Community Protection versus Individual Healing: Two Traditions in Community Mental Health

This article identifies two major traditions that drive the mandate for a community mental health care system-community protection and individual healing. It discusses the historical antecedents of these two traditions and how these traditions relate to different visions of what the "common good" means. It then discusses how they both operate in the current US-based system, creating inherent conflicts and tensions, and gives specific examples from the personal and professional experiences of the authors. The article proposes ways to reduce the tension and discusses what sacrifices and compromises this resolution would entail for the US community mental health system. Copyright © 2017 John Wiley & Sons, Ltd.

[(Community) psychiatry, a parenthesis?]

Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive.

Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement's aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.

[Research in social psychiatry - addressing future challenges of health- and social systems]

Demographic change, limited financial resources and increasing social exclusion of individuals suffering chronic illness are major challenges for health and social systems in general and for psychiatry in particular. The paper analyses to what extent social psychiatric research currently addresses this challenges. Future perspectives are discussed, exploring the relationship of clinical neuroscience and social psychiatry.

[Does sociotherapy lose importance in scientific discourse?]

BACKGROUND

Sociotherapy is an approved method in the treatment of mental disorders. The present study aimed at evaluating the role of sociotherapy in a scientific journal during the last 20 years.

METHODS

A systematic analysis of all papers published in the "Psychiatrische Praxis" in the years 1985/1986, 1995/1996 and 2005/2006 was carried out.

RESULTS

During the last two decades the proportion of papers with sociotherapeutic topics has decreased significantly. 20 years ago one out of four articles dealt with sociotherapy, currently only one out of ten. In addition, the spectrum of themes is diminished, only the topics work rehabilitation and relatives are represented in the latest issues of the journal.

CONCLUSION

In contrast to its clinical value, sociotherapy has lost importance in psychiatric research. Multidisciplinary collaboration is required to enhance sociotherapy in mental health care research.

Barriers to recovery and recommendations for change: the Pennsylvania Consensus Conference on psychiatry's role

OBJECTIVE

Recovery has emerged over the past decade as a dominant theme in public mental health care.

METHODS

The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change.

RESULTS

Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice.

CONCLUSIONS

The recommendations identify areas for change that can be accomplished through individual psychiatrist action and organized group efforts.

Religion and spirituality in psychiatric care: looking back, looking ahead

Cultural psychiatry has been an important contributor to the enhanced dialogue between psychiatry and religion in the past couple of decades. During this time, religion and spirituality have become more prominent in mainstream psychiatry in a number of areas of study and clinical care, including refugee and immigrant health, trauma and loss, psychotherapy, collaboration with clergy, bioethics, and psychiatric research. In looking towards the future, there is a great deal of promise for future enhancement of the study of religion and spirituality in psychiatric education, research, and clinical care.

[Social psychiatry in the field of contrasting context between psychiatry and Social Medicine]

OBJECTIVE

There has been a discussion going on that Social Psychiatry has entered a state of crisis in terms of its socio-scientific roots. Little is known, however, about its relationship to Social Medicine. The question is whether Social Psychiatry, having grown apart from Sociology, has also lost its scientific relation to Social Medicine.

METHOD

A systematic literature analysis of all works published in "Psychiatrische Praxis" - PP and "Das Gesundheitswesen"--GHW in the years 2004/2005 was done. All works concerning Social Psychiatry were analysed. The same procedure was applied to all abstracts, posters and presentations for the annual meetings of the German Society of Social Medicine and Prevention (DGSMP).

RESULTS

10 % off all articles published in GHW and 97 % in PP address issues of Social Psychiatry. Apart from similarities in terms of their theoretical, practical and institutional background and the research methods applied, there are a number of differences.

CONCLUSIONS

Social Psychiatry has not lost its scientific relation to Social Medicine, however, the scientific cooperation between the two needs to be intensified.

Social psychiatry and public mental health: present situation and future objectives. Time for rethinking and renaissance?

OBJECTIVE

To describe the social psychiatric challenges of modern psychiatry in European societies in the light of recent psychiatric research evidence and to show how these challenges could be conceptualized.

METHOD

Reviewing aggregate morbidity and mortality data from the WHO European Health for All Database, and summarizing consultations and fact-finding missions to many European countries during the authors engagement as WHO Regional Advisor for Mental health from 1998 to 2004.

RESULTS

Societal change in Europe is leading to stress and mental ill health for its populations. The consequence is a dramatic increase in burden due to mental illness and stress-related morbidity and mortality.

