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.
"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.
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.
Saturday, September 22, 2007
Thursday 20th September
Hi all,
Hope you enjoyed Thursday's lectures. Apologies for any confusion about the various questionnaires we sent around. Basically we are seeing if a) doing the psychiatry rotation and b) having the "Psychiatry and Society" lectures themselves lead to a change in attitudes among medical students to psychiatry as a career, as well as a change in attitude to mental illness. So we have been doing some questionnaires with the current group of students doing psychiatry as a rotation, which overlaps with what we handed out on Thursday. We are also doing more qualitative work on the Psychiatry and Society lectures. I'll post more about these in due course.
Hope my little bit about the essays was clear enough. As I said, don't be too intimidated about having to do essays on psychiatry and society topics. The essays will be very general. The more you can use material from the lectures to inform your essay, the better.
I hope you enjoyed Liam Delaney's presentation. The Geary Institute maintain their own blog (linked to on the right, but in any case the link is here: http://gearybehaviourcenter.blogspot.com/) There is lots of exciting work going on at the interface between economics and psychiatry. As Liam said, in the recent past economists tended to ignore the less economically tangible (ie less readily expressible in monetary terms!) aspects of human happiness (although in the more distant past economists were very aware of them) - however now this is changing.
Economists are also more aware that a population with a high prevalence of mental illness is a less productive one. We tend to have an image of capitalism as this ruthless, impersonal system which works "best" when taking the least account of the consequences. This might seem a total tangent (and a distraction coming up to the first half of the finals!) but I'd recommend to anyone interested a book called "The Writing On the Wall" by Will Hutton - which is mainly about the rise of China as an economic, military and political power, but also contains much eye-opening (for me anyway) stuff on how modern theorists are realising that, to work well, market economies need strong, independent institutions (some of which may seem to have a raison d'etre contradictory to capitalism) such as a free press, an independent judiciary, mechanisms to regulate banking and financial services etc. (and I might add, an independent medcial profession)
I missed some of the Pavee Point presentation for various logistic reasons. I would be interested to know what people made of it - both Irish and non-Irish. Certainly it helped open my eyes to the viewpoint of a group in our society almost entirely excluded from public discourse except in bad news stories, as some kind of problem to be solved by the rest of society. It was refreshing to hear travelling people speaking for themselves. I think as a presentation it may have seemed little heavy on the structure of services etc. One thing you realise when you begin working is that a lot of those things that seem either trivially obvious or boring (or both) when you are a student about teams being "multidisciplinary", about "consultation", and about the structure of the health system and services, becomes very relevant very quickly. So right now this kind of stuff seems dull (trust me, I know!) but it is important to get a sense of its importance)
Someone once told me that we should all do management courses, because management have so much control of our working lives that we should have some idea of where they are coming from - and their uniquely boring and opaque use of language!
Hope you enjoyed Thursday's lectures. Apologies for any confusion about the various questionnaires we sent around. Basically we are seeing if a) doing the psychiatry rotation and b) having the "Psychiatry and Society" lectures themselves lead to a change in attitudes among medical students to psychiatry as a career, as well as a change in attitude to mental illness. So we have been doing some questionnaires with the current group of students doing psychiatry as a rotation, which overlaps with what we handed out on Thursday. We are also doing more qualitative work on the Psychiatry and Society lectures. I'll post more about these in due course.
Hope my little bit about the essays was clear enough. As I said, don't be too intimidated about having to do essays on psychiatry and society topics. The essays will be very general. The more you can use material from the lectures to inform your essay, the better.
I hope you enjoyed Liam Delaney's presentation. The Geary Institute maintain their own blog (linked to on the right, but in any case the link is here: http://gearybehaviourcenter.blogspot.com/) There is lots of exciting work going on at the interface between economics and psychiatry. As Liam said, in the recent past economists tended to ignore the less economically tangible (ie less readily expressible in monetary terms!) aspects of human happiness (although in the more distant past economists were very aware of them) - however now this is changing.
Economists are also more aware that a population with a high prevalence of mental illness is a less productive one. We tend to have an image of capitalism as this ruthless, impersonal system which works "best" when taking the least account of the consequences. This might seem a total tangent (and a distraction coming up to the first half of the finals!) but I'd recommend to anyone interested a book called "The Writing On the Wall" by Will Hutton - which is mainly about the rise of China as an economic, military and political power, but also contains much eye-opening (for me anyway) stuff on how modern theorists are realising that, to work well, market economies need strong, independent institutions (some of which may seem to have a raison d'etre contradictory to capitalism) such as a free press, an independent judiciary, mechanisms to regulate banking and financial services etc. (and I might add, an independent medcial profession)
I missed some of the Pavee Point presentation for various logistic reasons. I would be interested to know what people made of it - both Irish and non-Irish. Certainly it helped open my eyes to the viewpoint of a group in our society almost entirely excluded from public discourse except in bad news stories, as some kind of problem to be solved by the rest of society. It was refreshing to hear travelling people speaking for themselves. I think as a presentation it may have seemed little heavy on the structure of services etc. One thing you realise when you begin working is that a lot of those things that seem either trivially obvious or boring (or both) when you are a student about teams being "multidisciplinary", about "consultation", and about the structure of the health system and services, becomes very relevant very quickly. So right now this kind of stuff seems dull (trust me, I know!) but it is important to get a sense of its importance)
Someone once told me that we should all do management courses, because management have so much control of our working lives that we should have some idea of where they are coming from - and their uniquely boring and opaque use of language!
Friday, August 31, 2007
Back
Hi all,
The next lectures are on September 20th. The lecturers are Liam Delaney from the Geary Institute in UCD and speakers from Pavee Point. Attendance will be taken.
