The context of healthcare, changes in comorbidities, and transformations in healthcare services and priorities are the major social, economic, and political factors influencing the delivery of mental healthcare, explained the plenary speaker.
Involving the expertise of carers and providing appropriate material and economic support is important
These factors have led to a variety of current mental healthcare practices, all of which would be better replaced by alternative services and support, including:
- current reliance on community care and deinstitutionalization would be better replaced by a variety of forms of care with quality assurance
- the current aim of rehabilitation would be better replaced by aiming for recovery
- the current task shifting with the development of new professional categories would be better replaced by well-organized and effective collaborative care and self-care
- the current tenet of fighting stigma would be better replaced by fighting discrimination
- the current practice of educating carers, which undermines their huge knowledge about the people they care for, should be replaced by involving them for their expertise and providing appropriate moral, material, and economic support1
Tasks for psychiatry in the 21st century
A review and revision of the strategies and quality of mental health programs, addressing and removing communication barriers, accepting the protection of dignity and human rights, and a nonjudgmental provision of global support for local healthcare are all tasks for modern psychiatry, the plenary speaker added.
Strategies include convincing decision makers including politicians, and he highlighted that psychiatrists need communication skills embedded into their training, so they can promote such initiatives effectively.
He noted that the prevention of cretinism, which affects 10–50 million children each year globally, and the need for appropriately organized care for people with comorbid mental and physical illness2 are particularly important priorities.
Opportunities for improving mental healthcare in Kenya
The speaker from Kenya highlighted that although healthcare provision in his country had experienced challenges in the past, for example as a result of corruption, mental healthcare now has many opportunities to improve. These result from:
- learnings from successfully managing HIV for implementing collaborative care;
- the extensive use of mobile phones throughout the population;
- its youthful population, who are keen to develop and implement innovate strategies
Focus on prevention, quality, and credibility
Psychiatrists need to think with a much more creative and transformative attitude
The speaker from India highlighted that if psychiatrists continue “business as usual” they will become peripheral to improving mental health globally. To become relevant, psychiatrists need to think with a much more creative and transformative attitude, he said. This means they need to focus on prevention, not just the challenges of providing care. He highlighted three important gaps in the global practice of psychiatry as:
- prevention3 — which needs to embrace the complexity of mental illness and the challenging contributory environments
- quality — and he noted that the premature mortality of patients who have mental illness needs to be urgently addressed
- credibility4 — which means acknowledging the lack of clear boundaries for mental disorders and the need to address their multidimensionality
He added that it is therefore essential to put the patient at the center of care and not be fixed to a treatment algorithm, recognizing that there are multiple approaches to the management of mental disorders, and no one answer fits all.
Collaborative care is the way forward
It is essential to put the patient at the center of care and not be fixed to a treatment algorithm
All speakers agreed that collaborative care is the way forward for improving mental healthcare and that this can be effectively implemented within the primary care environment.
Successful implementation of such care depends on accurate identification and involvement of people who are best placed and able to provide an individual with mental health needs with appropriate interventions and support at any point of time. The importance of effective communication channels between all members of the collaborative care team was also highlighted.