With these questions, I attended the 4th National Conference of Psychiatrists’ Association Nepal held in Kathamndu on March 24-25, 2010. The theme of the conference was “Integration of Mental Health into Primary Healthcare.”
Since I started campaigning for media advocacy for mental health, it was my first experience in attending a psychiatrists’ program in Nepal. There was nothing new in what the participants talked about, but every word had serious meaning for the future of mental health. I think it is a most humiliating experience for mental health workers that they lament for change every year, they continue talking, get older, but change doesn’t come.
While writing this commentary, I have the “Souvenir” released in the conference, comprising 24 scientific papers, and a few poster presentations. These papers talk about the whole system of mental health: mental health policy, human rights, stigma, mental disorders, reports, and case studies. But no one knows, once the conference is over, who will bring these issues into wider social advocacy. On one hand, it creates the public impression that psychiatrists are everything for mental health, and on the other, it is counterproductive because it creates a loophole for civil society to ignore it as they have nothing to contribute to the promotion of mental health. I think this is a major failure of psychiatrists in engaging civil society in mental health.
No doubt, psychiatrists are the key actors in mental health. They deserve high respect. Unfortunately, they don’t get it. However, even with deeply rooted professional stigmas and low social values, they choose psychiatry with a singular goal to create a mentally healthy society. But I always wonder that rather than talking about their professional specifications and limitations, why do psychiatrists create confusion that they are everything to mental health? Though there is a strong need of the civil society’s partnership to prevent mental disorders, and to promote the human rights of mentally suffering community, and to develop accessible mental health services for all, why do psychiatrists still show resistance to publicly acknowledging the role of the civil society?
The theme the conference adopted is a central goal of mental health advocacy. To promote mental health, the integration of mental health into primary care is the first choice for us to close the huge treatment gap which remains at 60-90% in a low-resource country like Nepal. From human rights perspective, too, this goal is fundamental. But how do we do it? I believe we need to adopt a radical move to make this goal a reality for us. Here, I would like to propose some radical agendas for psychiatrists.
First, psychiatrists must rethink how mental health institutions work, because these are increasingly incapable of delivering effective solutions for contesting mental health issues. As many participants highlighted in the conference, psychiatrists should not be late to advance the understanding of mental health as a close ally of political consciousness that, in fact, can open many innovative avenues in general to empower the society mentally. I strongly urge for political innovation for mental health to establish itself into the mainstream public health agenda.
Second, psychiatrists must celebrate the diversity of mental health, and the roles to be played by diverse actors. I believe the Movement for Global Mental Health (http://www.globalmentalhealth.org/articles.php?id=120) provides the best available scientific solutions for this goal. The Movement’s 10-point advocacy agenda is the mantra for all who cover the area of human rights protection and promotion, scaling up mental health services and dealing with the scarcity of resources.
The 10 points are:
1. Mental healthcare with focus on community mental health services;
2. Building alliance between health and social sector services –education, justice, finance, urban alliance;
3. Building the capacity of mental health leaders, health professionals, and service users; 4. Making available essential medicines for primary healthcare;
5. Building the capacity of users and caregivers for effective self-advocacy;
6. Challenging violence and discrimination against people with mental disorders;
7. Inclusion;
8. Awareness;
9. Funds; and
10. Providing adequate budgets for mental health at national and local levels.
Integrating mental health service with primary healthcare centers (PHC) is one of WHO’s most fundamental healthcare recommendations. Because integrating mental health with PHC addresses many mental health challenges, including human rights protection, accessible and economic treatment, social inclusion, less stigma, and timely intervention. If psychiatrists can take radical moves in communicating their messages and engaging civil society as an equal partner in mental health promotion, we can achieve huge changes in mental health area soon.
Lamichhane is a global mental health activist. He can be contacted at <jagannathlc@gmail.com>
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