bluuebunny/crossref_metadata_2025 huggingface dataset:
Rumination disorder
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

Rumination disorder (RD) is characterised by the effortless regurgitation of undigested food. Although it is a classified as two separate disorders (functional duodenal and as a feeding and eating disorder) this chapter is concerned with the second type. This chapter covers the epidemiology of the disease, and biological, psychological, and socio-cultural risk factors for developing rumination disorder. Presentation and clinical features are listed, and taking a history is explained, alongside potential differential diagnoses. Examination and investigations are discussed, and the diagnostic criteria are outlined. Psychological and potential pharmacological interventions are presented, with the importance of the multidisciplinary team. Complications, comorbidities, and prognosis are all included.
Emerging eating disorder diagnoses
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

This chapter covers the epidemiology, risk factors, presentation, and treatment for eating disorders that have not, or currently do not, have formal diagnostic criteria under the DSM or ICD. It covers emetophobia, which is currently classified as an anxiety disorder, but is often associated with food restriction; diabulimia, where the deliberate omission of insulin therapy in those with Type 1 Diabetes is used to reduce weight; ‘drunkorexia’ where compensatory food restriction or vomiting is used to counteract the calories associated with alcohol consumption; muscle dysmorphia; and orthorexia and its association with obsessive compulsive disorder.
Comorbidities
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

This chapter covers the comorbidities associated with eating and feeding disorders. It starts with the presentation, diagnosis, and subtypes of mood disorders, bipolar disorders, anxiety disorders, obsessive compulsive disorder, and post-traumatic stress disorder. It goes on to personality disorders, and alcohol and substance abuse, including withdrawal symptoms and conditions for admission for detox. It also covers autism spectrum disorder and attention deficit hyperactivity disorder, including various presentations, diagnosis, and management.
Acute emergency care
Authors: McNaught Elizabeth , Treasure Janet , Pollard Nick
Published: August 2022

Sometimes eating disorders may result in acute presentation in a hospital setting. This chapter covers acute emergency care of the patient with an eating disorder. It begins with refeeding syndrome, covering the physiology and clinical features, then goes onto the MARSIPAN (management of really sick patients with anorexia nervosa) guidelines for adult and junior patients. It contains the risk assessment, tests that should be performed, locations for admission, and management in different settings. It then explains the presentation, investigations, and management of hypoglycaemia, hypokalaemia, hypophosphataemia, hypomagnesaemia, and hypothermia.
Historical development
Authors: Bebbington Paul , Kuipers Elizabeth
Published: August 2022

Social factors are crucial to the genesis, maintenance, and outcome of psychiatric disorders. In the first chapter, the authors provide an account of the history of social psychiatry. They identify early thinking about mental disorder, and link it to subsequent developments originating in the scientific traditions of the West. They argue that social psychiatry is a history of ideas about the social understanding and causation of mental ill health, and that these ideas are capable of assessment and refutation. They emphasize the central importance of its scientific basis, and assert that progress has been the result of an insistence on the development of a rigorous set of definitions, methods, and assessment tools. These are necessary in order to capture both hypothesized independent variables (social measures of various sorts, such as life events, family relationships, and social support), and dependent variables (measures of mental disorder or of specific mental symptoms or attributes). Such measures must be valid and reliable. Consequently, it has been possible to establish accurate case finding and to identify specific types of social influence. It has also been possible to formulate causal hypotheses and investigate mechanisms of action. By clarifying the effect of social factors on the emergence of acute episodes of disorder and on the process of recovery, social psychiatry has, in turn, enabled the progression of targeted social and psychological interventions.
All psychiatry is social
Authors: Ventriglio Antonio , Wijesuriya Rajiv , Bhugra Dinesh
Published: August 2022

Psychiatry, although a medical speciality, has used biopsychosocial models for understanding the aetiology of mental illnesses. After identifying various causative factors, medical interventions with or without psychological and social therapies have been utilized to a varying degree of effectiveness. Social psychiatry is the branch of psychiatry that looks at social aetiology and social interventions. It is a truism and a given that all psychiatry is social, from causation to management. In order to navigate biopsychosocial models, it is important to understand the role social determinants and social factors play in the aetiology, therapeutic engagement and therapeutic alliance, and influencing outcomes. There is considerable evidence that social factors also affect biological and psychological factors. In order to engage patients and their carers and families in therapeutic interventions social factors at various levels need to be identified and managed, as these work at macro, meso, and micro levels. In addition, social mores and norms influence functioning of the individuals thereby defining abnormal behaviours and deviance.
Categories and their implications
Authors: Tyrer Peter
Published: August 2022

