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Table of Contents
ADVOCACY/DEBATE
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 67-69

Social psychiatry can “Empower” the individuals, families, and communities for mental health


Professor of Psychiatry (retd), Formerly of National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission06-Jun-2019
Date of Decision16-Jun-2019
Date of Acceptance26-Jun-2019
Date of Web Publication27-Sep-2019

Correspondence Address:
Prof. R Srinivasa Murthy
Professor of Psychiatry (Retd), Formerly of National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WSP.WSP_1_19

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  Abstract 


There is growing awareness of the limitations of the biological model for understanding and treatment of mental disorders, along with increasing evidence of the role of individuals, families, and communities in matters of mental health and mental disorders. By increasing the research into the social origins of mental health and mental disorders and by developing appropriate skills to “empower” individuals, families, and communities, social psychiatry can advance the cause of mental health of the populations.

Keywords: Communities, empower, families, individuals, mental health, social


How to cite this article:
Murthy R S. Social psychiatry can “Empower” the individuals, families, and communities for mental health. World Soc Psychiatry 2019;1:67-9

How to cite this URL:
Murthy R S. Social psychiatry can “Empower” the individuals, families, and communities for mental health. World Soc Psychiatry [serial online] 2019 [cited 2019 Nov 18];1:67-9. Available from: http://www.worldsocpsychiatry.org/text.asp?2019/1/1/67/267956




  Introduction Top


Social psychiatry is especially relevant for the mental health field in the current time. A recent book titled, “Mind Fixers” by Harrington[1] makes a broad and historical review of the development of concepts of mental health/mental illness. She “explores psychiatry's repeatedly frustrated struggle to understand mental disorder in biomedical terms.”

It is against this context that I explore the history of mental health and mental health care, the current crises of mental health, the recent research highlighting the importance of individual, family, and community factors in mental disorders and identify the priority research areas in social psychiatry.

Social psychiatry during the last 100 years has seen many ups and downs. The large-scale epidemiological studies of the early part of the 20th century emphasized the role of social factors in the prevalence of mental disorders. In the middle of the 20th century, the heyday of social psychiatry, there was recognition of the importance of social institutions such as family, community and for social cohesion beyond the individual-level characteristics and actions. However, social psychiatry, so apparently promising in the optimistic context of post-War America in the 1950s and 1960s, saw its influence and status decline within the American Psychiatry in the late 1960s and 1970s.[2] However, we are at a period where social psychiatry is regaining its importance. This change is reflected by the mental health group of “Future of Psychiatry,”[3] recognizing that psychiatry in the first quarter of the 21st century is at the cusp of major changes, identifies the scope as follows:

“Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatry's development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences.”[3]


  History of Understanding of Mental Health/mental Disorders Top


Throughout history, mental health professionals have been on the side of the persons with a diagnosis of mental illness, whether it was in shifting of the ill persons from jails to mental hospitals about 300 years back or shifting them from institutions to community care, about 70 years back or the recent efforts to guarantee the rights of persons with mental disorders. What is special about the 21st century is the better understanding of the brain and the psycho-social factors in the causation, course, and response to treatment. There is growing understanding of the social origins of mental disorders and need for social interventions, in addition to individual interventions. Rebuilding communities will be an agenda of the coming times.[4],[5],[6],[7]


  Current Crises in Mental Health Top


There is a crisis in mental health in all countries of the world. There are growing numbers of the population, needing different types of mental health care and decreasing resources to provide the same. This challenge was reflected during the recent times when Prince Williams, at Davos World Economic Forum, January 2019, talked about “We're all embarrassed by our emotions… British people particularly,…. Brits suppress emotions at risk of their mental health.” He reiterated the same on BBC recently.

Equally importantly, Honorable British Prime Minister Mrs. Theresa May, as part of her resignation speech on May 24, 2019, referred to “proper funding for mental health at the heart of NHS long-term plans.”

In addition, larger social changes such as urbanization, migration, refugees, wars, disasters, and climate change are presenting significant mental health challenges. The changes that are occurring at the individual and community is best summarized, by Misra's[8] recent book, “Age of Anger” which makes two important points, relevant to social psychiatry – amoral individualism and ressentiment:

“Many of these shocks of modernity were once absorbed by inherited social structures of family and community, and the state's welfare cushions. Today's individuals are directly exposed to them in an age of accelerating competition on uneven playing fields when it is easy to feel that there is no such thing as either society or state and that there is only a war of all against all.”

The other theme in the literature is the recognition of the growing need for a caring community:

“We are discovering that it takes a village to do more than raise a child. It is the key to a satisfying life. It turns out we need our neighbours and a community to be healthy, produce jobs, protect the land and care for the elderly and those on the margin.”[4]


  Mental Health and Social Aspects of Mental Disorders Top


There is a growing body of evidence of the role of individual, family, and social factors in the causation, treatment response and course of mental disorders, and mental health of the population. Few recent publications to illustrate the point:

  • Practice of yoga and meditation/mindfulness by individual can promote mental health, prevent mental disorders, and improve treatment response[9]
  • Family life in general and adverse child experiences, in particular, has vital role in the mental health of individuals throughout life[10]
  • Social factors such as the ethnic characteristics of community in which persons diagnosed with schizophrenia live can influence the mortality in this group[11]
  • Greening of the vacant areas can decrease the prevalence of depressive symptoms in the community[12]
  • The provision of self-management interventions alongside standard care improves outcomes for people with severe mental illnesses.[13]


I expect that this evidence will grow and there will be many interventions arising from these findings involving social psychiatric practices.


