See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/311881594
No Health Without Mental Health
Article in Mental Illness · December 2016
DOI: 10.4081/mi.2016.6609
CITATIONS
3
READS
131
4 authors, including:
Some of the authors of this publication are also working on these related projects:
Functional dysconnectivity in schizophrenia View project
Schizophrenia Utra High Risk View project
Andrei Novac
University of California, Irvine
36 PUBLICATIONS 483 CITATIONS
SEE PROFILE
A. Preda
University of California, Irvine
188 PUBLICATIONS 8,450 CITATIONS
SEE PROFILE
Robert G Bota
University of California, Riverside
93 PUBLICATIONS 1,638 CITATIONS
SEE PROFILE
All content following this page was uploaded by Robert G Bota on 27 December 2016.
The user has requested enhancement of the downloaded file.
[Mental Illness 2016; 8:6609] [page 55]
No health without mental
health
Cristina Vladu, Andrei Novac, Adrian
Preda, Robert G. Bota
University of California, Irvine, CA, USA
Two hundred years ago, the term psychiatry
was introduced (psyche-soul and iatros-physician) to designate a medical specialty that
would attend to those with mental illness.1 At
that time psychiatric conditions were recognized as being at the border of medicine, philosophy and theology. We are now ushering in
an era in which psychiatry and primary care
are creating a new alliance. We live in a world
of postmodern psychiatry in which numerous
previous structures and roles are being challenged. Postmodernism and neo-pragmatism
have brought us deconstruction.2 It applies to
many a change that modern research and new
demands of society have exerted on contemporary psychiatry. Public opinion about mental
illness has changed. New patient populations
have emerged. The emphasis on multidisciplinary approaches has often lagged behind.
Today the complexity of psychiatry among all
other medical specialties is rarely recognized.
A rather reductionistic over-identification with
neuroscience has often been professed and a
simplistic acceptance that a part is in fact the
whole has been too often purported. Yet
unquestionable remains the fact that psychiatric morbidity and disability outweigh the
burden of other medical conditions and that
our patients are the same people seen in primary care settings for most medical conditions.
As a consequence, a heavy burden is paid by
the world community. It is then on this note
that the World Psychiatric Association
Congress in Bucharest, Romania, June 24-27,
entitled: Primary Care Mental Health:
Innovation and Transdisciplinarity, stands out
among most other international conferences
of the past year.
Recognizing the urgency to addressissues of
health policy globally, the 2015 World
Psychiatric Association International Congress
presented the following resolutions, which
were approved by the participants and will be
forwarded to the United Nations:3
«WHEREAS, cardiovascular and mental disorders lead in the global burden of non-communicable diseases; WHEREAS, most mental disorders are attended to in primary care; WHEREAS,
mental disorders account for 30-45% of the
global burden of disability; WHEREAS, 50% of
mental disorders exist by age 14, and 75% by age
24; WHEREAS, these disorders result in billions
of dollars of negative economic consequences
across low-, middle-, and high-income nations;
WHEREAS, significant global health systems
fragmentation diminishes access to care and its
effectiveness; WHEREAS, more research into
the brain and into the determinants of health is
needed; WHEREAS, effective treatments for
mental disorders exist for most cases; and
WHEREAS, the collaboration and integration of
primary care, mental health, and public health
is proven to enhance access, quality, and sustainability […]
NOW BE IT RESOLVED THAT United Nations
member states adopt collaborative and integrated care as a means toward achieving total
health for all in the 21st Century; and be if further resolved that […] this goal be included in
the updated United Nations Sustainable
Development Goals; and be it further resolved
that, United Nations member states allocate the
necessary human, financial, and technological
resources for training, education, and implementation of this resolution [sic]».
Many topics presented at the Congress were
pertinent to health policy. Therefore, our team
further interviewed many presenters and
inquired about the foremost urgent aspects
that need to be addressed in the process of
integrating mental health into primary care.
The points below summarize the comments
and our observations
i) Psychiatric disorders account for a significant share of the global burden of disease. Psychiatric illness are characterized
by very high comorbidity with medical
and other psychiatric disorders.