I'll also outline the structure of the essay paper on the 20th, between the lectures.
See you then,
Seamus
The next lectures are on September 20th. The lecturers are Liam Delaney from the Geary Institute in UCD and speakers from Pavee Point. Attendance will be taken.
I'll also outline the structure of the essay paper on the 20th, between the lectures.
See you then,
Seamus
Wednesday, July 25, 2007
Small Group Needed
Hi all,
We are hoping to do some work with small groups to assess how the lecture series went and did it change any of your minds about psychiatry in any way. If you would be even vaguely interested, email me at seamus.macsuibhne@ucd.ie and I'll be in touch.
Hope the summer is going well wherever you are - and I hope to see you all (and I mean all) in September safe and well!
Seamus
We are hoping to do some work with small groups to assess how the lecture series went and did it change any of your minds about psychiatry in any way. If you would be even vaguely interested, email me at seamus.macsuibhne@ucd.ie and I'll be in touch.
Hope the summer is going well wherever you are - and I hope to see you all (and I mean all) in September safe and well!
Seamus
Friday, June 1, 2007
Yesterday....
Hi all,
Hope you enjoyed the presentations yesterday - those of you who showed up! Perhaps I'll reveal my ruthless authoritarian streak to ensure better attendance in the Autumn (for we'll have no lectures on June 21st - in September things will kick off again!)
I had to go off myself for a clinic before Prof Malone and Seamus McGuinness' presentation - I'd hope to have something online from them before too long. I hope you found Joe Little's presentation stimulating - it was perhaps more an overview of a journalistic career and the intersection with mental illness in various stories that he covered, rather than a more didactic lecture.
There was lots to think about as a result of the presentation - in particular the realisation that in Ireland we are not all that far away, either in terms of time or distance, from a long-term ethnic conflict which rumbled on for centuries. We tend to forget how ingrained trauma can become. I remember being told (sorry I have no more reliable source than this) that many of the population of Belgrade are still on benzodiazapenes following the NATO bombings of 1999. I was also reminded of another thing I was told (clearly I'm not in evidence based medicine mode today!) that one of the consequences of the Famine and the century-and-a-half economic malaise which followed in Ireland was that Irish males tended to either emigrate of stay around doing very little, setting up a dynamic of Irish males being either hardworking but absent, or feckless but present - which has had knock-on effects on their interpersonal relationships to this day.
The other thing I took from Joe's presentation was this tension between protecting people and respecting their rights - for instance when he talked about the exposé of illegal moneylenders in the 1980s, and the reaction from some quarters that people should be allowed go to hell in a handcart if that's what they desire. This is the sort of tension we see in compulsory detention, for instance, and perhaps it goes to the heart of psychiatry. Unlike most psychiatrists (I reckon) I tend towards the libertarian end of the spectrum, but on the other hand no one can spend much time in psychiatry without realising that there are lots of people who are vulnerable to scams and frauds and do need protection. For instance, a lot of those fraudulent lotteries and get-rich-quick schemes that most of us just delete from our Inbox or go straight to the recycling bin, and read and taken up by people with cognitive impairment or learning disability.
I guess this tension is increasingly at the heart of politics too - we have gone from a left-right dichotomy to a more libertarian-authoritarian spectrum.
Anyway enjoy the weekend, see the current students next week and see the rest of you in September!
Seamus
Hope you enjoyed the presentations yesterday - those of you who showed up! Perhaps I'll reveal my ruthless authoritarian streak to ensure better attendance in the Autumn (for we'll have no lectures on June 21st - in September things will kick off again!)
I had to go off myself for a clinic before Prof Malone and Seamus McGuinness' presentation - I'd hope to have something online from them before too long. I hope you found Joe Little's presentation stimulating - it was perhaps more an overview of a journalistic career and the intersection with mental illness in various stories that he covered, rather than a more didactic lecture.
There was lots to think about as a result of the presentation - in particular the realisation that in Ireland we are not all that far away, either in terms of time or distance, from a long-term ethnic conflict which rumbled on for centuries. We tend to forget how ingrained trauma can become. I remember being told (sorry I have no more reliable source than this) that many of the population of Belgrade are still on benzodiazapenes following the NATO bombings of 1999. I was also reminded of another thing I was told (clearly I'm not in evidence based medicine mode today!) that one of the consequences of the Famine and the century-and-a-half economic malaise which followed in Ireland was that Irish males tended to either emigrate of stay around doing very little, setting up a dynamic of Irish males being either hardworking but absent, or feckless but present - which has had knock-on effects on their interpersonal relationships to this day.
The other thing I took from Joe's presentation was this tension between protecting people and respecting their rights - for instance when he talked about the exposé of illegal moneylenders in the 1980s, and the reaction from some quarters that people should be allowed go to hell in a handcart if that's what they desire. This is the sort of tension we see in compulsory detention, for instance, and perhaps it goes to the heart of psychiatry. Unlike most psychiatrists (I reckon) I tend towards the libertarian end of the spectrum, but on the other hand no one can spend much time in psychiatry without realising that there are lots of people who are vulnerable to scams and frauds and do need protection. For instance, a lot of those fraudulent lotteries and get-rich-quick schemes that most of us just delete from our Inbox or go straight to the recycling bin, and read and taken up by people with cognitive impairment or learning disability.
I guess this tension is increasingly at the heart of politics too - we have gone from a left-right dichotomy to a more libertarian-authoritarian spectrum.
Anyway enjoy the weekend, see the current students next week and see the rest of you in September!
Seamus
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