Classification in psychiatry has lagged behind that in medicine and related disciplines but should not be abandoned for a number of reasons. There is no doubt that psychiatric disorders are difficult to classify as, unlike medical disorders, we do not have independent information that validates and confirms clinical findings in an objective way. However, it is also important to recognize that patients often request diagnosis and, in conveying this, a detailed discussion involving the concepts of categories and dimensions is crucial. Because social psychiatry deals with a person’s symptoms and functioning in a wider social context, almost any form of classification appears to be found wanting. This chapter looks at the advantages and disadvantages of both these approaches. Common mental distress can be medicalized into psychiatric disorders when new diagnostic categories are considered; this danger must be recognized.
Social constructs and diagnostic perspectives
Authors: Wigand Moritz E. , Becker Thomas
Published: August 2022

The aim of this chapter is to summarize different diagnostic concepts of mental illness. There are opposing (or complementary) views of mental illness ranging from neurobiological to social concepts, and psychiatry is prone to cyclical paradigm shifts, which emerge from complex social processes. To organize psychopathological data, different approaches such as dimensional concepts, categorical concepts, and the concept of ideal types have been proposed. For research purposes, there are several concepts such as the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and the p factor of general psychopathology. Being diagnosed with a mental illness means to be socially labelled, which can have both negative and positive consequences. In the history of psychiatry, diagnoses have been added and removed, and there has been political abuse of psychiatric diagnoses. There are models such as the biopsychosocial disease model trying to encompass the complex factors making up a psychiatric diagnosis.
Epigenetics and aetiology of mental illness
Authors: Campanile Gianluigi , Fanelli Giuseppe , Fabbri Chiara , Serretti Alessandro , Mendlewicz Julien
Published: August 2022

Over the last few decades, considerable progress has been achieved in understanding the aetiology of mental illness and its biological underpinnings. Genetic factors have been shown to play a substantial role, although genetics alone are not able to explain fully the heritability of these diseases. Epigenetic mechanisms, such as DNA methylation, histone modifications, and RNA interference, modulate tissue-specific gene expression and have been proven to be involved in the aetiopathogenesis of psychiatric disorders. Numerous epidemiological studies have confirmed a contribution of environmental factors, and convincing evidence suggests that socio-economic status, early life stressors, and childhood trauma impact significantly on the risk of psychiatric disorders via lifelong epigenetic modifications. This chapter will discuss in detail the different epigenetic mechanisms underlying the pathogenesis of psychiatric diseases and their interaction with genetic factors, providing an overall picture about the recent advances in psychiatric epigenomics.
Sociology and social psychiatry
Authors: Bhugra Dinesh , Pemberton Max , Gnanapragasam Sam N.
Published: August 2022

Sociology is described as a discipline that studies societies and the societal factors in which people are born, live, work, play, and age. This forms a crucial component of social psychiatry from basic observation of social and societal behaviours to recognizing and understanding social norms and mores. This discipline helps us understand the broader relationship of society and social factors with mental illnesses and well-being. The impact of social factors on the biological and psychological factors in clinical presentations cannot be underestimated. Recognition of illness behaviours and help-seeking are important aspects of therapeutic engagement. In this chapter, essential parts of sociology are covered in relation to social psychiatry. The aim is to describe illness and the sick role, challenges in biomedicine, interactionist perspectives, labelling theory, and psychiatry’s social contract.
The contemporary dynamics of the social relationship
Authors: Lucey James V. , Noctor Colman
Published: August 2022

In the past few decades the nature of social relationships has changed significantly. A number of factors play a role in this, including social media. Never has society experienced something with such an interactive capacity that can pervasively affect so many aspects of our lives and at such a remarkable pace. It can be argued that societies are perhaps going through the greatest social and emotional experiment of all time. The impact of technology on individual and collective social identity at an emotional level is likely to be significant. There is often a tension between a rights-based culture focused on a more liberal and facilitative approach to technology use, and a responsibilities-focused philosophy, which tends to focus more on protective paternalistic roles with more regulation and prohibitive actions. Impulses, such as a human need for social validation and the allure of recognition, are human behaviours especially relevant to social media and relationships.
Anthropology and social psychiatry
Authors: Hubbett Jack
Published: August 2022

