Psychiatrists as social engineers: a study of an anti-stigma campaign

Anti-stigma campaigns in the field of mental health appeared in a variety of countries and organizations during the 1990s. This paper examines one of these--the 'Changing Minds' Campaign of the Royal College of Psychiatrists in Britain. The paper aims to elucidate the role the campaign played in the professional project of psychiatry and situate it in a wider context of both sociology and changes in mental health policy. The interest work involved is set in the context of the long-standing controversies surrounding psychiatric theory and practice, as well as the network of other agencies and actors seeking improvements in the citizenship of people with mental health problems in a post-institutional world.     

International overview of psychiatric reform

There has been an increased incidence of mental health problems around the world while psychiatry is experiencing a crisis that concerns its own identity and the definition of the scope of its work. After more than half a century of deinstitutionalized community policies, neoliberal globalization is leading to changes that undermine public attention on mental health, particularly of the disorders that require greater social attention. There have been changes in the responsibility of the state and changes in the type of demand and in the way of understanding disease and its treatment. At the time, compared to the medicalization of society that mediates the expression of needs in health, user movements are beginning to emerge demanding autonomy, full citizenship, empowerment, recovery and advocacy.     

Community mental health: A review

Community mental health is the public health aspect of the mental health field. It is inhabited by a variety of mental health professionals in addition to psychiatrists; but it is inhabited also by social scientists, economists, politicians, social reformers, ex-patients and their families, and ordinary citizens. It needs to be differentiated from community psychiatry (which is the kind of psychiatry practiced by social system-oriented psychiatrists) and social psychiatry (which is really an interdiscipline in academia, comprising social scientists and psychiatrists who are concerned with understanding the ways in which behavioral science data illuminate human behavior, ordered and disordered). Community mental health has developed in full form largely in the past two decades, although its roots go far back in history beyond our own era. The particular themes which are intertwined in the matrix of community mental health are: (1) moral treatment, the focus on humane and humanistic approaches to the mentally disordered, and protection of their rights as citizens; (2) prevention of illness or of its consequences, the preventive medicine of psychiatry; (3) new developments and improvements in the techniques of clinical services in mental health care; and (4) The social concept of the right to health care, as it pertains to mental health programs and needs. The process by which these themes have been interwoven is one which has gone on at both federal and state-local levels, but the more enduring and significant process is that at the state-local level, as most extensively exemplified in the California system.     

精神卫生的先驱:菲利普·皮内尔

菲利普·皮内尔（Philippe Pinel,1745-1826）是法国著名的医生,杰出的精神卫生领袖。在启蒙运动思想的启发下,他对法国与日俱增的精神病人采取"道德疗法",率先以人道主义关怀理念科学、有效地缓解了精神疾病现状,解放了精神病人,打开了精神卫生的大门。通过实地观察和缜密的统计分析,他对精神疾病进行了较为全面的科学分类,为识别、治疗和预防精神疾病病人指引了方向,奠定了理论与实践基础。他诸多精神卫生领域的成果一直沿用至今,被后人誉为现代精神医学之父。     

A 'crisis' of closure and openness: the present state of the Swedish mental health system in the light of a policy of sectorisation

The Swedish mental health system has undergone rapid, if uneven change, since the early 1970s. Following a policy of sectorisation and mental hospital closure, there has emerged a new and more 'open' psychiatry. The expansion of community services has particularly benefited psychologists, while it has produced clashes of perspective as to the orientation of services. This paper explores the nature of these changes and the conflicts between psychiatry and psychology, and it points to the consequences of sectorisation for long term users of services.     

Clinical management special: mental health. Lost in liaison

Liaison psychiatry offers valuable support to general hospital patients, but remains an underdeveloped service. Although there is no mention of liaison psychiatry in the mental health national service framework, other NSFs emphasise the need for medical patients to have access to such services. Barriers to development are the lack of understanding of the service and funding issues arising from services falling between mental health and acute trusts.     

