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• Local authority health professionals perceive climate change as a risk to health in the UK.

• Local authority health professionals perceive climate change as a risk to health in the UK.

The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the “treatment gap” faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes “scaling up” mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial “evidence-based” approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in “silos,” focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs’ impact and ability to innovate. This commentary argues that any “scaling up” of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.

The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the “treatment gap” faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes “scaling up” mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial “evidence-based” approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in “silos,” focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs’ impact and ability to innovate. This commentary argues that any “scaling up” of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.

II. Concentrations of amino acids in plasma (maternal and fetal) and in placental tissue . . . . . . . . . . . . . . . . . . . . . . . . . . 171 A. Fetal maternal plasma concentration ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 B. Arterio-venous concentration difference in uterine and umbilical circulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 C. Placental tissue concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

II. Concentrations of amino acids in plasma (maternal and fetal) and in placental tissue . . . . . . . . . . . . . . . . . . . . . . . . . . 171 A. Fetal maternal plasma concentration ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 B. Arterio-venous concentration difference in uterine and umbilical circulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 C. Placental tissue concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Given the well documented climate sensitivity of malaria, the potential implications of global change have given rise to much speculation and controversy [1–5]. Because of the plethora of other parameters determining malaria morbidity and mortality, the extent to which climate change amplifies transmission remains a crucial question. Recent efforts to globally map malaria based on interpolated prevalence figures offer much needed help to guide and evaluate control, and an improved quantitative framework to describe distributional change [1].

Given the well documented climate sensitivity of malaria, the potential implications of global change have given rise to much speculation and controversy [1–5]. Because of the plethora of other parameters determining malaria morbidity and mortality, the extent to which climate change amplifies transmission remains a crucial question. Recent efforts to globally map malaria based on interpolated prevalence figures offer much needed help to guide and evaluate control, and an improved quantitative framework to describe distributional change [1].

The metabolism of toluene was found to be inhibited by a large dose of alcohol in seven volunteers exposed to 80 ppm of toluene under experimental conditions. When alcohol was taken during exposure, blood toluene concentrations were 42.5% greater on average than during exposure with no alcohol. This is probably due to competition for alcohol dehydrogenase which is required for the breakdown of both ethanol and toluene. In men exposed to toluene at work, it was found that blood toluene concentrations were lowest in those who drank regularly. These results suggest that continued alcohol intake increases the metabolism of toluene, presumably by inducing the microsomal oxidising enzyme system in the liver.