Psychosis & Global Mental Health Roundtable
On Tuesday 11th June, the IoPPN hosted an impressive panel that comprised many of the leading figures in psychosis research worldwide, to debate the place of psychotic disorders in the global mental health agenda and the role of cross-cultural research in understanding psychosis. Speakers included Prof. Oye Gureje, Professor of Psychiatry at the University of Ibadan in Nigeria and a previous President of the African Association of Psychiatrists and Allied Professions; Dr. Thara, co-founder and vice chair of the Schizophrenia Research Foundation in India; Prof. Sir Graham Thornicroft, Professor of Community Psychiatry at the IoPPN; Dr. Alex Cohen, anthropologist and previous director of the Global Mental Health programme at the Centre for Global Mental Health; Prof. Diana Rose, user-led researcher at the IoPPN and service user/survivor; Prof. Gerard Hutchinson, Head of Psychiatry at the University of the West Indies in Trinidad; Prof. Jonathan Burns, Professor of Psychiatry at the University of Exeter and previously University of KwaZulu-Natal in South Africa; and Dr. Ursula Read, occupational therapist and researcher in the department of Global Health and Social Medicine at KCL. Prof. Ricardo Araya of the Centre for Global Mental Health chaired the discussions, while Prof. Martin Prince synthesised the debate in his closing remarks.
There was a lively spirit of debate, covering topics such as whether the field of global mental health should place greater emphasis on psychosis as compared to common mental disorders (e.g. depression), human rights protections for people with psychotic illnesses, the role of traditional healers, public health approaches to psychosis, the role of social context in shaping people’s risk of psychosis and interpretations of these experiences, the mortality gap for people living with psychotic disorders, and whether outcomes for psychosis really are better in low- and middle-income countries. While there were plenty of differences of opinion, a few key themes that emerged were:
(a) There are huge geographic inequalities in psychosis research, and better data is needed from settings beyond North America/Europe/Australasia
(b) Promoting and protecting human rights should be central to efforts to improve mental health in low-(and high!) resource settings
(c) Antipsychotic medication can have great benefits for some people, but is not enough without wider social support
(d) Understanding the social context within which psychosis is experienced is essential and often neglected, requiring inter-disciplinary research and collaboration with service users
(e) We need to work with and learn from traditional/faith healers in settings where these provide most care for people with psychosis, to enhance the quality and dignity of services that people receive for both their mental and physical health
(f) High mortality of people with psychosis – whether due to medication side-effects or discrimination in health services – requires urgent attention
(g) Dividing the world into two categories (high-income and low- and middle-income countries) tells us little about the specific factors that explain variation in psychosis risk and the course of illness. We need to research the social, economic, cultural and health systems factors that improve or worsen psychotic symptoms, in order to develop public health strategies and build mentally healthy communities
Several of the panellists are currently collaborating on an international research programme called INTREPID II, which aims to generate comparable data on psychosis in India, Nigeria and Trinidad. You can read more about this programme here: www.intrepidresearch.org.