Anthropology and psychiatry both study aspects of humanity but from different angles. One, the how and why of humanity’s story; the other, the abnormalities of the human mind, which are classified as illness. This book chapter defines anthropology and how it can be subcategorized and applied to the study of mental illness. This includes specifically how the common teachings from anthropology can be considered through a social psychiatry lens, the value of considering the context and circumstance of the patient narrative, and also the problems encountered when an overly relativistic approach is taken. This text also explores the common qualitative methods used in anthropological study, and considers how scientific rigour is maintained within this framework, and subsequently applied to psychiatric research. Additionally, it reviews the role of cultural/family background in the interpretation and experience of mental illness, as well as the role that anthropology plays in public mental health.
Disasters, emergencies, and social psychiatry
Authors: Poulter Dan , Ventriglio Antonio , Gnanapragasam Sam N.
Published: August 2022

Disasters, be they natural or man-made, affect millions of people directly or indirectly every year. Not all people affected by disasters will develop psychiatric morbidity or need psychiatric help. Medicalization of normal human responses to disasters must be avoided. Disaster response policies should be driven by evidence, and need to be tailored to local needs and resources. This may require some innovation and working with community organizations and local stakeholders. Disasters can contribute to internal or external migration, and steps must be taken to manage these changes. Dealing with disasters requires clear national planning and policy, and where disasters are frequent, better preparation and risk reduction is needed at individual, community, regional, and national levels. Coordinated efforts between health, mental health, and structural organizational planning are essential to limit mortality and morbidity.
Psychiatry in the time of a pandemic
Authors: Ziafat Kimia , Westenberg Jean N. , Michael Krausz R.
Published: August 2022

The COVID-19 pandemic has and continues to have an impact on all areas of society, daily life, and health care, and it will have a major impact on the way health care will function beyond this public health crisis. For psychiatry, it also raises the fundamental question of how it could contribute to the response and redefine its role in medicine during changing conditions. Psychosocial care not only may help people cope with stressors such as loss and violence but also can help communicate public health measures to vulnerable populations in a way that is more easily accessible and comprehensible. Psychosocial care is of great importance in the field of prevention, protecting the most vulnerable and strengthening resilience.
Migrants, migration, and social psychiatry
Authors: Watson Cameron , Wijesuriya Rajiv , Bhugra Dinesh
Published: August 2022

The movement of people within the same country and across countries is not a new phenomenon. The personal, social, emotional, and psychological impact of migration on individual migrants and their families—those who accompany them and those who are left behind—is of great interest in order to understand the impact of stress on their functioning and psychiatric disorders. Migrants can be classified into different categories—those who are voluntary and involuntary, primary or secondary, economic or political. There are also political and economic asylum seekers whose needs will be similar but whose aspects of care will vary. Migration can be experienced in different stages, and different migrants have varying experiences of migration and settling down in the new culture. Psychosocial factors play a major role in postmigration adjustment and acculturation. Microidentities will be employed in managing stress and distress and mental health professionals need to be aware of stages of acculturation.
Trauma and resilience
Authors: Beyer Chad , Stein Dan J.
Published: August 2022

While exposure to traumatic events is highly prevalent, only a small proportion of those exposed to such stressors develop psychiatric illnesses. This raises a number of questions for social psychiatry. What are the mechanisms underlying risk and resilience after trauma? And what can be done to further decrease risk and increase resilience? This chapter reviews the epidemiology, neurobiology, and social determinants of post-traumatic stress disorder (PTSD) and resilience, in order to address these questions and to provide an integrative approach. An integrative approach to trauma and PTSD requires the recognition of a broad range of biological and societal risk and resilience factors that are relevant to trauma exposure, and that are important after such trauma, as well as the need for a range of interventions to target these factors. Such an approach aims to avoid both biological and sociological reductionism, instead emphasizing the need for a public health approach that reduces vulnerability to trauma and to PTSD, and to increase resilience.
Impact of trauma
Authors: Roberts Alice B. , Roberts Neil P. , Bisson Jonathan I.
Published: August 2022

Trauma and its impact are understood to be incredibly diverse in nature. Supported by an accumulation of research over the past two centuries, it is now recognized that certain psychologically and physically threatening experiences can have especially impairing consequences. Interpersonal trauma, particularly arising in childhood, can contribute to a plethora of detrimental outcomes extending throughout life. These can affect psychological and physical well-being and reduce longevity, with significant implications for wider society. Consequently, childhood trauma has been identified as a global health concern. Trauma-related psychopathology, including symptoms characteristic of post-traumatic stress disorder (PTSD) such as nightmares and flashbacks, are perhaps most widely recognized with regard to the impact of trauma. Acknowledgement of the relationship between trauma and the range of diverse outcomes that can follow, which include, but are not limited to, PTSD, is required in order to address holistically the complex needs of traumatized individuals.
Social determinants and mental health
Authors: Bell Ruth , Marmot Michael
Published: August 2022