When ants crawl around in the brain: challenges and facts in cultural psychiatry

Culture influences the experience, expression, course, evolution, prognosis, and treatment of mental disorders (as well as mental health policy) but has been neglected by general psychiatry, which has failed to integrate it appropriately into epidemiological research, clinical practice, and health policies. The main reason for this failure has been a lack of awareness concerning the "culture of psychiatry". This article aims to contribute to the theoretical debate in cultural psychiatry by reviewing studies on: (i) theoretical discussions and ethnographic studies of mental health services, (ii) cross-cultural comparative studies on psychiatric disorders, and (iii) the use of the cultural skills model with ethnic minorities and refugees.     

The production of the psychiatric subject: power, knowledge and Michel Foucault

Abstract   The issue of power has become increasingly important within psychiatry, psychotherapy and mental health nursing generally. This paper will suggest that the work of Michel Foucault, the French philosopher and historian, has much to contribute to the discussion about the nature, existence and exercise of power within contemporary mental health care. As well as examining his original and challenging account of power, Foucault's emphasis on the intimate relationship between power and knowledge will be explored within the context of psychiatry and mental health nursing. This is to say that the paper will investigate Foucault's account of how power and knowledge are central to the process by which human beings are 'made subjects' and therefore how 'psychiatric identities' are produced. In doing so, it will be suggested that Foucault's work can not only make a valuable contribution to contemporary discussions about power and knowledge, but can also provide a significant critique and reconceptualization of the theoretical foundations and associated diagnostic and therapeutic practices of psychiatry and mental health nursing.     

Unpromising configurations: Towards local historical geographies of psychiatry

This paper introduces a theme section comprising of three other papers, written from cross-disciplinary perspectives, exploring what might be termed ‘local historical geographies of psychiatry’, and in particular demonstrating how pioneering innovations in the treatment of mental health problems sometimes emerge from the most ‘unpromising’ of spaces and places. The introductory paper contextualises the studies that follow, laying out claims regarding the need to take seriously the thoroughly situated character of the knowledge and practices that are taken to comprise the ‘stuff’ of science, technology and medicine, and more specifically drawing out what such claims mean for an emerging ‘spatial turn’ in historical research on psychiatry and other mental health subjects. We focus on innovations which emerged where least expected, in ‘backwaters’ or even ‘deprived’ locations and institutions, thereby qualifying more conventional accounts of change in the field that prioritise centres of learning as the key sites from which developments arise and diffuse.     

Evaluating the role of gender inequalities and rights violations in women's mental health

This article examines the concept of women's mental health articulated as a human right in international documents and the current public health concern regarding the contribution of depressive and related anxiety disorders--which disproportionately affect women--to the global health burden. There is a growing awareness, supported by health research and accepted in recent international documents such as the Beijing Platform for Action, that gender inequalities and rights violations such as economic dependence, lack of decision-making power, conflicting gender roles, disproportionate domestic responsibilities, and violence are closely linked to mental health problems of women. The article argues that governments and international agencies, as well as women's health and rights advocates, must place more emphasis on women's mental health and its relationship to underlying gender discrimination and rights violations.     

Optimizing the Roles of School Mental Health Professionals

ABSTRACT: Each mental health discipline offers unique contributions to the development and operation of school-based mental health programs. The collaboration of professionals from different disciplines with each other, as well as with health and educational staff, is essential for service delivery in school settings. Conversely, interprofessional conflicts and turf issues can impede the development of effective school-based mental health programs. The authors, who represent counseling, nursing, psychiatry, psychology, and social work, discuss the roles and competencies of each profession in providing school-based mental health services. Training requirements within each discipline that relate to school mental health are described. Barriers to effective interdisciplinary collaboration, and methods of overcoming them, are delineated     

Does having an occupational mental health service make any difference?

