Dinesh Bhugra

The right to mental health and parity

Byline: Dinesh. Bhugra, Jonathan. Campion, Antonio. Ventriglio, Sue. Bailey Introduction The prevalence of mental disorders is common, but although many policies and settings cover patients with psychoses, other psychiatric conditions are put to one side. Furthermore, the majority of people with common mental disorders (which include anxiety and depressive disorders), addictions, intellectual disabilities and co-morbidities receive no intervention ven in the best-resourced countries. Although mental disorders are defined by diagnostic criteria, social and value-laden personal constructs usually override these so that stigma, discrimination and ignorance result in a lack of access to evidence-based interventions to treat mental disorder, prevent mental disorder and promote mental health. In this paper, we highlight the need for both the policy makers and those who provide services to consider issues related to parity between resources allocated to physical and mental health. Right to Health Right to health incorporates civil, social and health dimensions. Regarding the right to health, the World Health Organization (WHO, 1946) constitution made it clear that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Governments have a responsibility for the health of their people, which can be fulfilled only by the provision of adequate health and social measures. [sup][1] The Universal Declaration of Human Rights (1948) also reads: Everyone has the right to a standard of living adequate for the health of himself and of their family, including food, clothing, housing and medical care and necessary social services. [sup][2] Subsequently, the Alma Alta declaration [sup][3] of 1978 reiterated the fundamental right to the enjoyment of the highest attainable standard of health and is widely recognized in many human rights declarations (International Convention on the Elimination of All Forms of Racial Discrimination: ICEAFRD, 1965; [sup][4] Convention on the Elimination of All Forms of Discrimination against Women: CEAFDAW, 1979; [sup][5] Convention on the Rights of the Child: CORC, 1989; [sup][6] European Social Charter, 1965; [sup][7] African Charter, 1981; [sup][8] American Convention, 1988 [sup][9] ). These charters and amendments are often used as the basis of the legal framework, but regrettably not all the time. The Universal Declaration of Human Rights has at its core three key aspects important to health care: *Preserve, extend and improve the life of the people in need based on equality (for treatment and cure irrespective of gender, race, language, religion and opinions and socioeconomic conditions) *Quality (high quality, up-to-date interventions) *Social responsibility (health and well-being of citizens as a well-funded priority and effective in health promotion and prevention of ill health). In looking at human rights based parity across all health - be it physical or mental or psychosomatic - policymakers must bear these three facets in mind. Hogerzeil in 2006 has pointed out that human rights are legally guaranteed by international, regional and national human rights laws through which individuals are protected especially against actions, which may interfere with human dignity and fundamental freedoms. [sup][10] The right to a disability-free life and to health is closely associated with the right to life, and these rights are indispensable for the exercise of most other human rights. Freedom from discrimination is at the core of all rights. Evolution of Rights It is important to acknowledge that these frameworks and associated changes take a considerable period to be implemented. Higgins in 2012 has highlighted that the recognition of rights at an international level gathered pace after the Nazi atrocities and mass migration after the Second World War. …

Social sciences and medical humanities: the new focus of psychiatry

The clinical practice of psychiatry should incorporate a biopsychosocial model of illness, acknowledging both cultural and social influences on the patient’s experience. Medical humanities include a number of academic disciplines that complement the clinical practice of psychiatry. The medical profession, including psychiatry, has a social responsibility to study the psychosocial context within which people become ill and have to be treated. Although the biopsychosocial model of illness has strong theoretical foundations, its application in clinical practice is limited. A new approach would be to restructure medical student teaching to include medical humanities in the first year, and to share such education with other professions.

Schizophrenia: Metabolic Consequences

People affected by schizophrenia and other severe mental illnesses show a reduced expectancy of life as compared with the general population because of a high rate of comorbidities (obesity, diabetes, hypertension, dyslipidemias, metabolic syndrome) and unhealthy lifestyles. In fact, the cardiometabolic risk is considered to be higher for people affected by schizophrenia with a two- to threefold increased risk of death mostly from cardiovascular and metabolic disease. Antipsychotic agents are an effective and necessary component of the management of such major severe mental illness. Although there may be an independent link between schizophrenia and metabolic conditions, there is a considerable literature regarding the metabolic adverse effects of antipsychotic agents, particularly for the second-generation antipsychotics. Over recent years, international organizations have developed screening and monitoring guidelines in order to reduce modifiable risk factors, comorbidity, and mortality rates among patients affected by schizophrenia and improve the outcome of illness, including patients functioning and quality of life.