This chapter applies the conceptual framework of the social determinants of health to discuss determinants of mental health across the life course. The health and well-being of individuals is strongly influenced by social determinants. Social determinants of health (SDH) encompass wider social, economic, environmental, cultural, and political factors that shape health-related behaviours and physical and mental health outcomes. SDH can be summarized as the conditions in which people are born, grow, live, work, and age. Systematic inequalities within societies create differential experiences of social determinants across the life course, and an accumulation of positive and negative effects of social determinants shape inequalities in health. The conceptual framework describes structural factors, political, and economic factors across the lifespan. The schooling, work environment, and natural and built environment, including housing, are important factors in good health. The impact of social factors on health, including mental health, is well recognized. The relationship between physical health and mental health is bidirectional. Psychosocial factors such as work stress affect mental health. Having control over aspects of life underpins how individuals cope with stressors and is key to mental health and well-being.
Revisiting the ‘gap’
Authors: Banerjee Debanjan , Bhattacharya Prama
Published: August 2022

Quality of mental health, risks for developing psychiatric disorders, and access to mental health care are all unevenly distributed in the global landscape. The inequalities of these social determinants have been well-recognized. The medical model has increasingly laid more emphasis on biologized factors through genetics, imaging, and other neurophysiological correlates. At the same time, it has often eschewed the biopsychosocial model, undermining the social determinants including inequalities. Socio-economic disadvantage and relative poverty have been shown to be related to poor mental health. Psychiatric disorders are influenced by various inequalities through ‘social causation’, while those with mental illnesses tend to be very often socially excluded, leading to ‘social drift’. Besides poverty, there are a myriad of economic, political, cultural, relational, and ecological factors that can maintain the global inequalities in psychosocial well-being. Homelessness, urbanization, migration, social stigma, ageism, sexism, low educational attainment, and unemployment are some of them. In this chapter the aim is to provide an overview of the various social dimensions that cause, maintain, and perpetuate the mental health inequalities, and the underlying relationships. Strategies to address these issues are described, with a special focus on the role of advocacy, tailored policies, and intersectoral collaboration at various levels.
Spirituality and resilience
Authors: Verhagen Peter J.
Published: August 2022

Resilience contributes to positive health outcomes in the physiological, social, mental, and spiritual domains. Spirituality, religion, and meaning-giving are resources and means that help individuals cope with adverse life events and circumstances. Thinking about resilience should therefore include spirituality. In this chapter, this position is substantiated by a reflection on resilience and on an innovative concept of positive health, based in part on Antonovsky’s salutogenic approach, especially the construct of a sense of coherence. The concept of positive health involves six dimensions depicted in a six-pointed spider’s web. Especially important is that a spiritual/existential dimension is included in this dynamic concept of health, which is defined as the ability to adapt and to self-manage. The concept is illustrated with an uncomplicated, everyday case vignette. Subsequently, the meaning-making process and the available empirical evidence are discussed in more detail. The meaning-making process is invaluable in terms of meaningfulness as an outcome of resilience and positive health. The empirical evidence supporting spirituality and religion in relation to the promotion of mental health is still undervalued and therefore deserves to be brought up again and again.
Families and psychiatric disorders
Authors: Thomas Bino , George Tony Sam
Published: August 2022

The known, untold, and obscure dynamics of families have been a wonder, curiosity, and a matter of investigation in psychiatry for a long time. The onset of scientific understanding of psychiatric disorders, the empirical search to appreciate the living experiences of people with mental illness, and the acceptance of the bio-psychosocial model have laid the foundations for involving families in psychiatry practice, teaching, and research. The accompanying journey of families with mentally ill members have seen bitter, exhausting, challenging, helpless, frightening, insecure, disabling, accommodating, fulfilling, uncompromising, empowering, and partnering experiences in mental health practice. Families continue to be the significant stakeholders, providing primary-level care to mentally ill family members and consuming mental health services.
The web and its impact on mental health care
Authors: Krausz Reinhard Michael , Kazemi Alireza , Bacinschi Ssophie , Kamel Mostafa
Published: August 2022

The paradigm shift in communication and web-based technologies is already changing our society in all major sectors like education, commerce, and, increasingly, health. Low-income countries with a lack of health care resources can especially benefit from international collaboration and support in this field. This is already the most significant paradigm shift in health care today, as shown by the COVID-19 pandemic, when all of a sudden virtual care became the main resource of care in different areas of the system. The significant improvements include better access, capacity building, and access to expertise with higher quality of care, including the potential for a learning system. The critical is the question, who will design and develop this new framework, and what will the therapeutic paradigms be?
Personality disorders
Authors: Orme William H. , Fowler J. Christopher , Oldham John M.
Published: August 2022