CONCLUSION

A re-thought and re-conceptualized social and societal psychiatry with focus on public mental health must have a renaissance. Innovative efforts are of crucial and imperative importance seeing mental health in the light of recent experience and science as probably the most important public health issue.

[Social psychiatry and psychoanalysis - "immature, jostling and rivaling siblings"?]

AIM

We want to determine the influence of psychoanalysis on social psychiatry today and 30 years ago.

METHOD

Systematic analyses of all articles appearing in Psychiatrische Praxis in 1974, 1975, 2004, and 2005.

RESULTS

While almost one in five articles referred to psychoanalysis or Freud 30 years ago, currently this hardly occurs at all.

CONCLUSION

The social-scientific claims of psychoanalysis often heard in the 1970 s play no role in current social psychiatry. Psychoanalysis is also losing significance as a method of social psychiatric patient care.

[Quo vadis geropsychiatry? Perspectives for a new "state of the art"]

The number of older geropsychiatric patients is increasing dramatically. "The Big Three -- Dementia, Depression, Delusion" are challenging our care system. Today 80 % of those affected live at home, with 5-8 % receiving care in facilities. There is very little between. What is lacking: cross-facility co-ordination, co-operation, systems of reference with overall responsibility, ease of access, particularly of clarification and consulting services, mobility of psychical support, massive support for relatives, and specialised, graduated services for various areas of life and needs. A vision of an integrated supply of services is delineated, the intertwining of private, mobile and inpatient modules adumbrated. Simultaneously the problems with transitions, education and case conferences, specialists, conference of the supporters and quantity structure of services are addressed. Solutions are suggested and the solvability of this important socio-political problem of the next decades demonstrated.

A resident's experience in cross cultural/community psychiatry

This report examines a psychiatric resident's consultation experience in a community psychiatry rotation serving South Asian women victims of intimate partner violence. It explores experiences related to negotiating and developing a partnership between culturally specific domestic violence services and community mental health services. It also discusses the resident's progression from consultant to administrator and ultimately to the rotation's termination.

[Social psychiatry and schizophrenia--changes and perspectives]

There will be an enormous change for general as well as social psychiatry in the next decade. With regard to schizophrenia it is apparent that only innovative research strategies and practical care together may be able to improve the clinical outcome of these disabled persons in the long term. Definitely, a modern social psychiatry does need a better understanding of different aspects of schizophrenia, which includes comprehensive knowledge about its ethiological genetic- and cognitive-based hypotheses as well as awareness of modern drug strategies and effective rehabilitation programs. Alike health economic aspects will reform social psychiatry as its own concepts have to prove their efficacy not only from a therapeutical view but also with respect to its short-, middle- and long-term cost effectiveness.

[Integration of district psychiatric hospitals into the development of regional community psychiatry networks--the actual state. Results of a survey among medical directors of Bavarian district hospitals]

In this study, the medical directors of all Bavarian district psychiatric hospitals evaluated certain aspects of the integration of their hospitals into the development of regional community psychiatry networks ("Gemeindepsychiatrische Verbunde" - GPVs). They were asked to rate the actual quantity of cooperation between their hospitals and diverse community based services and to express their requests concerning the quality of cooperation. An estimation of possible advantages of the hospitals' integration in GPVs and expectations to future perspectives of GPV development were also investigated. The data were collected by a written questionnaire. The results of the survey indicate that a high relevance is attached to GPV: inspite of current heterogenous developments and inspite of existing skepticism concerning the feasibility of a complete GPV structure, medical directors strongly approve of seeing their hospitals actively engaged in the further development of community psychiatry networks.

[Social psychiatry without sociology. Analysis of a scientific journal]

AIM

Psychiatry and Sociology have followed separate avenues in Germany since the mid 1970 s. The aim of this work is to investigate their present relationship by means of an analysis of a scientific journal.

METHOD

All original works dealing with social psychiatric subjects and appearing in Psychiatrische Praxis in the years 2002 and 2003 were analysed.

RESULTS

Sociologists appear to be a minority among the authors. Questions that are explicitly related to sociological theories were an exception, and sociological authors have hardly been quoted.

CONCLUSION

Social psychiatric research in Germany is still conducted without Sociology. If social psychiatry is to gain in importance as a scientific discipline, closer cooperation with its mother discipline is imperative. As an example, the application of the rational choice theory in psychiatric research is discussed.

[The prelude to psychiatric reform in Brazil: the contradictions of the 1970s]

The article provides a historical reconstruction of the period leading up to what has become known as Brazil's Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazil's official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.