Therefore, they constitute a major public
health burden.
ii) Current health systems are unprepared to
address the ever-increasing needs of
patients suffering from mental illness.
Financial resources allocated for mental
health are far from being proportional
with the burden and prevalence of the
mental disorders. Striving for adequate
resources is of utmost importance.
iii) The modern health care emphasis on biological formulations for urgent or acute
care is poorly fitted to address the needs
of most psychiatric patients, who suffer
from chronic conditions with important
psychosocial determinants.4 To improve
the somatic and mental health outcomes
of the people suffering with mental illness the future systems of care should
consider the needs of chronic care and
the psychosocial context.
iv) The complexity, chronicity and comorbidity of most psychiatric conditions
requires a reconceptualization of mental
health and illness across the levels of
individual patient care, community care,
health care organizations and policies,
emphasizing the bi-directional relationships between mental and somatic illness.
v) As reflected in most of the presentations
of the WPA 2015 in Bucharest and given
the precarious state of the health care
services provided to the mentally ill worldwide, there is an urgent need to re-conceptualize and reform the health delivery
systems for the mentally ill. The new
approach should be guided by principles
of social justice and dignity. Patients with
psychiatric disorders should be given the
same priority and importance as patients
with all other medical conditions.
vi) The fragmentation of most current health
care services decreases the quality of care
for patients with mental illness. By integrating psychiatric and other medical
services future care services will foster
health, improve efficiency, decrease
waste and improve the overall experience
of patients.3
vii) A new approach to psychiatry should
include the entire spectrum of services
from primary prevention to treatment and
rehabilitation services for the mentally ill.
viii) Sustained integration and coordination of
services between family medicine, primary health care teams and the psychiatric care at the front end is needed.
ix) As it is known that stable long-term functioning teams of professionals produce
better treatment outcomes, a new
approach should rely on such teams,
enabling the provision of continuous and
tailored care to mentally ill.
x) The PHC/community care teams should
have an increasingly developed role; the
WHO chronic care model should be
applied and tools to activate communities
should be used. Screening tools should be
given to cover the most prevalent psychiMental Illness 2016; volume 8:6609
Correspondence: Robert G. Bota, UC Irvine
Health Neuropsychiatric Center, 101 The City
Drive South, Orange, CA 92868, USA.
Tel.: +1.714.456.2056.
E-mail: [email protected]
Key words: psychiatry; mental health; WPA.
Contributions: the authors contributed equally.
Conflict of interest: the authors declare no potential conflict of interest.
Received for publication: 20 May 2016.
Accepted for publication: 20 May 2016.
This work is licensed under a Creative Commons
Attribution-NonCommercial 4.0 International
License (CC BY-NC 4.0).
©Copyright C. Vladu et al., 2016
Licensee PAGEPress, Italy
Mental Illness 2016; 8:6609
doi:10.4081/mi.2016.6609
Non commercial use only
[page 56] [Mental Illness 2016; 8:6609]
atric disorders. A range of evidence-based
cost-effective interventions should be
taught and applied by these teams.
xi) A new approach to medical education
should include early exposure of medical
students and other trainees to behavioral
sciences and to the development of interpersonal skills and team building approach
to enhance the cultural competence of the
health care workers.
It is our hope that the congress has created
a critical mass for a new direction in the world
community of psychiatry and primary care.
References
1. Marneros A. Psychiatry’s 200th birthday.
Br J Psychiatry 2008;193:1-3.
2. McGowan Jr. Postmodernism and its critics. Ithaca, NY: Cornell University Press;
1991.
3. World Psychiatry Association. Bucharest
statement of collaborative and integrated
care. 2015. Available form: http://www.wpa
2015bucharest.org/download-files
/uGZfrv3.pdf. Accessed on: July 2015.
4. World Health Organization. Innovative
care for chronic conditions: building
blocks for action: global report. 2002.
Available from: http://www.who.int/chp/
knowledge/publications/icccglobalreport.p
df. Accessed on: July 2015.
Editorial
Non commercial use only
View publication stats