Controversy has surrounded the latest publication of the Diagnostic and Statistical Manual (DSM) of mental health disorders, in part because of concerns that the guideline pathologizes many behaviors that some people might consider normal, theoretically increasing the opportunity to prescribe pharmaceuticals for non-pathological behavior. But beyond the field of psychiatry, there are increasing concerns that “medicalization” may be doing more harm than good for patients (especially where tests and therapies have marginal benefit but potentially great risks), and may be influenced by profit motives and desires to define disease so expansively as to intrude on normal living to a stifling degree. A recent comprehensive study of medical panels’ decisions about expanding disease definitions shed some light on this debate, and revealed some concerning findings… In 2009, the Institute of Medicine published a landmark report entitled “Conflict of interest in medical research, education, and practice”. In the report, the IOM found “widespread relationships with industry have created significant risks that individual and institutional financial interests may unduly influence professionals’ judgments” in medicine. Subsequent recommendations from the IOM revealed that a major area of concern was the writing of medical guidelines that physicians around the country (and, indeed, around the world) typically use to decide when to screen patients for diseases, how to define a disease, and when and how to treat such diseases.
Image Credit: Marcie Casas, Flickr At the launch of the Turning the World Upside Down website earlier this year Paul Farmer, from Harvard University, spoke of the ‘fetishisation of the quantifiable’ in global health. That is not to say the quantifiable outcomes are not important, but instead to highlight that there is a lot to learn from the experience of researchers, clinicians and policy makers beyond the measurable. This is a key motivation of PLOS Medicine’s Global Mental Health Practice series, which aims to emphasize the importance of “practice-based evidence,” by placing value on the experiences and impact of interventions in real-world settings as evidence for implementation. In this week’s PLOS Medicine we publish a new case study, as part of the series, by Oye Gureje from the University of Ibadan, Nigeria and colleagues who describe their experience of contextualizing and adapting the World Health Organization’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for Nigeria. The guide is designed to help scale up the coverage of mental health services in low resource settings by providing guidance for non-specialists to provide mental health services.
A new article in the current NEJM explores the burden of mental health and potential solutions for closing the gaps in treatment.
Dear colleagues, This week many of us were in Cape Town, to assist the Emerging Voices 2013 in making an impact on the 17th ICASA conference. They presented, tweeted (if the rather unreliable internet connection allowed it at the conference and in our hotel) and blogged, while networking their way through the conference. This IHP issue will have a special EV section on ICASA, with a number of blogs by EVs, and also the guest editorial of the week comes from an EV 2013. If you go through them, you’ll get a fairly good overview of the conference, the highlights, the gaps, key messages, etc. Check out also the hashtag of the conference, #icasa2013 and the Emerging Voices hashtag, #ev4gh.
10 December 2013 — MiNDbank, a new WHO database goes online today, presenting a wealth of information about mental health, substance abuse, disability, human rights and the different policies, strategies, laws and service standards being implemented in different countries. It also contains key international documents and information.
“December 10 marks Human Rights Day, which this year celebrates 20 years since the Vienna Declaration and Programme of Action — a reaffirmation of the global community’s commitment to human rights. It is also two decades since the U.N. General Assembly’s Declaration on the Elimination of Violence against Women,” a Lancet editorial states. “The anniversary…More
6 December 2013 — One month after Typhoon Haiyan hit the Philippines, WHO identifies as top priorities expanding essential health services, reviving clinics and hospitals, preventing disease and scaling up mental health services as the relief effort shifts from emergency to early recovery programmes.
“In recent years, growing interest and awareness has resulted in global mental health finally stepping out of the narrow field of psychiatry and beginning to occupy space in public health discourse,” Julia Beart, head of business development for the U.K. charity Basic Needs, and Shoba Raja, director of policy and practice for the charity, write…More
This week, London School of Economics and Yale graduate Pooja Yerramilli returns to explore the role and need for multidisciplinary approaches to global health and cancer research. It is no secret that over half of all cancer deaths in low and middle-income countries (LMICs) are preventable or avoidable. Primary and secondary prevention have long been advocated as cost-effective means for controlling cancer. And, as Kuguru, et. al
Dear Colleagues, We’ll keep the intro short this week as there is plenty of material, not the least because last week our newsletter was sent out on Thursday, before the weekly Lancet issue in other words which coincided with November 1st. This week the focus will, among other issues, be on the upcoming HRH Forum in Recife (including the special WHO Bulletin issue on HRH for UHC), the first translational medicine conference on HIV research “What will it take to achieve an AIDS-free world” in San Francisco, a two-day seminar in Barcelona on ‘Building a Global Health Social Contract for the 21st Century’ (we hope to offer you an editorial on this event next week), … There’s plenty of other news, though, for example on the first 5 thematic groups established by HS Global (see the new issue of their newsletter, which also contains news on the approval of the first strategic plan by the Board). No time for pontificating or populist slogans this week, in other words. We do however want to draw your attention to Tom Paulson’s sharp reflection on a new KFF survey on American public’s attitudes regarding global health and foreign aid.
“In many poor and developing countries, thousands of mentally ill people are warehoused in dirty and dangerous institutions,” freelance writer John Rudolf writes in a New York Times opinion piece. “Institutionalization is just one facet of the broader catastrophe of mental health care in the developing world,” he adds. “Government and humanitarian funding to treat…More
This is a joint post with Rachel Silverman, consultant and candidate for MPhil in Public Health at the University of Cambridge. On Halloween, children and adults alike pay tribute to history’s most frightening fictional characters – monsters, witches, super-villains, and the list goes on. But one need not search under beds or deep in closets for spooks and scares