BACKGROUND: The effects of mental disorder on UK's workforce are increasing, yet most occupational health (OH) providers have limited expertise in dealing with mental health issues. AIMS: To examine the effectiveness in terms of organizational and clinical outcomes, of an OH liaison psychiatry service in an inner city area. METHODS: A retrospective survey of case notes from the first 2 years of an OH liaison psychiatry service was carried out. RESULTS: Seventy-six cases were identified and 68% were seen within 1 month of referral. After assessment, females were significantly more likely to be given a formal psychiatric diagnosis than males. Overall, 45% of patients had mood disorders, 14% anxiety disorders and two cases of psychosis were identified. Advice was offered to the referring OH practitioner in 80% of cases. CONCLUSIONS: This study found that liaison psychiatrists were able to fulfil a useful role in an OH department. Most of the cases seen within the department would not be classed as serious mental illness and therefore it is unlikely that community mental health teams would become involved in their routine care. Specialist mental health support from an 'in house' service is likely to be of considerable benefit from both occupational and medical perspectives.     

Consumer citizenship: acting to minimise environmental health risks related to the food system

Public health practitioners interested in supporting consumers to make healthy, sustainable food choices need to understand consumer motivations to reduce food system risk. Increasingly food technologies that have enhanced access to food supply are being recognised as also impacting on the sustainability of the food system. This study explored the actions taken by Australian participants in response to their concerns about perceived food related threats to health and environment. Variance in willingness to act is analysed within the context of environmental and ecological citizenship, and a continuum describes the range of positions held. From the outset some participants self-identified as environmentally concerned and proactive, while others indicated a secondary interest in the environment. The catalyst for action for the majority was the priority of individual health and such self-interest can be a powerful motivator for change. Others related health to the environment and described efforts to minimise individual impact. Equally important for action to occur is being at a stage in life where other demands do not compete for the time and energy necessary to take citizenship actions. These results provide insight into the support that public health practitioners can offer to consumers who wish to make sustainable food choices.     

Digitising psychiatry? Sociotechnical expectations,performative nominalism and biomedical virtue in (digital) psychiatric praxis

Digital artefacts and infrastructures have been presented as ever more urgent and necessary for mental health research and practice. Telepsychiatry, mHealth, and now digital psychiatry have been promoted in this regard, among other endeavours. Smartphone apps have formed a particular focus of promissory statements regarding the improvement of epistemic and clinical work in psychiatry. This article contextualises and historicises some of these developments. In doing so, I show how purportedly novel fields have been constituted in part through practices of ‘performative nominalism’ (whereby articulations of a neologism in relation to established and recent developments participate in producing the referent of the new term). Central to this has been implicit and explicit extolment of what I term biomedical virtues in public‐facing and professionally orientated discourse. I document how emphases on various virtues have shifted with the attention of psychiatry to different digital modalities, culminating with knowledge‐production in mental health as one significant focus.     

A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps

People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20‐year mortality gap compared to the general population. This ‘scandal of premature mortality’ is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.     

Mental health: rebuilding knowledge in nursing

The insane asylum, in spite of being criticized, reformed or even denied, is still a predominant habit in taking care of people with mental disturbances. That habit has as its basic principle the isolation of the mental sick, contradicting all the possibilities of assistance centered in an ethical humanism. This essay tries to interpret the institutionalization of the asylum, psychiatry, mental sickness and also the process of psychiatry reform, searching to contribute to all the reflections about uninstitutionalization, nursing knowledge and practice in mental health.     

Ships of fools and vessels of the divine: Mental hospitals and madness,a case study

Rural Balinese conceive of madness as a phenomenon which gives men intimations of another reaility transcending the everyday world, and which reveals the possibility of more direct communication with the divine. European views of madness became gradually secularized over a period of several centuries, and were finally absorbed by the predominantly medical models of modern psychiatry. In Bali, this transformation is occurring within a much shorter time span, under different socioeconomic conditions. In this paper, I examine the ideas which traditional healers in Bali and their clients invoke about madness, and how these ideas are integrated with broader notions about health, human personality and the influence of the supernatural in worldly affairs. I then contrast traditional classifications and treatments of madness with the version of Western psychiatry currently practised in mental hospitals and out-patient clinics on the island. This section of the paper is based on the author's field study of mental health services in Bali, incorporating a survey of mental hospital inpatients and their families. I conclude with a discussion of the genesis, future development and possible effects of the increase in psychiatric facilities on the island.     