  Personal Experiences Top


Six years back, in 2013, I was diagnosed with colon cancer. This took to the new world of cancer. I recognized both my need for emotional health care, both to minimize my distress and to improve survival. However, there was little that was available for self-care and that was suitable to Indians. This led me to think of developing self-care skills for persons diagnosed with cancer. To my surprise, there was so much that was evidence proven that could be done by individuals, families, and community. This has resulted in a program to maximize personal skills for self-care of emotional health[14] (blogpost: myemotionalhealth.in.com).


  Looking to the Future Top


Need for re-recognition of social psychiatry is an important part of the development psychiatry. For nearly a century, the biological framework has been the dominant force.

The theme of “mental illnesses are like physical illnesses” was only partially helpful to fight the stigma of mental disorders. It probably empowered the professionals and pharmaceuticals. In social psychiatry, we can “empower” individuals, families, and communities.

The call of Misra,[8] to address the changing society, for a “need for some truly transformative thinking, about the self and the world,” is relevant to mental health.

My thoughts about the needed areas for attention are identified in [Box 1].



At this historical juncture in time, there is a revolution in thinking about mental health and mental disorders.[3] There is a convergence of the biological, psychological, and social understandings raising the possibilities of a holistic approach to mental health care, in general, and depression, in particular.

However, in our enthusiasm and efforts, it is important to avoid the errors of the past, best summarized by Harrington:[1]

“Freudians had lost credibility by insisting that they could be experts on everything; the new generation of biological revolutionaries repeated their mistake: they declared themselves the new experts on everything. No one suggested that it may be prudent to decide which forms of mental suffering were best served by a medical model, and which might be better served in some other way. Revolutionaries do not cede ground.”

It was Emile Durkheim, who nearly 200 years back referred to suicide as an individual act with social origin. The recognition of this two-sided nature of mental health and mental disorders, and strengthening of both these sides, is the challenge/opportunity of our times for Social Psychiatry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Harrington A. Mind Fixers – Psychiatry's Troubled Search for the Biology of Mental Illness. New York: Norton; 2019.  Back to cited text no. 1
    
2.
Blazer GD, Kinghorn W. Positive social psychiatry. In: Jeste DV, Palmer BW. Positive Psychiatry- A Clinical Handbook. Washington: APA Press; 2015.  Back to cited text no. 2
    
3.
Bhugra D, Tasman A, Pathare S, Priebe S, Smith S, Torous J, et al. The WPA-Lancet Psychiatry Commission on the Future of Psychiatry. Lancet Psychiatry 2017;4:775-818.  Back to cited text no. 3
    
4.
McKnight J, Block P. The Abundant Community-Awakening of the Power of Families and Neighbourhoods. San Francisco, California: Berrett-Koehler; 2012.  Back to cited text no. 4
    
5.
Srinivasa Murthy R. Globalization, market economy and mental health. Chapter 46. In: Chaddha R, Kumar V, Sarkar S, editors. Social Psychiatry, Principles and Clinical Applications. New Delhi: Jaypee Brothers; 2019. p. 508-20.  Back to cited text no. 5
    
6.
Srinivasa Murthy R. Future of mental health. Asian J Psychiat 2018;38:7-11.  Back to cited text no. 6
    
7.
Hari J. Lost Connections – Why You Are Depressed and How to Find Hope. London: Bloomsbury; 2018.  Back to cited text no. 7
    
8.
Misra P. Age of Anger – A History of the Present. New Delhi: Juggernaut; 2017.  Back to cited text no. 8
    
9.
Lam LC, Riba M, editors. Physical Interventions for Mental Health. Cambridge: Cambridge University Press; 2016.  Back to cited text no. 9
    
10.
Harris NB. The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Boston, MA: Houghton Mifflin Harcourt; 2018.  Back to cited text no. 10
    
11.
Das-Munshi J, Schofield P, Bhavsar V, Chang CK, Dewey ME, Morgan C, et al. Ethnic density and other neighbourhood associations for mortality in severe mental illness: A retrospective cohort study with multi-level analysis from an urbanised and ethnically diverse location in the UK. Lancet Psychiatry 2019;6:506-17.  Back to cited text no. 11
    
12.
South EC, Hohl BC, Kondo MC, MacDonald JM, Branas CC. Effect of greening vacant land on mental health of community-dwelling adults: A cluster randomized trial. JAMA Netw Open 2018;1:e180298.  Back to cited text no. 12
    
13.
Lean M, Fornells-Ambrojo M, Milton A, Lloyd-Evans B, Harrison-Stewart B, Yesufu-Udechuku A, et al. Self-management interventions for people with severe mental illness: Systematic review and meta-analysis. Br J Psychiatry 2019;214:260-8.  Back to cited text no. 13
    
14.
Murthy RS. Lessons of being a patient – Personal thoughts about psycho-oncology in India. Mens Sana Monogr 2016;14:171-86.  Back to cited text no. 14
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Introduction
History of Under...
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Mental Health an...
Personal Experiences
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