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The future of academic psychiatry may be social

  • Stefan Priebe (a1), Tom Burns (a2) and Tom K. J. Craig (a3)
Summary

The past 30 years have produced no discoveries leading to major changes in psychiatric practice. The rules regulating research and a dominant neurobiological paradigm may both have stifled creativity. Embracing a social paradigm could generate real progress and, simultaneously, make the profession more attractive.

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Copyright
Corresponding author
Stefan Priebe, Unit for Social and Community Psychiatry, Academic Unit, Newham Centre for Mental Health, London E13 8SP, UK. Email: s.priebe@qmul.ac.uk
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Declaration of interest

None.

Footnotes
References
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1 Craddock, N, Antebi, D, Attenburrow, M-J, Bailey, A, Carson, A, Cowen, P, et al Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 69.
2 Katschnig, H. Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry 2010; 9: 21–8.
3 Saraga, M, Stiefel, F. Psychiatry and the scientific fallacy. Acta Psychiatr Scand 2011; 124: 70–2.
4 Bolton, D, Hill, G. Mind, Meaning and Mental Disorder: The Nature of Causal Explanation in Psychology and Psychiatry. Oxford University Press, 2004.
5 Jaspers, K. General Psychopathology: Volume 1. Johns Hopkins University Press, 1997.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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The future of academic psychiatry may be social

  • Stefan Priebe (a1), Tom Burns (a2) and Tom K. J. Craig (a3)
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eLetters

Developing country perspective of social aspects of Psychiatry

Thanapal Sivakumar
06 June 2013

Sir,We read the guest editorial by Priebe et al (1) with interest. We would like to highlight a developing country perspective in this regard. A WHO survey showed that 76%–85% in Lower and middle income countries (LAMICs) had received no treatment in the previous 12 months(2).More than a third of low-income countries rely primarily on out-of-pocket payments for their treatment(3). There are huge economic implications of treating patients with newer, expensive, branded medications rather than cheaper, equally effective, older, generic medications. LAMICS are furtherhandicapped by shortage of mental health professionals (4,5).Worldwide and particularly in developing countries, lack of awareness about mental disorders in the community, stigma towards and discriminationagainst people with mental health problems are important barriers to identify and treat mental disorders (6). In India, precious time is spent by patients with psychiatric disorders in visiting faith healers, religious places and alternative systems of medicine before seeking psychiatric care from psychiatrists(7). Despite tremendous advances over the last few decades, benefits of modern psychiatry have still not fully reached the masses. ‘Scaling up’ of mental health resources is urgently needed.8 In developing countries like India where patients usually live with their families, training of family and other informal resources in the community can ensure a highly motivated workforce with least chances of attrition (5). In an Indian study on outcomes desired by patients with schizophrenia and caregivers, social functioning, employment/ education and activity were the most important outcomes for both groups (9). With an increasing emphasis on recovery oriented models, the emphasis is gradually shifting from clinical recovery (treatment response/ symptom remission) to social recovery (10). The three core concepts of recovery namely hope, agency andopportunities (10) have deep social roots. As mental health professionals, we at times get too close to the tree to lose sight of the forest. In this context, the guest editorial by Priebe et al 1 was a timely and thought provoking reminder.

References1. Priebe S, Burns T, Craig TKJ. The future of academic psychiatry may be social. Br. J. Psychiatry. 2013 May 1; 202(5):319–20. 2. WHO. mhGAP : Mental Health Gap Action Programme : scaling up care for mental, neurological and substance use disorders. Geneva: WHO;2008. 3. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. The Lancet. 2007 Sep; 370:878–89. 4. WHO. The World health report : 2001 : Mental health :new understanding, new hope. Geneva: WHO; 2001. 5. Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet. 2007 Sep; 370:1164–74. 6. Thornicroft G, Alem A, Antunes Dos Santos R, Barley E, Drake RE, Gregorio G, et al. WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry Off. J. World Psychiatr. Assoc. Wpa. 2010 Jun;9(2):67–77. 7. Trivedi JK, Jilani AQ. Pathway of psychiatric care. Indian J. Psychiatry. 2011 ;53(2):97–8. 8. Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, et al. Scale up of services for mental health in low-income and middle-income countries. The Lancet. 2011 Oct; 378:1592–603. 9. Balaji M, Chatterjee S, Brennan B, Rangaswamy T, Thornicroft G, Patel V. Outcomes that matter: A qualitative study with persons with schizophrenia and their primary caregivers in India. Asian J. Psychiatry. 2012 Sep; 5(3):258–65. 10. South London and Maudsley NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust (2010) Recovery is for All.Hope, Agency and Opportunity in Psychiatry. A Position Statement by Consultant Psychiatrists. London: SLAM/SWLSTG.

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