brings together a group of faculty whose work stretches across continents and communities, united by a commitment to expanding the reach and relevance of social work worldwide. Through their research, faculty members actively shape the future of international practice and drive meaningful global impact.
In this interview series, they share how they continue to advance their work amid tightening funding landscapes, along with their candid perspectives on why global social work remains essential to building a more just and connected world.
The research of Dr. Flora Cohen, Assistant Professor at the School of Social Work, is driven by a central question:
How can we expand access to high-quality, equitable, and culturally-relevant mental health care? Embedded in this question, Dr. Cohen explains, are a few more questions: How can we determine cultural relevance? What do we mean by “high quality”? And what is “equity” when we consider the social drivers of mental health?
Dr. Cohen’s work was inspired by a desire to understand how people and communities conceptualize their own distress and healing. Dr. Cohen urges future social workers to consider the origins of evidence-based practice. Through her work, she has found that many “evidence-based interventions” were never developed, adapted, or tested for global contexts. She highlights the risks of exporting Western mental health diagnoses and treatments to global contexts, including exacerbating social inequities, capitalizing on the commercialization of psychopharmaceuticals for profit, and intensifying distress. She says, “Some of the prevailing global mental health paradigms have been barriers, rather than facilitators, of recovery.”
Meanwhile, she notes the benefit of using existing interventions. Expanding reach and access to high quality services could improve the circumstances for increasingly more people diagnosed with depression, anxiety, and PTSD. She indicates that she shares a “moral imperative to expand mental health access, while simultaneously questioning the interventions that are implemented.” She also notes that, “individuals in all corners of the world have been facing mental health challenges and finding local solutions for far longer than we often give them credit for.”
Dr. Cohen usually works in low or middle-income countries (LMIC) with limited resources. In LMIC, there is a dearth of funding dedicated to mental health (often less than 1% of the country’s health budget), and 99% of the funding is for institutional care, such as residential inpatient programs. There are few mental health professionals, in some countries, and there may be one mental health professional per one million people.
“This leaves 95% of people with mental health conditions untreated,” Dr. Cohen says. “This is the scale of the global mental health crisis. While mental health resources are severely limited, the challenges are not insurmountable. I view resource gaps as opportunities to explore local solutions. Engaging communities in mental health literacy, working alongside mental health training programs, recruiting more students, and generating creative solutions to funding community-based programs are important parts of my work.”
During the COVID-19 pandemic, Dr. Cohen lived in a refugee settlement in Uganda. While managing the implementation and evaluation of a parent mental health and skill-building program, she was able to witness the impact of two years of school closures on children and their families.
“I worked alongside communities to develop solutions that would keep their children safe and supported,” she says. “For example, without virtual school, some families collaborated to build a small, informal tutoring program so their children could continue learning. Another group of families facing severe food ration shortages collaborated on a community farm. We incorporated the provision of seeds for farms and structures for schools within the mental health program. Through this process, I learned how to adapt interventions for rapidly evolving contexts with limited resources and significant restrictions. It shaped me both as a researcher and a practitioner, reinstating my commitment to locally-led solutions.”
For Dr. Cohen, global social work matters because while the drivers of mental health inequities are global, the experiences of distress are personal. “Conflict, climate change, poverty and racism affect everyone,” she says. “The impact of a war in Iran reverberates across the globe. But mental health is often divorced from its causes, as if reading about daily trauma or dealing with excessive financial challenges doesn’t impact us on a personal level. Bridging that connection requires an approach to mental health that honors individual perspectives, collective trauma, and cultural meaning-making while strengthening systems to support the most marginalized.”
Dr. Cohen highlights the lessons she learned from refugees all over the world. “In conversations with refugees from Afghanistan, Somalia, South Sudan, Iran, Palestine and other contexts, I learned that the pathologization of refugees is not the solution that will help to heal centuries of forced displacement and trauma,” she says. “While the answers varied, many refugees want to be heard, they want political justice, prayer with their communities, and they want a safe place to call home. I strive to hear, and to elevate those voices.” For the communities Dr. Cohen works with—especially forcibly displaced people—global social work offers a pathway to visibility and dignity. Dr. Cohen describes how global social work helps ensure that services reflect their worldviews, languages, and priorities, rather than imposing external models that may do more harm than good. “More broadly, global social work challenges the inequities embedded in global health and humanitarian systems,” she explains. “Social work has the moral imperative to push the field toward decolonized, participatory, and community-led solutions. Globally, our collective perspective can make a significant impact on individual and community well-being.”
Alongside collaborations with local communities, Dr. Cohen works alongside colleagues across disciplines, including public health, anthropology, psychology, and sociology. Highlighting the benefit of learning from each field, she says, “if we stay squarely in anthropology, we will have an excellent understanding of local culture, but we may miss intervention design, development, implementation, and evaluation. And, if we rely solely on public health perspectives, we risk applying one-size-fits-all approaches to populations with vastly different needs and resources. Personally, these collaborations have challenged me to see pervasive mental health challenges from nuanced perspectives, in order to implement more effective and sustainable solutions.”
There are many aspects of global social work that give Dr. Cohen hope for the future. She has been impressed by recent research that highlights advances in measurement, intervention development and delivery, and the benefits of investing time with local communities. But, her optimism for her work comes from her time as a case manager in Brooklyn, New York.
For Dr. Cohen, healing starts the moment a person feels heard. “I recall a client I had, a mother of two young children. She was overwhelmed and living in an unsafe situation with an abusive partner. When we met, she was angry and scared, beaten up by institutional racism and a system that wanted to pathologize her pain. After over a year of meeting once to twice per week, we were able to get her kids in day care, find her a job, move her and her children to a safe place to live, and she was able to find joy again for both herself and for her little family.”
“I think about her often, not about the evidence-based interventions I used or didn’t use, or the amount it cost to get her care, but about the time we spent talking about the pain in her life and strategies for sustainable solutions.”
The School of Social Work is dedicated to fostering global collaboration, dedicating our efforts to the development and implementation of innovative solutions that address the world’s most pressing physical and mental health challenges. For those interested in finding out more about global social work, and global mental health specifically, we invite you to check out our Annual Daniel S. Sanders Peace and Social Justice Memorial Lectures.
This year’s lecture, “There Is No Health Without Mental Health: What is it, why does it matter?”, given by Dr. Jerome Galea, Associate Professor, University of South Florida, will take place on March 24. While registration may be closed, we encourage all interested participants to keep an eye out on the School of Social Work calendar for future lectures.
For School of Social Workers students, a lunch will be held with Dr. Jerome Galea on March 24 at 12:00pm (noon) in 2000P, catered by Rosati’s Pizza. Students interested in attending this lunch with Dr. Jerome Galea during this lunch should reach out to Hellen McDonald.
This story is part of a completed series highlighting the global social work done by the School’s International Committee.