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   Table of Contents - Current issue
January-April 2023
Volume 5 | Issue 1
Page Nos. 1-86

Online since Wednesday, April 26, 2023

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Recovery from Mental Illness, Challenges, and Solutions from Across the Globe Highly accessed article p. 1
Andrew Molodynski, Rajesh Mohan
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Belonging is to Social Psychiatry What Attachment is to Child Psychiatry Highly accessed article p. 4
Vincenzo Di Nicola
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Recovery from Mental Illness: From Social Control to the Bio-, through the Psycho-, toward the Social Essence of Recovery p. 7
Debasish Basu, Nitin Gupta
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The Dynamics of Globalization and the Effects on Mental Health: Social, Anthropological, and Phenomenological Aspects p. 9
Rachid Bennegadi
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The Onslaught of Civilization and Emerging Mental Health Issues p. 15
Savita Malhotra
Civilization evolved through 1000 of years as epicenters in several parts of the world and has now become a global civilization. The main pursuits have been for better survival, increased longevity, societal development, peaceful living, and individual development among others. It is also known that the evolution of civilization goes parallel with evolution of brain through continuous processes of adaptation and reorganization of brain functions by gene–environment interactions and epigenetic processes. Thus, civilization has a major impact on brain development and mental health. Current civilization in many ways has come in conflict with the biological objective of survival of the human species. There is value on economic growth and productivity, control and conquering of nature with devastating consequences. Socioeconomic disparities, poverty, inequity in resource distribution and social power, fragmentation of family and communities, individualistic materialistic outlook, lack of psychological anchoring, mindless globalization, climate crisis, and so on are some of the facets that have unleashed a spate of new mental health challenges across the globe. Researches on social determinants of mental illness have shown significant risk factors emanating from one common factor that is civilization. Mental illness is not individually produced and therefore cannot be tackled in silos. It will require whole society's response and systemic approaches beyond the domain of health alone. There is a need to pursue pro-mental health policies at the global societal level to rein in the ever-expanding pool of mentally unwell population.
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Attachment, Family, and Social Systems: London's “Cradle to Grave” Contributions as a Model for Social Psychiatry p. 21
Vincenzo Di Nicola
This article explores the parallels among postwar Britain's “cradle to grave” welfare state with its “social safety net,” especially the National Health Service, the consequent social realism and social upheaval in every sphere of the society, and the birth of the Social Psychiatry (SP) movement in London. From Bowlby's attachment theory, to the pivot from individual to relational therapies, and from research on the social origins of depression in women and Expressed Emotion in family relationships, to the hospice movement, London has uniquely served as a model for SP. There is an organic relationship among these social phenomena in a collectivist society that values “the commons” that created a social safety net, manifested by social realism in the arts reflecting a social upheaval that challenged tradition, notably the class structure of British society. The hallmark of SP is to discern governing patterns across social domains. Anthropologist Gregory Bateson sought “the pattern that connects” while sociologists and systems theorists found patterns in the structures, scripts, and systems of a society. What distinguishes SP is in perceiving these patterns, taking them seriously to re-vision how we think about determinants and influences of mental and social health, and to construct new approaches in psychiatry from research to pedagogy and clinical practice to policy-making.
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From Individual Psychiatry to Planetary Health Care: A Personal Account of a Brazilian Social Psychiatrist p. 29
Olga Garcia Falceto, Enrique Falceto de Barros
This article describes the personal journey of an experienced Brazilian child psychiatrist who also trained as a systems-oriented family therapist who realized that she was not systems oriented enough. Her son, a family doctor, has been influencing the inclusion of planetary health care in her work. Personal, intergenerational, and professional development go hand in hand in this account, along with scientific developments. The account aims at inspiring other social psychiatrists and mental health workers to include 1 min for the planet in consultations, preventive, and rehabilitative work and to spread the word to our countries and international mental health institutions.