Since the beginning of theorizing about personality disorders (PDs), social factors have figured centrally into models of pathogenesis. The relative emphasis on social factors has changed over the years in response to a growing appreciation of genetic contributions to personality pathology. However, factors such as abuse, neglect, disturbed parental involvement, burden of stress, socio-economic status, and peer victimization continue to receive support from longitudinal studies for their associations with PD development. This chapter reviews theories of PD pathogenesis, details current research on known social factors, and highlights social impairments linked with PDs. A brief review of social cognition research is offered to explain broader functional impairments associated with PDs. Finally, treatment and prevention efforts are highlighted to illustrate that these factors, traditionally researched within the social domain, often have favourable impacts on the course of illness.
Social psychiatry and addictions
Authors: Wanigaratne Shamil , Mitcheson Luke , Hill Robert
Published: August 2022

This chapter deals with the historical and contemporary aspects of addictions and its relationship with social psychiatry. It is argued that the biopsychosocial model, despite its utility, has not quite lived up to its promise and the tendency towards binary thinking has been less than helpful. It is also argued that a common vocabulary constructed in order to work with related disciplines such as community psychology is the best way of building a common understanding and approach towards mental health and addiction. Power and its manifestation through social deprivation, social exclusion, social drift, and stigma is discussed in the context of addiction, and a range of evidence-based socially orientated interventions are described. The current impetus on implementing a public health approach to dealing with addictions, and the potential for social psychiatry to play a greater role along with areas for future research are presented.
Late life disorders
Authors: Trinh Nhi-Ha T. , Wallace Bridget , Bernard-Negron Richard , Ahmed Iqbal ‘Ike’
Published: August 2022

The world’s ageing population is increasing in size and diversity, highlighting the need to understand how the intersection of ageing and minority identities impact disease prevalence and disparities in psychiatric care. This chapter explores how sociocultural background, as well as transnational factors such as immigration, affect the mental health of older adults. In addition, other sociocultural factors such as race, ethnicity, gender identities, socio-economic status, climate change, stigma, and social isolation play a significant role in the development of psychiatric conditions, clinical care, and research within the elderly population. While the prevalence of mental health disorders is on the rise for older adults, these sociocultural factors can disproportionately impact the prevalence of psychopathology and access to psychiatric treatment for older adults. In order to address these discrepancies, high-quality research and clinical training is necessary to create culturally competent interventions and psychiatric treatments that benefit all members of the ageing population.
Somatization
Authors: Mehta Urvakhsh Meherwan , Chaturvedi Santosh K.
Published: August 2022

Medically unexplained symptoms (MUS) are particularly common presentations in primary care settings. They lie on a severity spectrum, with significant overlaps with other functional somatic syndromes, psychiatric diagnoses like depression and anxiety, and general medical conditions. Typically, symptoms present with either no identifiable medical aetiology, or are disproportionate to the cause, with associated distress and preoccupations, health-related anxiety, and help-seeking behaviours. Cultural factors are known to shape shared mental representations about interpreting such symptom experiences and are therefore vital determinants of health and illness reporting. The nosology of MUS has been debated, deliberated, and transformed several times over the last century. Several models have been proposed to understand the pathogenesis of MUS based on the complex interaction of developmental, personality, cognitive–perceptual, cultural, and emotional processes within a bio-psycho-socio-cultural framework. Effective and sensitive communication of socio-culturally grounded and individualized illness formulations that link the individual’s belief systems, diagnosis, and treatment options are key to managing MUS. Medications are used to treat severe symptoms or comorbid psychiatric diagnoses. Psychotherapy that targets coping, help-seeking behaviours, and real-world functioning is also effective.
Social and cultural factors in perinatal mental health
Authors: Varma Deepthi Satheesa , Kukreti Prerna , Chandra Prabha S.
Published: August 2022

This chapter explores the social and cultural factors that contribute to the perinatal mental health of women in diverse settings. It also includes the various risk factors for poor perinatal mental health such as psychological and psychiatric risk factors, obstetric risk factors, and social risk factors, including intimate partner violence and trauma. How family, traditional practices during pregnancy and the postpartum period serve as a risk, as well as a protective factor, for women who experience perinatal or postpartum depression or anxiety is also discussed. Explanatory models to understand the impact of trauma on peripartum mental health and sociocultural determinants of help-seeking behaviours is also presented. The chapter concludes by discussing several prevention interventions that have been proven to be successful in improving perinatal mental health in women worldwide.
A contemporary view of suicide
Authors: de Leo Diego , Giannotti Andrea Vieccelli
Published: August 2022

