Community psychiatry in developing countries – a misnomer?

Abstract

There has been a rush towards community psychiatry in the developed world in the past few decades (Tyrer, 1998a). In developing countries the concept has been equally popular and various programmes have been described (Burns, 1998; Goldberg, 1992; Issac, 1996). The term ‘community psychiatry’ originates from a peculiar historical background, is based on certain principles and is shaped by the existing pattern of mental health services in many Western countries. Although the term is vague, its application is especially problematic in developing countries. In this article an attempt will be made to highlight the origins of the term community psychiatry and its application in developing countries.

Conceptual Models of Depression in Primary Care Patients

“…Culture, social class, and ethnicity make a major difference along the pathway to depression care, influencing diagnosis, treatments prescribed, and treatment utilization. Depressed individuals from White, middle class backgrounds are more likely than working class and ethnic minorities to be treated for depression (Bristow & Patten, 2002; Gillam, Jarman, White, & Law, 1989; Farooq & Minhas, 2001). While problems of access to treatment play a role, evidence to date suggests that these disparities in rates of treatment may also be related to differences in attitudes and preferences regarding treatment (Burroughs et al, 2006; Givens et al, 2006; Sleath et al, 2005).…”

Reasons for consultation in the psychiatric out-patient clinic of a university teaching hospital in Nigeria: is this optimal use of psychiatrists' time and expertise?

“…Policy-makers must be made aware of the inefficiencies in clinic service provision so that the meagre funds available for health care services can be utilised optimally. Farooq & Minhas (2001) have stressed that community psychiatry as practised in the developed world context is not the answer to the mental health problem in developing countries but 'primary care psychiatry' is, as proposed by the World Health Organization (1975). In several developing countries there are small pockets of models integrating mental health into primary health care but these models are never implemented on a national scale.…”

The multiplier role of psychiatrists in low income settings

“…This necessitates conceptualising, directing and conducting mental health research as well as dissemination of research output, in which psychiatrists are expected to play a crucial role as well (Farooq & Minhas, 2001). Further, as part of capacity building and mentoring, psychiatrists must inculcate a research oriented approach/culture at all levels of service delivery; sharing out challenges, solutions and new discoveries.…”

“…The psychiatrist will for the foreseeable future remain an expert clinician for service delivery both at primary and tertiary levels, with key roles of clinical assessment, diagnosing and treating persons with mental illness; training fellow mental health professionals as well as developing and disseminating guidelines for fellow professionals (Farooq & Minhas, 2001;Patel, 2009). This should be in addition to other key roles with multiplier effects such as influencing resource mobilisation, generating demand for service utilisation and contributing to the provision of an enabling professional environment for scaling up mental health services.…”