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Novel Approaches to Community-Based Psychoeducation to Improve Mental Health Awareness in Diverse Settings p. 36
Atasha Jordan, Kristin Nguyen, Maria Bernadett Carandang, Wydad Hikmat
Background/Objectives: The authors are early career psychiatrists practicing worldwide who aim to increase access to mental health care and reduce associated stigma by utilizing culturally informed psychoeducation-based programs tailored for nontraditional communities. Methods: The authors chose four distinct communities to provide mental health psychoeducation, including churches in Philadelphia, a fandom group in the Philippines, nonpsychiatric healthcare workers in Nepal, and families of patients in Morocco. Results: Dr. Atasha Jordan founded the Christian Mental Health Initiative to improve mental health outcomes of Christians in the US and the Caribbean; in a pilot study (n = 29), the research team used Mental Health First Aid to increase mental health care literacy and mental health care utilization in Black Churches. Dr. Bernadett Carandang co-created Hallyu Wednesdays, an online fandom-based mental health group that meets weekly to explore mental health topics through Korean media and provide online safe spaces for their community. Dr. Kristin Nguyen, as part of the Health, Equity, Action, Leadership (HEAL) global mental health fellowship program, co-created psychoeducational videos on burnout and ways to mitigate it for the staff of a hospital in rural Nepal that can be disseminated to other Nepali healthcare workers. Dr. Wydad Hikmat implemented a family psychoeducation program, Profamille, for caregivers and families of patients with psychosis, leading to improved mood and coping strategies for patients. Conclusions: All four psychoeducational interventions used innovative approaches to addressing mental health challenges and promoting mental wellness among diverse populations worldwide.
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Prison Mental Health in the United States of America and India: A Dual Perspective p. 42
Rachel Natasha Varadarajulu, Ananya Mahapatra
Approximately 40% of the incarcerated population in the world are reported to suffer from a mental health condition. People in correctional settings are subjected to multiple psychosocial adversities which negatively affect their mental health. Moreover, people with mental illness are at higher risk for abuse and exploitation within the criminal justice system. The prison populations of the United States (US) and India are among the highest, among both high-income and low-middle-income countries, respectively. In this article, we aim to describe the existing prison mental health services in the US and India and discuss their challenges.
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Global Aspects of Psychosocial Rehabilitation p. 47
Marianne Kastrup
Rehabilitation is required when limitations in health prevent full functioning. On a global level, WHO estimates that more than 2.4 billion could benefit from a rehabilitative intervention of some kind. The health limitations may have several causes frequently with a mental health dimension and the benefits of psychosocial rehabilitation are increasingly recognized globally. An example is given of a psychosocial model focusing on traumatized individuals and the development of a rehabilitative field manual to be used in Low and middle income countries (LOMIC) or settings of limited resources.
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Contemporary Mental Health Rehabilitation: Keeping it Simple in a Complex World p. 51
Helen Killaspy
A major driver during the era of 'deinstitutionalisation' was the change in societal attitudes towards people with mental illness, away from exclusion and marginalisation towards inclusion and participation in society. More recent mental health policy has tended to focus on promotion, prevention and early intervention, with little mention of those with more complex problems. However, despite the significant investment in early intervention services, long term studies consistently show that around a quarter of people newly presenting with psychosis do not do well. Nevertheless, there is good evidence that with appropriate treatment and support from specialist mental health rehabilitation services, even people with the most severe problems can achieve, sustain and enjoy a rewarding life in the community, yet many 'deinstitutionalised' countries fail to provide rehabilitation services, placing this group at risk of neglect, exploitation and institutionalisation. Happily, this situation is beginning to change. The publication of the first National Institute of Health and Care Excellence (NICE) Clinical Guideline on Rehabilitation for People with Complex Psychosis (NICE; CG 181, 2020) represents a sea change in the recognition of the needs of those with the most severe mental health problems and provides evidence-based recommendations about the treatment and support that should be provided. Alongside this, policy makers in many countries are beginning to recognise the need to include rehabilitation services in their mental health plans. It has been a long time coming, but mental health rehabilitation services are finally being acknowledged as an essential component of the mental health system.