The concept of intentionality is of fundamental importance when defining the act of suicide as it clearly distinguishes it from other ways of dying. Rates of suicide vary across different cultures and societies and age groups, as well as over time, and are strongly influenced by a number of social factors. Rates of suicide attempts are much higher and, again, are strongly affected by social factors. Economic factors play a major role in rates of suicide as do socio-economic factors and gender. Methods chosen for the act of suicide depend upon availability of means and vary across countries. Prevention of suicide is an important strategy and nations need to have policies for this. At an individual level, support and resilience can help reduce the likelihood of suicide.
Sexual diversity
Authors: Bagga Harjit , Kalra Gurvinder
Published: August 2022

Historically, diversity in human sexuality, such as same-sex attraction (or the older term, ‘homosexuality’), was steeped in psychopathology, but is now accepted as a healthy variation of the human experience. This chapter aims to explore this evolving area through a review of its history in psychiatry to present-day best practice suggestions for clinicians. Commonly used terminology in the field will be reviewed, and the current research to understand the aetiology, prevalence, and cultural factors associated with sexual diversity as worldwide phenomenon will be explored. Changes in diagnostic nomenclature and the underpinning influences in these processes will be discussed. Finally, commonly co-occurring mental health issues and current best practice guidelines to support this cohort clinically will be presented.
Intellectual disability
Authors: Jesu Amala Jovia Maria , Gangadharan Satheesh Kumar , Bhaumik Sabyasachi , Alexander Regi T.
Published: August 2022

Irrespective of geographical, cultural, and socio-economic variations, about 1–2% of the general population have an intellectual disability (ID). Although diagnostic labels of and societal outlook towards this group have changed over time, there are enduring challenges about how they are integrated into mainstream society. While the Western world today focuses on this social integration, low- and middle-income countries face more fundamental issues ranging from diagnostic recognition to the provision of the very basic of support around health and social care. People with ID have not only a high prevalence of physical and mental health problems but also a high rate of preventable deaths. Some of the key reasons for this are discussed in this chapter, along with potential ways of addressing this inequity. Given the shortage of specialist expertise and difficulties in accessing basic resources in some parts of the world, the approaches that have been successful have relied on empowering parents, up-skilling staff working in non-government organizations, and using community support workers. The primary focus of these initiatives is to deliver a model of care that is accessible to the community where people with ID live.
Public mental health
Authors: Campion Jonathan
Published: August 2022

Mental disorder and poor mental well-being result in broad impacts on physical health, risk behaviours such as smoking, self-harm and suicide, life expectancy, social functioning, education, employment, inequalities, and quality of life. Effective evidence based public mental health (PMH) interventions exist to treat mental disorder, prevent associated impacts, prevent mental disorder from arising, and promote mental well-being and resilience. However, even before the COVID-19 pandemic, only a minority of people with a mental disorder received any treatment, which is far less in low- and middle-income countries. Far fewer received interventions to address associated impacts, while there is negligible provision of interventions to prevent mental disorder, and promote mental well-being or resilience. This implementation failure has further widened since COVID-19 and results in broad impacts, associated economic costs, and population-scale suffering, and represents a systematic contravention of the right to health. There are various reasons for the implementation failure, which are important to address to improve population coverage. Coverage of effective PMH interventions at the population level can be improved in several ways, including by mental health needs assessment, PMH practice, PMH training, improved population knowledge about mental health, settings-based approaches, integrated approaches, use of the internet and phones, maximizing existing resources, particular interventions, application of relevant regulation and legislation, adopting a human rights approach, and research focused on improving implementation. This will result in broad impacts across health, education, employment, and social interaction, with associated economic returns, even in the short term. The economic cost of the PMH intervention implementation gap and economic benefits of PMH interventions also makes improved coverage a key part of sustainable economic development.
Social prescribing
Authors: Burn Wendy , Bhugra Dinesh
Published: August 2022

In many countries social prescribing has become of major interest in both primary and secondary care of patients with psychiatric disorders. Social prescribing is defined as referring patients with psychiatric illnesses to a range of local and largely non-clinical services. This chapter reviews the data from some countries where social prescribing is relatively better established. Using community link workers (also known as community navigators) patients are directed and supported to attend community organizations so that they receive informal and, if needed, formal help. A number of activities have been described and there is research evidence to support the usefulness of some of these. The evidence from different countries reflects specific approaches that can be helpful in improving engagement. Various models exist for social prescribing and have been described in literature. Research evidence indicates that, embedded in primary care, such approaches can reduce the number and duration of admissions.
Tele-mental health
Authors: Hariman Keith
Published: August 2022

