Friday, October 26, 2007

A vitally important study

An important study which I would like to bring to your attention: http://news.bbc.co.uk/2/hi/health/7061887.stm

Who knows, perhaps this might come up in the exam.

NIall Crumlish podcast

A podcast of Niall Crumlish being interviewed by Raj Persaud was posted on the Royal College of Psychiatrists website - there's a link to it on the main RCPsych page, but the podcast itself is at http://www.rcpsych.ac.uk/pressparliament/podcasts/insightandfunctioning.aspx.

Friday, October 5, 2007

Stigma

Stigma will be an important topic for the essay papers. The lecture on stigma on Blackboard from March is a good starting point for reading about the topic. Stigma has been a common theme that has run through most of the lectures on Thursdays. From the stigma associated with suicide, and the stigma associated with mental illness which helps prevent people from seeking help for mental distress and thereby contributes to suicide, to the particular stigma for mental illness among minority groups such as travellers and refugees/asylum seekers (these are groups that are already to some degree stigmatised by the wider society), stigma has recurred. In the next series of lectures there will be presentations on psychiatry in a developing world setting and a historical perspective, which will further illuminate the topic of stigma.

Ultimately, stigma is an individual experience - look at the stigma presentation and be clear about the distinction between "felt" stigma and "enacted" stigma. Much "felt" stigma comes from the wider social and cultural attitudes to madness and rationality, but it is important to remember that stigma is experienced by individuals. So try and relate the topics on the course to the individual experience of people with mental illness.

This paper might be worth looking at : http://tinyurl.com/2yg22a

Wednesday, October 3, 2007

New links

As you can see, there are lots of new links to the right - I would recommend looking through them.

Age shall not wither

"The world’s population is getting older. In the next 50 years, the number of older people will nearly quadruple, growing from about 600 million to almost 2 billion people. Today, one in every ten is 60 years and older. By 2050, this will become one out of every five, and by 2150, one third of the people in the world are expected to be 60 years of age or older.

"In some developed countries and countries with economies in transition, birth rates have fallen below replacement levels, and the number of older persons will be greatest in developing countries, where the older population is expected to quadruple over the next 50 years. Eighteen out of the 20 countries in the world with the highest percentages of older people are in WHO’s European Region. In these countries, between 13.2% and 17.9% of the population are over 65 years old."

The above is from the wesbite of "Technology Research For Independent Living." - http://www.trilcentre.org/ . We hear a lot about the ageing population and the attendant stresses on pension systems and social welfare systems. We also hear quite a lot about how our lives as doctors/future doctors will be affected by this. There's no doubt that the burden of dementia and the needs of carers will dramatically increase.

However, the ageing population is invariably posed as a problem. As websites like the above reveal, many companies are seeing these demographic issues as commercial opportunities. Perhaps there are other potential positives we don't see yet. Certainly, notions of "old age" and the capabilities of those formerly classed as elderly are changing. A generation of people who came of age in the 1960s and who have very different expectations from life than their parents is now coming into the "elderly" bracket.

No health without mental health

The Lancet has recently published a paper entitled "No health without mental health." It's worth a look, I'll be putting it up on Blackboard under the Psychiatry and Society label.


The abstract in full:

"About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public
health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream eff orts to improve health and
reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and
evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on
existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition;
and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health aff ects progress towards the achievement of several Millennium Development Goals, such as
promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care."

Something of particular interest:


"The population-attributable fraction (which is the proportion of cases of disability that would not have occurred in the
absence of mental disorders) could be as high as 0∙69,which suggests that failing health and consequent disability
could be the most important contributory cause for late-life
depression."

In other words, 69% of disability - even that ostensibly not related to mental illness - is due to mental health.