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Smartphone Apps for Addictive Disorders p. 55
Yasser Khazaal
The use of smartphone apps for addiction treatment has become increasingly popular in recent years. These apps aim to support individuals in their recovery by providing a range of features such as digital brief intervention, assessment and normative feedback, cognitive behavioral therapy and social support networks. Some of the available apps rely on behavior changes theories. Several studies have demonstrated the potential efficacy of smartphone apps for the treatment of addictive disorders. There are also some challenges associated with the use of smartphone apps for addictive disorders such as concerns about the privacy and security of personal data as well as challenges related to drop-out rates in natural settings. Further development are also need for blended integration of such tools with the other services.
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Photovoice: Beyond Public and Patient Involvement, Participatory Action, and Co-Production in Research p. 59
Roisin Mooney, Doreen Joseph, Sayeeda Bashrat, Michaelt Molete, Neil Caton, Kam Bhui
There is a need in health services research for better processes that result in an evidence base that is informed by and includes voices of those who have experience of the services in an authentic manner. In the UK, public and patient involvement (PPI) has become a common, and in some cases, a mandatory component of much research pertaining to mental health research, often comprising a group that sits parallel to the research and advises on various processes. More recently, PPI has extended beyond a consultancy model to be more collaborative, with language such as participatory research and coproduction permeating the literature. However, there is often a little clarity as to what these terms represent in reality, the impact that they will have on those taking part, and consequently, the body of evidence that we draw up on to inform how mental health services are designed. We need to do more to enable those impacted by poor mental health to contribute to research in a meaningful and fulfilling way. This article was coproduced by the Co-Pact patient and public research group, and shares how photovoice as a research method may advance the current understanding of how patient voices are represented in mental health research.
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Reducing the Treatment Gap for Psychiatric Disorders – The Role of Accredited Social Health Activists in South India p. 63
Shivam Gakkhar, P Lakshmi Nirisha, Gajanan Sabhahit, Patley Rahul, Nithesh Kulal, Nisha R Harshitha, N Manjunatha, Jagadisha Thirthalli, Naveen C Kumar, Adarsha Alur Manjappa, Rajani Parthasarthy, Prabhat Kumar Chand, Sanjeev Arora, Suresh Badamath
Objective: The objective of this study was to evaluate the effectiveness of mental health work carried out by accredited social health activists (ASHAs) on reduction of the “treatment gap” for severe mental disorders (SMD), common mental disorders (CMDs), and substance use disorders (SUDs) in rural communities. Methods: This study is an offshoot of a larger randomized controlled trial designed to comprehensively compare the effectiveness of two methods of training and empowering grassroots-level workers in mental health. Three primary health centers (PHCs) were selected (simple random sampling) as the study group (SG). Thirty-five ASHAs were trained and mentored (National Institute of Mental Health and Neurosciences-Extension of Community Health Outcomes model of skilled capacity building using digital technology) for a period of 18 months in identifying/counseling/referral of commonly prevalent mental health problems in the community. Control group (CG) PHCs' ASHAs (n = 36) received “training as usual” (i.e. 1 day in person classroom training session). Both the groups were regularly contacted by the research team to monitor for progress. Reduction in “treatment gap” was evaluated using pre–post design for SG and CG separately, and the same was compared between SG and CG. Results: A total of 35,023 adults were screened, and positives were identified, counseled, and referred for care and treatment. Treatment gap for SMDs and SUDs reduced significantly both in SG and CG (SMDs: 10% vs. 38%, respectively; P = 0.03 for both; SUDs: 51% vs. 70% respectively; P < 0.001 for both) while it increased for CMDs (13% vs. 14% P < 0.01 and 0.09, respectively). Comparatively speaking, SG fared better for SUDs (P < 0.05), and CG did better for SMDs (P < 0.05). It was unequivocal for CMDs (P = 0.48). Conclusion: ASHAs could be effectively empowered to carry out mental health work resulting in meaningful reduction of treatment gap for the priority mental illnesses including SMD and SUDs.
