Chronic pain is the leading cause of years lived with disability globally. Populations in low- and middle-income countries bear a disproportionate burden of chronic pain because of greater exposure to road injuries, interpersonal and political violence, unregulated manual labor and limited access to healthcare. Lessons from the field of global mental health can provide a foundation to begin tackling the global burden of pain. These lessons include the use of task-sharing of front-line psychosocial care to non-specialized health workers; a transdiagnostic approach; use of syndemic models incorporating social determinants and co-morbidities; incorporating cultural idioms of distress, the symbolic meaning of pain, and traditional healing practices; and a person-centered approach emphasizing the embedded nature of an individual in her/his family, context and culture. The implications of this evidence for chronic pain management are manifold, for example: using transdiagnostic psychosocial interventions delivered by non-specialist, non-physician health workers as the first step; personalized medicine approaches based on good practice principles of chronic disease management; and concurrently addressing the social determinants often associated with pain syndromes. Taken together, these principles should be used to design intervention platforms that can address the burden of chronic pain, while reducing risks of over-utilization of opioid medications, globally.

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Addressing mental health needs of 100,000 ethnic Nepali Bhutanese refugees relocated from Nepal is a new challenge for mental health clinicians in the receiving countries. A limitation of current services is the lack of knowledge about cultural understandings of mental health. Ethnopsychology is the study of emotions, suffering, the self, and social relationships from a cultural perspective. Nepali ethnopsychology can be used to develop and adapt mental health interventions for refugees. We discuss applying ethnopsychology to provide safe and effective mental healthcare for Bhutanese refugees, including cultural adaptation of cognitive behavior therapy, interpersonal therapy, and dialectical behavior therapy. Psychological interventions are proposed for the high rates of suicide among Bhutanese refugees. The contribution of ethnopsychology to applied anthropology and the growing field of neuroanthropology are discussed.

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The COVID‐19 pandemic has transformed healthcare for both clinicians and patients. This conceptual article uses ideas from the moral distress literature to understand the challenges MedFTs and physicians face during the COVID‐19 pandemic. The authors highlight earlier themes from the moral distress literature and share current reflections to illustrate similar challenges. Some clinicians who were already experiencing a rise in burnout due to the mass digitization of healthcare are now facing increased moral distress due to ethical dilemmas, pervasive uncertainty, boundary ambiguity, isolation, and burnout brought about by emerging COVID‐19 policies. Fears about personal safety, exposing loved ones, financial concerns, self‐doubt, and frustrations with telehealth have contributed to increased moral distress during the COVID‐19 pandemic. Building resilience by setting one's personal moral compass can help clinicians avoid the pitfalls of moral distress. Five steps for developing resilience and implications for guiding trainees in developing resilience are discussed.

This study describes the effects of a psychoeducational multiple-family group program for families of people with severe mental illness in post-war Kosovo that was developed by a Kosovar-American professional collaborative. The subjects were 30 families of people with severe mental illnesses living in two cities in Kosovo. All subjects participated in multiple-family groups and received family home visits. The program documented medication compliance, number of psychiatric hospitalizations, family mental health services use, and several other characteristics, for the year prior to the groups and the first year of the groups. The families attended an average of 5.5 (out of 7) groups, and 93% of these families attended four or more meetings. The uncontrolled pre- to post-intervention comparison demonstrated decreases in medication non-compliance and hospitalizations, and increases in family mental health service use. The program provided training for mental health professionals, led to policy change in the Ministry of Health, and resulted in dissemination to other community mental health centers. This study provides preliminary evidence that a collaboratively designed and implemented psychoeducational, multiple-family program is a feasible and beneficial intervention for families of people with severe mental illness in impoverished post-war settings.

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Psychiatric education is confronted with three barriers to managing stigma associated with mental health treatment. First, there are limited evidence-based practices for stigma reduction, and interventions to deal with stigma against mental health care providers are especially lacking. Second, there is a scarcity of training models for mental health professionals on how to reduce stigma in clinical services. Third, there is a lack of conceptual models for neuroscience approaches to stigma reduction, which are a requirement for high-tier competency in the ACGME Milestones for Psychiatry. The George Washington University (GWU) psychiatry residency program has developed an eight-week course on managing stigma that is based on social psychology and social neuroscience research. The course draws upon social neuroscience research demonstrating that stigma is a normal function of normal brains resulting from evolutionary processes in human group behavior. Based on these processes, stigma can be categorized according to different threats that include peril stigma, disruption stigma, empathy fatigue, moral stigma, and courtesy stigma. Grounded in social neuroscience mechanisms, residents are taught to develop interventions to manage stigma. Case examples illustrate application to common clinical challenges: (1) helping patients anticipate and manage stigma encountered in the family, community, or workplace; (2) ameliorating internalized stigma among patients; (3) conducting effective treatment from a stigmatized position due to prejudice from medical colleagues or patients’ family members; and (4) facilitating patient treatment plans when stigma precludes engagement with mental health professionals. This curriculum addresses the need for educating trainees to manage stigma in clinical settings. Future studies are needed to evaluate changes in clinical practices and patient outcomes as a result of social neuroscience-based training on managing stigma.