Mental health promotion: concepts and strategies for reaching the population

There have been many attempts to define mental health promotion. To date, there is no consensus in the field as to what it entails. While some understand it as a holistic concept including intervening at structural, societal and political levels to positively influence mental health, others conceptualise it basically as strategies with an individual focus to improve personal competencies. Many of these differences are related to the distinct understanding of the concepts of mental well‐being and positive mental health. The lack of clarity on the boundaries of mental health promotion has divided professionals and is a missed opportunity, as momentum is moving mental health promotion on to political agendas. In Europe, two important milestones for mental health, the WHO Ministerial Conference and the EC Green Paper on Mental Health, have moved mental health promotion into the political landscape, recognising positive mental health and mental well‐being as fundamental to the quality of life and productivity of Europeans and a contributor to sustainable development. Although proven efficacious, ad hoc implementation of mental health promotion programs alone is not sufficient to ensure improvement of the population's mental health. Co‐ordinated action that includes efficient ways to deliver such interventions in a sustainable way is essential. Two such delivery mechanisms in the search for efficiency are discussed in this paper: a) identifying co‐occurrence of mental and physical health problems in order to include mental health promotion components into existing health promotion interventions; and, b) supporting the inclusion of mental health indicators into sound public policy options in order to prove that efficacious policies in labour, education, environment, etc, also bring about positive mental health outcomes. To support the current interest to bring about positive mental health it is essential that evaluation of existing initiatives is put in place, as well as exploring more efficient ways for program delivery. Clearer concepts and understanding of mental health promotion's scope among practitioners would support the development of the field and the inclusion of mental health action across sectors.     

Gilles Deleuze: psychiatry, subjectivity, and the passive synthesis of time

Abstract  Although 'modern' mental health care comprises a variety of theoretical approaches and practices, the supposed identification of 'mental illness' can be understood as being made on the basis of a specific conception of subjectivity that is characteristic of 'modernity'. This is to say that any perceived 'deviation' from this characteristically 'modern self' is seen as a possible 'sign' of 'mental illness ', given a 'negative determination', and conceptualized in terms of a 'deficiency' or a 'lack'; accordingly, the 'ideal'therapeutic' aim of 'modern' mental health care can be understood as the 'rectification' of that 'deficiency' through a 're-instatement' of the 'modern self'. Although contemporary mental health care is increasingly becoming influenced by the so-called 'death' of the 'modern self', this paper will suggest that it is the work of the 20th century French philosopher, Gilles Deleuze, that is able to provide mental health care with a coherent determination of a ' post- modern self'. However, a Deleuzian account of subjectivity stands in stark contrast to 'modernity's' conception of subjectivity and, as such, this paper will attempt to show how this ' post- modern' subjectivity challenges many of the assumptions of 'modern' mental health care. Moreover, acknowledging the complexity and the perceived difficulty of Deleuze's work, this paper will provide an account of subjectivity that can be understood as 'Deleuzian' in its orientation, rather than 'Deleuze's theory of subjectivity', and therefore, this paper also seeks to stimulate further research and discussion of Deleuze's work on subjectivity, and how that work may be able to inform, and possibly even reform, the theoretical foundations and associated diagnostic and therapeutic practices of psychiatry, psychotherapy, and mental health nursing.     

The Role of “Evidence” in Recovery from Mental Illness

Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States’ mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mental illness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental health reform? This paper identifies four attempts, in the mental health literature, to delineate the role of “evidence” in recovery. One is the strong version of evidence-based practice—an applied science model—and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas’ work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships.