A critical issue for our field is how to define contemporary social psychiatry for our times. In this article, I address this definitional task by breaking it down into three major questions for social psychiatry and conclude with a call for action, a manifesto for the 21^st century social psychiatry: (1) What is social about psychiatry? I address definitional problems that arise, such as binary thinking, and the need for a common language. (2) What are the theory and practice of social psychiatry? Issues include social psychiatry's core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self. (3) Why the time has come for a manifesto for social psychiatry. I outline the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action, a manifesto for the 21^st century social psychiatry.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The author follows up and replies to the three invited commentaries on his social psychiatry manifesto published in the first issue of World Social Psychiatry, emphasizing points of agreement with three practical examples of how research, practice, and policymaking can benefit from social psychiatry – or falter without implementing its powerful and relevant insights.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Mental disorder is responsible for at least 20% of global disease burden which COVID-19 is likely to increase. Effective public mental health (PMH) interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising and promote mental wellbeing. However, implementation is poor with only a minority with mental disorder receiving treatment even in high-income countries, far fewer receiving interventions to prevent associated impacts, and negligible coverage of interventions to prevent mental disorder or promote mental wellbeing. There is an urgent need to address this implementation failure which contravenes the right to health, results in broad population scale impacts and preventable suffering, and is further amplified by COVID-19. PMH practice including during COVID-19 can prepare for and address the implementation gap in the following ways: assessment of size, impact, and cost of the current and future PMH intervention implementation gap taking into account COVID-19; estimation of impact and associated economic returns from improved coverage of PMH interventions; use of this information to inform national policy and transparent decisions about acceptable levels of national coverage of different PMH interventions which then informs level of provision, required resource and commissioning; operationalization of intervention implementation nationally and locally; evaluation of coverage and outcomes; and communication to the population and different professional groups. Coverage of PMH interventions can be increased including during quarantine/lockdown through appropriate professional training, improving population knowledge, digital technology, settings and integrated approaches, maximizing existing resources and application of relevant legislation. PMH practice should be an integral part of the response to COVID-19.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Socially disaffiliated elderly Nigerians are at higher risk for major depressive disorder (MDD). It is unclear whether subjective experience of loneliness has independent association with MDD. Methods: A household multistage probability sample of persons who were 65 years or older was drawn from a geographical area with approximately 25 million population. We measured loneliness using the three-item University of California at Los Angeles scale. Poor social engagement, social isolation, and MDD were assessed using the World Health Organization (WHO) Disability Assessment Schedule II and Composite International Diagnostic Interview (WHO), respectively. Results: Of 1704 respondents, 179 (16.7%) were classified as lonely. Lonely respondents were more likely to have poor social engagement (P < 0.001) and social isolation (P < 0.001). While loneliness (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.3–4.0) and poor social engagement (adjusted OR = 3.1, 95% CI = 1.6–6.1) were independent correlates of MDD, the association of loneliness with MDD was substantially, but not totally, mediated by poor social engagement. Conclusion: The association of loneliness with late-life depression in this African sample is partly explained by poor social engagement. Interventions for loneliness based on social activity schedules and networking programs can be adapted to reduce loneliness and lower the burden of late-life depression in Africans.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

With the emergence of the COVID-19 pandemic, humanity experienced, at the same time, social confinement as a way to protect itself and the vulnerability of human life and institutions. In the past, overcoming calamities was done by being together, and now, with this pandemic, the form of protection is the opposite, social isolation. Over the past 27 years in Brazil, we have developed integrative community therapy (ICT) as a psychosocial intervention within the Brazilian Public Health System that is implemented in various contexts marked by the rupture of social bonds. The techniques of ICT, which have always had an essentially experiential character in face-to-face encounters, now need to be reinvented. To deal with the pandemic, ICT was offered to the general public virtually, with the following objectives: To strengthen bonds and build support networks; to minimize stigma and prejudices toward affected persons, encouraging empathy; and to offer a listening space by professionals involved in the fight against COVID-19. In March and April 2020, we conducted 100 sessions online with 3579 participants from 15 countries. The most frequent concerns expressed were fear and anxiety (53%), helplessness (30%), problems in dealing with family relationships (10%), and loneliness (7%). The techniques of virtual ICT became a support network for instilling hope for those in social confinement and moreover for discovering unknown potentials to transform life's adversities. Conducted in 15 countries and in four languages, emotional reactions were similar everywhere, demonstrating that pain and suffering have no frontiers and unite us in our humanity.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

