Behavioral medicine: principles and practices
Julie M Schirmer MSW, Alain J Montegut MD, Stephen J Spann MD, Gabriel Ivbijaro MD, Alfred Loh MD in Behavioral Medicine in Primary Care, 2017
The World Health Organization (WHO) recommends that it should be primary healthcare practitioners who bring mental health and behavioral healthcare to the community level of care.5,6 Desjarlais and colleagues suggest basic principles for countries to improve mental health services, which include the following: ➤ national and regional commitment to mental healthcare➤ deinstitutionalization and decriminalization of mental illness➤ development of community psychiatry➤ development of special mental health units in district hospitals➤ the use of psychiatrists as teachers and consultants to non-physician primary practitioners➤ the involvement of families in care and recovery➤ the use of public health interventions (safety, clean air and water, shelter, and food) to prevent and reduce disability.3
Psychoactive Drugs, Psychotechnology, and the New Biologism
Phil Brown in The Transfer of Care, 1985
The new biologism is characterized by several aspects, some of which have already been addressed. Psychiatric training and practice have become more biochemical and more opposed to community psychiatry, largely as a result of the ability of drugs to control psychiatric symptoms. Renewed biologism also stems from psychiatry’s attempt to protect both its public image and its reputation within the medical community. Such protection in part reflects the loss of optimism concerning social treatments, a paradigm shift similar to the mid-nineteenth-century retreat from the cult of curability to the cult of incurability. NIMH research and training funds, which were central to community orientations, have been drastically curtailed, and funding now emphasizes biochemical modes. Psychology and psychiatry therefore are unable to support graduate and professional training in social psychiatry, thus cutting off that option for many practitioners. Research in mental illness, particularly in the psychoses, has gone in a more biochemical direction, since both physician and non-physician researchers consider chemical intervention to be more reliable than other treatments.
Madness between Sanity and Normality
Petteri Pietikainen in Madness, 2015
Rosenhan’s conclusions were too disturbing and too much discussed to be ignored by the psychiatric establishment. One who took it upon himself not only to reply to Rosenhan but also to reform American psychiatry was Robert L. Spitzer from the New York State Department of Mental Hygiene. In his rebuttal of Rosenhan’s study, Spitzer called it ‘pseudoscience presented as science’ (Spitzer 1975, 442). Spitzer defended the use of schizophrenia as the only proper diagnosis in cases of auditory hallucinations of longer duration (Rosenhan had told Spitzer personally what he did not mention in his article, namely that the pseudopatients had heard voices for three weeks). More importantly to the future of psychiatry, Spitzer raised the question of the reliability of psychiatric diagnosis. Dissatisfied with the prevailing diagnostic criteria, he had begun to cooperate with his like-minded colleagues in the so-called St Louis group associated with the Department of Psychiatry at Washington University in St Louis. Together, they had an ambition to develop a totally new and more scientific classification of mental disorders based on empirical evidence and stringent diagnostic criteria rather than on sloppy and frustratingly vague psychodynamic speculations that were at least partly to be blamed for the weaknesses and problems that Rosenhan’s study had exposed. Another major change was going to happen in the institutional form of mental health care: large hospitals were to be replaced by outpatient care, clinics and ‘community psychiatry’ that would help mental patients in their own social environment.
The role of psychiatry in modern medicine*
Published in International Review of Psychiatry, 2018
Andrea Fiorillo, Mario Maj
One further element that has modified psychiatric clinical practice is the implementation of community-based care. There is a general consensus on the principles of community psychiatry among psychiatrists, the scientific community, the general public, patients and their relatives. However, although the community-based model of care has actually made it possible to close down asylums and has opened up the way to community care for other branches of medicine, a reconsideration seems now necessary in light of recent social changes. In many cases, traditional community mental health centres seem inadequate to give an answer to the modernization of the communities, characterized by urbanization, mass migration and structural changes in modern families (Bhugra & Fiorillo, 2012); moreover, the difficult transition for many young patients from child to adult mental health services and the frequent comorbidities of mental disorders with other medical conditions make the need for a reconfiguration of traditional mental health centres even more cogent.
Argentina: A mental health system caught in transition
Published in International Journal of Mental Health, 2021
Dermot J. Hurley, Martin Agrest
As a result of deinstitutionalization, the number of psychiatric beds has markedly decreased in most Western countries. However, concerns have been raised about re-institutionalization as evidenced by the increase in forensic units, homeless shelters and community based institutional settings (Steadman et al. 2011). In Argentina, for example, according to Moldavsky et al. (2011), the decreasing number of public psychiatric inpatient beds has given rise to a larger number of private psychiatric inpatient beds. This has led some to argue that a process of trans-institutionalization is taking place, whereby patients who would have formally been institutionalized, end up in residential homes, forensic hospitals and prisons (Saxena et al., 2003). Such concerns have triggered a call for further comparative research to evaluate new forms of institutionalized care in the community (Fakhoury & Priebe, 2002). It is generally agreed that a comprehensive organized system of care is necessary, and that a balanced care approach would combine brief acute hospital admission with follow-up services in the community (Killaspy, 2006; McDaid & Thornicroft, 2005). The movement from institutional to community psychiatry has been the subject of extensive research, covering key areas such as residential housing, supported employment, social integration and social skills training (Roessler, 2006). Deinstitutionalization requires a fundamental change in mind set beginning with a re-visioning of what mental health means, an understanding of the concept of recovery, the reallocation of mental health funds, a commitment to community-based programs and a balance between community and hospital care (Thornicroft & Tansella, 2004). These issues will be explored further in the discussion portion of this paper.
The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe
Published in The World Journal of Biological Psychiatry, 2021
Johannes Thome, Jocelyn Deloyer, Andrew N. Coogan, Deborah Bailey-Rodriguez, Odete A. B. da Cruz e Silva, Frank Faltraco, Cathleen Grima, Snaebjorn Omar Gudjonsson, Cecile Hanon, Martin Hollý, Jo Joosten, Ingegerd Karlsson, Gabriela Kelemen, Maria Korman, Krzysztof Krysta, Boleslav Lichterman, Konstantin Loganovsky, Donatella Marazziti, Margarita Maraitou, Serge Mertens deWilmars, Merja Reunamen, Shyhrete Rexhaj, Muhammet Sancaktar, Javier Sempere, Isabelle Tournier, Emilie Weynant, Christiaan Vis, Marie-Clotilde Lebas, Laurence Fond-Harmant
While many of the challenges discussed above are in the process of being addressed on a general or global level, specific solutions need to be developed on a national and regional level taking into account the specific service structures, funding systems, and policy frameworks in each area (e.g. availability or lack of inpatient facilities, role of community psychiatry, implementation of telepsychiatry). In any case, our hope is that, without neglecting existing heterogeneity and given the common threat of COVID-19, it will be possible to implement common solutions within the context of the European frame.
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