The recent series of Satander lectures on global mental health and cultural psychiatry held at the Wolfson Institute of Preventive Medicine, Queen Mary University of London, highlighted the synergies between cultural psychiatry and global movements to improve the mental health and wellbeing of all populations. Tackling inequalities, empowering local communities, and buiding services and resilience are essential, within an overall policy framework. The global part of this is the policy and perhaps a set of principles, but it is generally accepted that global imposition of service models may be going too far. The recent disquiet about DSM5 and the suggestion that it is not scientific or sufficiently grounded in neuorscience speaks to a different paradigm for improving mental health care around the world. Perhaps DSM5 over-emphases categories of illness rather than contexts, wellbeing and resilience. Yet DSM5 does include a cultural interview to guide local practitioners to take account of culture in assessment and encourages deliberations about appropriate intervention. This is more guidance than has been found in previous versions of DSM or in the ICD-10. The polarisation of the debate is inevitable where relevant points need to be simplified to foreground concerns that need further detailed unpacking. These concerns are partly theoretical and also reflect the poor history of scientific endeavour and global movements to not quash local strengths and opinions. Cultural psychiatrists have been grappling with these issues for over 50 years, they try to balance humane and personalised care, empower individuals and communities to promote resilience and self care, and manage diagnostic uncertainty whilst needing to provide an evidence-based approach to health care. In our local cultural consultation service (www.culturalconsultation.org) we have emphasised the need to consider identity, explantory models, and the relational and social aspects of care, including trust and multiple narratives, placing greater weight always on the narrative of the person seeking care or help. Derek Summerfield, gives further voice to these concerns in a BMJ article this week (http://www.bmj.com/content/346/bmj.f3509), offering a critical account of why global health movements are not to be accepted without question. Furthermore, the article includes challenges to the priority given to mental disorders in global efforts to tackle health and illness, especially through pharmacological remedies versus tackling the root causes, the social and moral traumas faced by people without influence, power, and resources. At the same time, in England, Duncan Selbie CEO of Public Health England, sets out the many example of good public health seen around the country, and he makes reference to the Global Burden of Disease study which indicates people are living longer but with disabilities including those related to emotional and mental disorders (http://phbulletin.dh.gov.uk/tag/duncan-selbie/). There is much work showing premature mortality of those suffering mental disorders, yet this research does not sit easily with the GBD findings, reasons for the apparent discrepancy are being deliberated by researchers and policy makers. Much work is yet to be done on public mental health, including developing a confident workforce that understands prevention is a priority and a workforce that can be active in building resilient and connected communities, the very assets that Summerfield fears might be damanged by global movements. These issues will be debated at the Royal College of Psychiatrists International Congress to be held in Edinburgh in July 2013. Much progress has been made in public mental health, but more needs to be done to ensure care practices and the cultures of care do not damage personal and community assets, cultural capital being one of those assets. Tackling inequalities, addressing parents health and wellbeing as a way of giving their children better chances of health and wellbeing in the life-course, investing in the early years at critical developmental points, tackling work stress and enabling people to work, reducing harms due to alcohol and drug misuse, and the prevention of dementia and improving the care of people with dementia to ensure dignity and quality of life are all priority areas. A fundamental concept within this work is that improving wellbeing in all people, whether receiving care or not, is essential to protect against illness but also to maxismie people’s life chances of health and happiness and living in safe communities. I have also put forward the idea that public health frameworks should include the prevention of violence, protection of women and children exposed to violene, and even the radicalistion of violent extremists ( http://www.biomedcentral.com/1741-7015/10/16). The recent tragedy in Woolwich has been met by communities resisting provocation and saying no to polarised and extremist responses, empowering Muslim and non-Muslim communities to see their shared interests, assets and humanity in resolving problems and facing tragedy. These issues will be discussed at a forthcoming meeting in Bologna (organised by ESTSS; http://www.estss-2013conference.eu/Default.aspx), in a symposium sponsored by the World Association of Cultural Psychiatry (http://www.waculturalpsy.org/) and Careif (www.careif.org). So the interplay of Global, Cultural and Preventive Psychiatry with Public Mental Health offers new insights and opportunities for improving health and wellbeing. Please join our Public Mental Health networks and help build a safer and healthier society.
Kamaldeep Bhui MD FRCpsych
Public Health Lead, Royal College of Psychiatrists
President World Association of Cultural Psychiatry & Director of CCS at QMUL
Trustee of Careif