COVID-19 is creating a mental health crisis among children and youth around the globe. At the time of this writing, more than 1.5 billion, i.e., 91% of the world's students are out of school. The pandemic is raising fears, and causing clinginess, distraction, irritability, anxiety, depression, lethargy, impaired social interaction, and reduced appetite. Adolescents are at higher risk for depression, anxiety, distress, low self-esteem, substance use disorder, and suicide. Mental health consequences of the pandemic can be categorized as adjustment disorders, reactions to social isolation, reactions to family and family events, violence against women and children, and intensification of preexisting mental health conditions. Major challenges are being experienced by those struggling with attention-deficit hyperactivity disorder, autistic spectrum disorders, medical complications, posttraumatic stress disorder, and other conditions. After a short description of each category, we provide case examples, which, though fictitious, bear sufficient resemblance to real-life situations encountered in our daily practice to serve as useful vignettes. The mental health community, social psychiatrists and pediatricians, and other health-care providers should take an active role to address these serious issues.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Social psychiatry is grounded in the recognition that we are fundamentally cultural beings. To advance the field, we need integrative theory and practical tools to better understand, assess, and intervene in the social-ecological cultural systems that constitute our selves and personhood. Cognitive science supports the view that mental processes are intrinsically social, embodied, and enacted through metaphor, narrative, and discursive practices. The circuits of the mind, therefore, extend beyond the brain to include our interactions with others through bodily and verbal communication. This ecosocial view of mind, brain, and culture calls for a shift in perspective from a psychiatry centered on brain circuitry and disorders toward one that recognizes social predicaments as the central focus of clinical concern and social systems or networks as a crucial site for explanation and intervention. The ecosocial perspective insists that we consider the powerful effects of structural violence and social inequality as key determinants of health. Social systems also have their own dynamics which can amplify inequities or provide sources of resilience. These social processes are framed, mediated, and maintained by cultural narratives, models, and metaphors. Hence, cultural analysis and critique must be foundational to social psychiatry. This opens the door to a creative engagement with human diversity in all its forms.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

History of child psychiatry is interlocked with society, child-rearing, family, and many social psychiatric aspects. Children make up one-third of the world's population and are the most physically, economically, and socially vulnerable group. Mental health problems represent the largest burden of disease among young people. Worldwide, 10%–20% of children and adolescents experience mental disorders. For the last 200 years, understanding of children and adolescents, their vulnerabilities, resilience, and treatments to enhance their mental health has been exploding. As we entered the 21^st century with industrialization, urbanization, modernization, and globalization along with many aspects of our lives, children's mental health, and their rights, advocacy for their health has been of intense research and care. In this article, we address some of the most relevant topics – contributions of culture, immigration, digitalization, child maltreatment, discrimination, stigma, changes in the family structure. We also report here the efforts of the United Nations and various countries, with special emphasis on low- and middle-income countries. Finally, we also advocate various ways for children's mental health advancement from a social psychiatric perspective.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The COVID-19 pandemic creates a cascade of social and mental health consequences for children, adolescents, and their families. After reviewing the known pediatric and epidemiological data on children, we discuss key features of children's mental health in response to this crisis, their specific needs, and the impacts of social distancing, confinement, and adverse childhood events. While acknowledging potential long-term consequences in this psychosocially vulnerable population, we also caution health and social care workers against pathologizing normal reactions to an abnormal global crisis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: In India, there is an urgent need to evaluate cost-effective methods providing basic awareness on mental illness. Family psychoeducation (FP) for caregivers of patients with severe mental illnesses (SMIs) is one such important intervention. Due to high treatment gap, concepts of “scaling up” and “task sharing” have been advocated; evidence is available through the use of “community lay workers.” However, there is no evidence for the delivery of FP by lay persons in a hospital setting. Objectives: The study had the following objectives, namely (i) to compare the effectiveness of delivery of “FP package” (FPP) to caregivers of persons with schizophrenia using different professionals versus hospital-based health workers (HHWs) and (ii) to see whether FPP brought any change in the level of knowledge, burden, needs, and effect for the caregivers. Methodology: The study was conducted at the Disability Assessment Rehabilitation and Triage Services, Mental Health Institute, Government Medical College Hospital 32, Chandigarh, using the “Service Evaluation Framework.” Twenty-two caregivers of patients with SMI, attending the Family Intervention Services, were divided into three groups and provided FPP (NIMHANS Manual) by pair of psychiatrists, psychiatric social workers (PSWs), and trained HHW, respectively. The three groups were assessed using Assessment Questionnaire (AQ) and then compared across and pre–post intervention as per identified objectives. Results: All the three groups were comparable across relevant socioclinical variables. At baseline, all three groups were comparable on the AQ; post-FPP delivery, they remained comparable. In addition, FPP, as an intervention, did not improve the level of knowledge, burden, needs, and effect for the caregivers in any of the three groups. Conclusions: HHWs, after receiving appropriate and adequate supervision, are able to deliver FPP using “The Manual” as effectively as other mental health professionals (psychiatrists, PSWs). However, this is not able to bring about effective change in the level of knowledge. Nevertheless, this adds to the evidence base of use of “lay workers,” “task-sharing strategy,” and “scaling-up approach” from low- and middle-income countries such as India.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

It seems that Japan is succeeding in overcoming the COVID-19 pandemic, with the minimal sacrifice. The long-term confinement to one's home exposes the behavioral characteristics and mentality of each country. Authoritarianism, which depends on the government, and collectivism, in which groups take precedence over individuals, still remain in Japanese society. This creates synchronized pressure and mutual monitoring. We mental health professionals are needed to help people recover from injuries to their mental health, but this does not mean a simple return to the past values and styles.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The WHO Alma-Ata Declaration of 1978 aimed to include social and economic sectors within the scope of attaining health. Health is seen as a human right, and a goal was to reduce disparities in health in 2000. Forty years later, we are far from having reached these goals, and inequity in health both between and within countries is still a major problem that receives too little public and political attention. This article discusses the social determinants of mental health and reasons for disparities thereof. To achieve equity is a goal that is beyond reach, but there are many strategies how to reduce the inequity in health, and examples thereof will also be discussed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]