In broad terms, tele-mental health is the delivery of psychiatric intervention from a distance. The modalities of delivery typically involve real-time videoconferencing or pre-recorded video, which will be the main discussion of this chapter. This technology has been gradually evolving over the past 50 years or so, and there has been research demonstrating its benefits in terms of clinical efficacy, cost-efficiency, and acceptability. This chapter will introduce the research on telepsychiatry, discuss special settings and population groups that might particularly benefit from telepsychiatry, and describe the training required. The challenges in its implementation, along with potential problems related to regulation and confidentiality, will also be detailed. The chapter concludes with a discussion on the impact of the COVID-19 pandemic on telepsychiatry, which may prove to be the tipping point needed for the more widespread adoption of the technology.
Psychopharmacology and social psychiatry
Authors: Werneke Ursula
Published: August 2022

The advent of modern psychopharmacology has shaped modern psychiatry like no other event. For the first time, it became possible to treat severe mental disorders effectively and at a scale. It also allowed mental disorders to be seen in a different light. There were repercussions for society as a whole. This chapter is about milestones in psychopharmacology and their impact on society. It will first look at psychiatry before the advent of psychopharmacology. Then, it will examine the social impact of psychopharmacology in five case studies. These case studies concern chlorpromazine, selective serotonin reuptake inhibitors, benzodiazepines, olanzapine, and amphetamines and other central stimulants. Finally, the chapter will give an outlook on future developments in psychopharmacology and their potential impact on society.
Leisure activities
Authors: Sukhanova Ekaterina
Published: August 2022

Using the theoretical framework of a semiotics approach to art production and perception, this chapter focuses on art as a type of leisure activity whose dialogical mechanisms make it a powerful tool in counteracting stigma, including self-stigmatization. Creative works by patients provide a key source of information in the diagnostic process. Furthermore, working with patient art aids the clinician in gaining a better understanding of the preserved aspects of a patient’s personality and establishes a stronger therapeutic alliance. At the community level, outsider art is a powerful tool in anti-stigma campaigns. Many medical schools are now incorporating the arts and humanities in holistically conceived medical curricula to enhance cultural competence and effective communication skills. Connecting spectators to meaning just as it connects the artists to collectivity, art fosters cooperative communication in which the dignity and individuality of a mental health patient may be reaffirmed.
Resilience, mental health, and migration
Authors: Raghavan Raghu , Brown Brian , Coope Jonathan , Sivakami Muthusamy
Published: August 2022

This chapter will explore mental health and resilience in the context of migration. The notion of resilience has received increasing attention recently as a way of making sense of how people cope with adverse events and hardship, and as a possible protective variable that makes mental health difficulties less likely. At a time when health care providers and policymakers are attempting to come to terms with the high levels of inter- and intranational movement of people in the early twenty-first century, it is appropriate to consider what resilience offers as a way of making sense of the psychological and psychiatric issues raised by migration and what it means for health care providers and migrants themselves. This chapter will therefore review the literature that has addressed resilience and migration, with a focus on low- and middle-income countries. We describe the life experiences and resilience of internal migrant communities in low-income neighbourhoods in India, and the insights on resilience and migration in responding to the mental health needs of individuals and families who have migrated. In addition to different ‘idioms of distress’ it is proposed that it is important to be attentive to the different ‘eudaemonic idioms’ through which different cultural groups express the factors that are significant to them in maintaining happiness and promoting coping.
Integrative community therapy
Authors: Barreto Adalberto , Camarotti Henriqueta , Hugon Nicole
Published: August 2022

Integrative community therapy (ICT) emerged from within a Favela in Fortaleza, inside the ‘4 Varas’ project, as a response to the suffering of a displaced population experiencing extreme precariousness and poor mental health. Thus, a methodology for group facilitation was born, structured by rules and a stable sequence of steps. From these local roots, ICT has adapted to a variety of contexts around the world. The authors describe the principles, objectives, and development of ICT, including how it achieves its goals and helping to develop sound self-esteem, rebuilding damaged social bonds, and restoring cultural values. It acts as a resilience space for both individuals and community. The latest developments in ICT research are discussed. The studies confirm that ICT is relevant in primary care, prevention, and rehabilitation, and physical and mental health promotion. It improves the relationships between the population and professionals. Urgent public policy action is required that considers specific medical and psychosocial intervention which will improve public and population health.
Deinstitutionalization in the UK
Authors: Craig Tom J. , McCarthy Jane
Published: August 2022