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Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations p. 71
Ditte Lammers Vernal, Merete Nordentoft, Mads Juul Christensen, Lisa Charlotte Smith, Lise Mariegaard, Jan Mainz, Louise Birkedal Glenthøj
Background: Auditory verbal hallucinations are a prevalent symptom in schizophrenia and other psychotic disorders, affecting around 70% of patients. A sizable proportion does not achieve adequate treatment response with current interventions, including antipsychotic medication. Virtual reality-based therapy (VRT) shows promise as a new intervention. Methods: The Challenge Trial is a randomized controlled study examining the efficacy of VRT compared to standard treatment for auditory hallucinations in patients with psychotic disorders. In the intervention arm, virtual reality software and voice modulation are used to design a visual representation of the patient's voice (an avatar) and to transform the therapist's voice to sound like the voice the patient hears. The aim is to foster a dialogue for the patient to strengthen their power, practice self-efficacy, and alter their relation to the voice. During therapy, the avatar becomes more compassionate and/or less powerful. Results: Quantitative data are currently unavailable as recruitment is ongoing. Instead, the design and intervention are presented along with recruitment data, retention rates, and case vignettes. Early clinical experiences are promising, with high acceptability and tolerance among patients. The trial has successfully enrolled a diverse patient population, including those with long-standing histories of hospitalization, medication use, and chronic hallucinations. The effectiveness of VRT varies, for example, some patients have reported significant reductions in the frequency of voices and associated distress, whereas others have primarily noted improvements in emotional responses to the voices. Conclusions: Based on the first 2 years of the Challenge Trial, VRT shows considerable promise as a potential treatment for auditory verbal hallucinations.
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Patient and Public Involvement in Developing and Testing Mental Health-care Interventions: Strategies and Reflections from Three Research Programs p. 77
Domenico Giacco, Agnes Chevalier, Philip Mcnamee, Nick Barber, Kamran Shafiq, Imogen Wells
Patient and public involvement (PPI) is valued and widely practiced in mental health research but in different ways. We present three research programs, aiming to develop and test mental healthcare interventions and we discuss their PPI strategies and activities. In all these programs, PPI has been sought from their initial conception and design and has helped their management, intervention development processes, quantitative and qualitative evaluations, and in the assessment of PPI activities themselves. The programs focus on different groups (patients with chronic depression, patients with psychotic disorders, and carers) and develop different interventions. Comparing these programs offers the opportunity to appreciate different models of involvement. These, for example, range from training lived experience collaborators to analyze qualitative data directly to asking them to comment on findings; from involving lived experience collaborators in the design of new interventions to involving them in intervention adaptation to a particular group or circumstance; and from carrying out formal PPI evaluations to collecting informal feedback during meetings. Even in the diversity of programs and PPI activities presented, common themes could be identified in relation to: specifying (and ideally co-designing) expectations and role of contributors; making bureaucratic procedures as user-friendly as possible; appropriately choosing or blending online and offline meetings; and designing flexible and inclusive arrangements to maximize participation. Our experiences contribute to a growing evidence base that can help researchers to develop meaningful, enjoyable, and constructive collaborations with people with lived experience. These collaborations will keep clinical mental health research relevant, impactful, and tailored to patients' needs.
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Bridging the Mental Health Gap using the Already Available Resources: The Kenyan Experience p. 82
David M Ndetei, Victoria Mutiso
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A Pandemic Presidency: How RCPsych Responded and How we Take forward the Recovery p. 84
Adrian James, Emily Gibbons
Having become President of the Royal College of Psychiatrists in July 2020, Dr. Adrian James had a first-hand experience of how the health-care system in England responded to the pandemic. This article explores the College's response to COVID-19's impact on mental health services and how they worked to support psychiatrists and patients alike. It also reflects on how the long-term implications of the pandemic on mental health are just starting to come to light, as well as some of the new challenges facing psychiatry worldwide.
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