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Do we really need more psychiatrists or psychologists?

By Professor Catherine Campbell of LSE's Department of Social Psychology

There is growing reference to an increasing epidemic of mental illness worldwide. Some argue that as many as 1 in 4 people in the UK suffer from mental ill health. Experts recently argued for the need for 10 000 more clincial psychologists to offer cognitive behavioural therapy to Britain's 'clinically' depressed and anxious.

Throwing the net more widely, claims have more recently been made about rocketing levels of mental illness across the globe. Under the banner of the Movement for Global Mental health, a group of psychiatrists and mental health professionals are drawing attention to what they call the mental health 'treatment gap' in low and middle income countries and calling for an extension of psychological and psychiatric treatment services worldwide.

Does the world we really need more psychiatrists? Can psychiatry or individual psychology really advance mental health in settings where emotional distress is caused by factors such as poverty, conflict and gender inequality? Is this drive to diagnose the emotional damage caused by social inequalities and conflict as 'individual illness' an intervention with genuine potential to reduce suffering? Or does it simply serve to mask the health-damaging effects of social inequalities and economic stress, drawing attention away for the need for radical economic and social change, and opening up markets for western health services and pharmaceutical drugs?

These issues are central to a special edition of Transcultural Psychiatry co-edited by Professor Catherine Campbell and Rochelle Burgess of the Health, Community and Development Group at the LSE's Department of Social Psychology: http://tps.sagepub.com/content/49/3-4/379.abstract|

Pulling in a range of local and international contributors, the special issue questions the growing tendency to medicalise peoples' responses to life problems such as unemployment or social displacement after conflict. Contributors argue that labelling normal distress as illness may unintentionally send out an unhelpful message to distressed individuals that they are personally at fault (due to individual weakness) rather than victims of unbearably difficult social settings, undermining the likelihood that affected people will work together to tackle the negative social circumstances that place their health at risk.

So-called 'humanitarian' mental health interventions are often driven by political interests rather than a genuine and long-lasting commitment to social reconstruction. In non-western settings, imposition of western psychiatric categories and treatment modalities in every different cultures - in the absence of involvement of affected communities in helping to define how best to define and respond to mental distress - may have the unintended consequence of disempowering local support structures, and undermining non-western understandings of how best to understand and support the mentally ill.

The special issue argues that recognition of the limitations of western psychiatric understandings of mental illness, as well as workign closely with affected communities, is vital if the Global Movement is to achieve its aims of improved global mental health. Psychiatry and psychology may sometimes be blunt tools in the face of complex social realities.

Posted 26 November