Post No.: 0369
Public mental health care includes the promotion of healthy lifestyles, the direct prevention of particular diseases, case identification, providing a satisfactory level of standard treatment, the maintenance or long-term care of patients to prevent relapse, and aftercare or rehabilitation.
Prevention is the crucial ‘first line of defence’ strategy – prevention can be broken down into universal prevention (preventions aimed at the general population regardless of anyone’s individual risk factors e.g. school programs or mass media campaigns), selective prevention (preventions aimed at high-risk groups e.g. women during the post-partum period or the offspring of parents with mood disorders or drug addictions), and indicated prevention (preventions aimed at specific individuals who exhibit some symptoms but do not quite meet the full diagnostic criteria e.g. people who exhibit potential signs of substance abuse or trauma after a stressful event). You can learn about the common causes of mental health problems in Post No.: 0326.
There are two opposing broad views regarding mental health care across the world – the etic view believes in globally standardised perspectives and approaches, and the emic view believes in local and cultural perspectives and approaches.
Our culture, values and spirituality affect how we perceive, diagnose, promote the care of, cope with, seek treatment for and treat psychosocial disabilities. This includes how neurotic one must be before one is considered neurotic, or how much are males allowed to express their feelings before being labelled as peculiar or abnormal?
Depression thus presents differently in different cultures. For example, in many parts of the Far East and Africa, depression is currently expressed less via affective symptoms and expressed more via somatic symptoms such as aches or fatigue (even though physical causes for these symptoms are seldom found). Some cultures prefer more voluptuous body shapes while others prefer more skinny body shapes thus eating disorders will be viewed differently in different cultures. Some symptoms regarding a specific disorder can be more prevalent in some places than others. In some cultures, people with schizophrenia can even be believed to have special powers of prophecy or insight. The manifestations of specific disorders may be universal (e.g. for psychosis, hallucinating will be universal, although the content of these hallucinations may exhibit different cultural patterns) but there are differences in how they are interpreted or understood.
The level of stigma against mental disorders is also highly cultural, and therefore affects what treatment options will be locally accessible. Therefore we need to take into balance both a biological and cultural approach to disorders, particularly when it comes to those of the mind – we need to consider both biomedical explanations and sociological explanations. One may think that taking a hard-line biomedical approach will be most effective but we live in a diverse world in which we must be culturally respectful too, and not just judge others according to our own culture, values and spirituality. We need to win hearts and minds to get anywhere productively if we really want to help others in foreign countries. Besides, who is to say that one’s own (current) culture, values and spirituality are the objectively right ones?
Having said that, we must not take an overly culturally sensitive approach because many mental health issues, as well as human rights issues, are universal and global. For example, punishing the mentally ill for being ‘possessed by evil spirits’ should not be accepted anywhere even though it might be what a local culture believes in doing. People in these places need to be (re)educated.
In one’s own country, a helpful idea could be to better educate primary care workers to recognise the symptoms of depression, anxiety and so forth – but a counter-argument is that they’re likely already busy enough. Another idea is to use screening measures to improve detection. Simple questionnaires are cheap to administer – but could be too crude and so lead to a lot of misdiagnoses. Structured interviews, multiple and/or longer GP/PCP visits and/or analysing patient medical records are far more effective – but are proportionately more costly.
The ‘collaborative care model’ combines the use of supervised depression care managers, the education of providers, and brief therapies – and this approach may be showing promise. ‘Health homes’ that integrate behavioural health care and primary care so that a person’s entire healthcare needs can be addressed through a single entity may also be more efficient and effective – but we must ensure there are adequate healthcare laws/acts and the proper regulation of all care provider entities, for there have been a small number of isolated but terrible cases of patient abuse in some places.
Properly-trained professionals (not just psychiatric but occupational, maternal, etc. professionals) certainly contribute to mental health care, but beware of self-proclaimed ‘experts’ who are only really there to promote themselves and their own agendas and/or products with the main focus on personal profit. (We see this a lot in all facets of, for instance, the nutrition and fitness industry, where some people make the relatively simple health goal of eating healthfully seem more expensive than it really is, and they just so coincidentally happen to be selling the ‘solution’ that we all ‘need’! Take everything on a case-by-case basis and don’t over-extrapolate genuine scientific findings – but enough of the public keeps on thinking ‘all those past trends were just fads but this new one is something we shouldn’t ever live without anymore’… until we move a couple of years into the future and realise that it was just another fad like those gone before!) Those professionally working in mental health care should have relevant and reputable qualifications and perhaps there should be mandatory accreditation for all therapists – do not be afraid to check their credentials before agreeing to their service.
Mental health care should arguably be under primary care rather than only under specialist care. It’s important that anybody and everybody who is in direct or indirect contact with a patient should have some scientific knowledge of mental health to best benefit the patient. Awareness by and proper education for all therefore helps; and this means trained (and supported and supervised) ordinary citizens can be invaluable too – just like the benefit of everyone holding at least some basic knowledge of first aid for physical health care in workplaces. Interpersonal care by everyone can reduce the reliance on medical options.
It takes all stakeholders understanding and being supportive, and passing on their understanding and support to all others in society. It also takes long-term care. The solutions aren’t necessarily expensive or esoteric (although funding is an area that presently needs improvement in the UK at least – for a while now, there’s been inadequate funding for mental health care (CAMHS (Child and Adolescent Mental Health Services) and the NHS (National Health Service) in general) and some people must travel a very long way to get treatment).
Lockdown, the fear of an invisible threat, social distancing, isolation, job losses, lost school terms and general uncertainty during the coronavirus pandemic will have no doubt increased the number of cases of mental health problems – many of which will be hidden and untreated due to healthcare services being diverted onto something with greater immediate priority. Mental health care must not be overlooked for the mid and long terms though.
It might not be sufficient alone in all cases but simply caring for each other and showing furry compassion is the single greatest driver of better mental health and well-being in society.