This chapter describes the evolution of deinstitutionalization and community care in the UK for adults suffering from severe mental illness and intellectual disability. Deinstitutionalization was driven by awareness that the impersonal, regimented care in the hospital asylums was as disabling as the disorders they sought to contain. It was encouraged by psychiatric optimism in light of new pharmacological and psychosocial treatments which showed that most patients could be safely managed in the community and so maintain or regain social, occupational, and leisure function. Overall, this has been a successful enterprise with improvements in quality of life and personal satisfaction for many. But it is not a cheaper alternative to hospital care, and services still struggle with the balance between encouraging independence and managing risk. Institutions still exist and, indeed have been growing, for forensic services and in the non-statutory sector.
Mental health legislation and social rights
Authors: Kelly Brendan D.
Published: August 2022

Mental illness is commonly associated with denial of social rights, despite the advent of ‘community care’ in many countries. There are several potential ways to address these issues: political activism to build more just societies; expansion of social support to reach those most in need; reform of mental health services to ensure minimum standards of care; and revision of mental health legislation to accord with international standards such as the United Nations’ Convention on the Rights of Persons with Disabilities. India’s new mental health legislation, the Mental Healthcare Act, 2017, was commenced on 29 May 2018 and is the first piece of major mental health law that seeks explicitly to comply with the Convention. The legislation includes both specific provisions relating to delivery of mental health care and broader provisions centred on a range of rights, including social rights. Most significantly, the 2017 Act provides a legally binding right to mental health care to the entire population of India, which includes 1.3 billion people or one-sixth of Earth’s population. Other key social rights in the legislation relate to housing, community living, and ‘a right to live with dignity’. The extent to which this ambitious legislation will succeed in protecting and promoting the social rights of the mentally ill has yet to be seen. Clearly, adequate resources and training of more mental health professionals are both essential if social rights and social inclusion are to become realities for the mentally ill and their families in India and around the world.
Mental health care in Eastern Europe and the Balkans
Authors: Lecic-Tosevski Dusica , Milosavljevic Maja
Published: August 2022

Eastern European and the Balkan countries have historical geographical, political, and economical specificities. Health care systems, including mental health care, in these countries is going through significant transition, which began after the fall of the Iron Curtain in 1989. Deinstitutionalization, trans-institutionalization, and destigmatization, accompanied by community mental health care, are the main characteristics of this transition. The introduction of health policies with national strategies, an insufficient portion of gross domestic product allocated to health systems, and privatization have marked the period. Advantages of the mental health care systems of the countries of this region are the well-developed mental health services in primary health care, open access for patients, a large number of well-educated mental health professionals, and an individualized psychosocial approach in treatment. The main challenge for health care systems in Eastern European and Balkan countries is to find a way to bridge development policies, national strategies, funds supporting mental health care, and the development of community care.
Psychological treatments in low- and middle-income countries
Authors: Fernández Diego Asturias , Poulter Daniel , Gnanapragasam Sam N.
Published: August 2022

Major barriers and challenges exist that prevent the provision of psychological treatments in low- and middle-income countries (LMICs). A shortage of resources often means that focus shifts towards pharmacological treatments. Psychological treatments are not easily available or accessible. Cultural differences in the perception of mental illness and of psychological treatments also play a role. The evidence for treatments invariably emerges from high-income countries (HICs), thereby adding to the challenges of determining the applicability of ego-based treatments. The mental health gap remains very high around the world, and is even more so in LMICs. This chapter examines the current evidence related to the availability, access, and effectiveness of different psychological interventions across LMICs. Psychological treatments and approaches are considered a mainstay of mental health treatment in HICs. However, there is emerging interest in psychological treatment modalities and approaches in LMICs. This chapter explores the current evidence in LMICs related to different schools of psychological interventions such as psychodynamic therapy, cognitive behavioural therapy, behavioural therapy, interpersonal therapy and religious/shamanistic therapies. It also considers the related facilitators and barriers to availability, access and efficacy, including consideration of cultural context.
Mental health in the Middle East
Authors: Okasha Tarek
Published: August 2022

Psychiatry is the branch of medicine that most prominently incorporates the humanities and social sciences in its scientific base and in its treatment of illness. It also attempts to explain the full range of human behaviour, including behaviour associated with mental illness. Psychiatry has often needed to go well beyond the world of natural science into the philosophical realm. Mental health providers in developed countries are increasingly treating patients whose backgrounds are much different from their own, so it is important for them to understand cultural belief systems, including religious thought and practice, and social norms within the society that relate to mental health and illness. The understanding and interpretation of many psychiatric symptomatology by both patients and their relatives can depend greatly on their upbringing, education, and society.