World Social Psychiatry

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This essay introduces the sociopolitical notion of the Global South as a bridge between globalization and the global mental health (GMH) movement that offers an emergent apparatus or conceptual tool for social psychiatry. A brief history of the Global South reveals that it is wider and deeper than economic and geopolitical notions such as the Third World, the developing world, and the nonaligned movement across a broad swathe of history and culture. I then turn to globalization and its critics, examining critiques of economics, human rights, and problems associated with humanitarian services. A feature of GMH, “the health gap,” is contrasted with “the epistemic gap,” a divide between the epistemologies of the North and emergent Southern epistemologies. Three key features of the Global South – conviviality, porosity, and syncretism – are discussed with examples from my practice of social psychiatry with consultations in child psychiatry and family therapy in Haiti and Brazil. Finally, the Global South is affirmed as a conceptual and clinical apparatus for social psychiatry.

Global mental health (GMH) is important for sustainable futures, but neglected, especially in low- and middle-income countries (LMICs). Child and adolescent mental heath (CAMH) is one of the essential components of GMH. CAMH is influenced by several factors and at several levels, of which resilience to adversity or stress is an integral component. In this narrative review, we first explore the concept of individual and family resilience (FR) and then review various resilience promoting interventions at school and family/community settings across the world but with a special focus on published research arising from LMICs. Resilience has been traditionally conceptualized at the individual level, but FR is also very important, especially in LMICs where there are severe resource constraints. Resilience, contrary to what was thought initially, is not an inherent, innate, unmodifiable personality “trait” but rather a dynamic multilevel systemic “process” that is changeable over time and in turn changes the outcomes related to mental health, adjustment, and thriving in the face of adversity and stress. An important corollary of this reframed conceptualization of resilience is that resilience – both at the individual and family level – is changeable and hence lends itself to interventions. These interventions can be school based (e.g., by imparting life skills education [LSE] in schools) and/or family/community based. Published studies in the area of CAMH, resilience, LSE, and related areas are heavily biased toward high-income countries, with a wide gap in published research from LMICs. However, the limited available literature suggests that such interventions are at least partially effective, and potentially feasible in LMICs, despite challenges. The available evidence also demonstrates the need for (a) using a multicomponent intervention; (b) involving families and focusing on family functioning as well; (c) using trained lay counsellors and peers rather than depending solely on teachers and health practitioners; and (d) working within a context of the culturally and locally sensitive needs, with a longitudinal perspective. Based on this review, we sound a call for action by proposing to develop, through research, models for promoting resilience at both individual and family levels, by working with children and adolescents and their families in school and family settings in an integrated manner in India and Kenya.

Background: Suicide is one of the leading causes of death across all age groups globally and poses a significant public health burden. In response to the United States Joint Commission National Patient Safety Goals, a tertiary hospital in the Northeast U.S. developed a suicide risk assessment and response protocol, consisting of systematic screening of patients for suicidal ideation/behavior with a screening version of the Columbia Suicide Severity Rating Scale (C-SSRS) and a response algorithm based on risk levels derived from the screen. Methods: A total of 837 nurses were trained and 24,168 patients ages 12 and above were screened with the C-SSRS Screener. Results: Posttraining interrater reliability on the C-SSRS Screener definitions of ideation and behavior was high and independent of level of education or mental health experience. Of the patients screened, only 144 patients (0.93%) were in the highest risk category, and they were assigned patient safety monitors until a follow-up consultation. The highest risk levels from the C-SSRS Screener reasonably identified subsequent attempts at self-injurious behavior during hospitalization. Screening resulted in lower burden due to reduction in the rate of psychiatric consultations and one-to-one observation shifts. Conclusions: These findings suggest that a systematic screening and clinical response protocol using the C-SSRS Screener can potentially enhance the ability to identify suicide risk in the general hospital population and focus services on patients with the most need.

Understanding the social paradigm of health and especially mental health is important to the physician today. The approach in Ayurveda and in ancient Greek was person centred, focusing on quality of life and health rather than disease. Biological factors can be fully understood only when applied along with natural sciences and this is essential for progress in Medicine. Biological reductionism happens in psychiatry when we try to over-simplify human behaviour, neglecting the complexities of the mind. Our approach in psychiatry has traditionally been medical or biological. This approach continues, despite the evidence base for such reductionism not being inspiring. On the contrary, biopsychosocial model is concerned with the experience of not only illness but also health and the individuals with their health problems and environment are viewed holistically. In contrast to the biomedical approach which takes a reductionist view, the biopsychosocial model does not prescribe a unitary approach, but tries to understand different clinical scenarios at several levels in a continuum. The need tody is to study what happens between people rather than what is wrong with an individual wholly detached from a social context. This should happen without ignoring the existing neuro-biological and psychological dimensions. Mental illness does not become mere failure of an individual, rather it is product of the society to which he/ she belongs.

Interpersonal violence is a very serious public health hazard that is often overlooked. Ignored, trauma is known to cause family and community dysfunctions than can span generations. Unfortunately, the trauma stories of many survivors are untold because they are either too painful for the people to share or too scary for loved ones and professionals to handle. I had the great privilege of working in multiple disaster-stricken and war-torn contexts. My focus through Project Untangled is on family bonding and youth empowerment with the goal of ultimately untangling the web of dysfunction and breaking the cycle. In this first-person account, I share my recent experience working with the Rohingya refugees in Bangladesh: what I felt, what I did (or tried to do), what I learnt, how it changed me, and the implications of these experiences for social psychiatry.

The World Association of Social Psychiatry working party on coercion in mental health care recently released a set of guiding principles and standards, developed from the research and collaboration of members alongside issues highlighted in the literature and raised by service user and human rights groups. These principles are set out below and are designed to be applicable in all countries.

Online since 8^th July 2019