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Midland Psychiatric Research Group UK Annual meeting
More civilized Nations look after their children,
elderly, disabled and poor well - Prof. Norman Sartorius
Decentralization taking place by passing on responsibility
without authority has done more harm than doing any good
De-civilization, De-centralization and new forms of corruption have made
the situation worse Today the Duty to live is being replaced by the Right to die

From our special correspondent

COVENTRY(UK): Prof. Norman Sartorius from Mental Health Division of World Health Organization, a world renowned authority on mental health was the guest speaker at the annual meeting of Midland Psychiatric Research Group UK held here from June 8-10th 2006. As usual it attracted a large number of mental healthcare professionals including a number of guest speakers who have contributed a great deal to the medical literature in the discipline of psychiatry. The inaugural session held on June 8th was jointly chaired by Prof. Pedro Ruiz President of American Psychiatric Association (APA) and Prof. Hamid Ghodse from UK. The theme of Prof. Norman Sartorius guest lecture was “The future of Psychiatric Care”.

Prof. Norman Sartorius, Dr. Afzal Javed and Prof. Hamid Ghodse speaking at the inaugural session of
Midland Psychiatric Research Group annual conference on June 8th 2006.

Speaking about the sources of influence on mental health care Prof. Norman Sartorius mentioned society, medicine, psychiatry and mental healthcare consumers. The trends of development in society, he said, include ideological imperialism, growth of gaps between countries and between groups within the country. De-civilization, De-centralization and new forms of corruption have made the situation worse. The ideal was to have more and more uniformity but it did not happen. Sudan which used to have thirty six psychiatrists today has only four left. Gap between rich and poor is growing and within groups is also growing. It is extremely harmful for psychiatry. Rich are becoming richer and the poor further poor. The amount of care to children, elderly, disabled and poor is extremely important. The more they are looked after, the more civilized that Nation is. Child mortality, he said, has gone up in USSR while mortality in other Russian states is also going up. The process of de-civilization is going on more and more. Decentralization is taking place by passing on responsibility and not authority which has harmed rather than bringing any benefit. New forms of non-visible corruption have been introduced and useful reforms are blocked, he added.

Talking about trends and developments in medicine Prof. Norman Sartorius said that health was now being considered as a commodity which he called “co-modification”. It means now health can be sold and bought. Duty is going in to the back ground. More money, he said, does not mean better health. We the mental healthcare professionals Prof. Norman Sartorius remarked are also guilty. We say does this you will save money though we should be saving lives. Brain drain, he said, has always happened but what is new that now rich countries send recruiting teams to developing third world countries. It is being done by the governments which will eventually result in epidemic of brain drain.

Eclecticism in selection of treatment

Now doctors rely too much on apparatuses. They are building empires. Use of more machines means more money for the doctors. Whenever a physician examines a patient, he tells them to wait till the machine will tell what is wrong with them. In the past we used to have mobile X-ray plants for screening of TB patients and other diseases. People can be self reliant. Educated intelligent people can give informed consent for any treatment or procedure but what about the poor who cannot rely on themselves. Under these circumstances the duty to live is being replaced by right to die. Striving for cure is giving way to learning how to live with the disease and impairment. Enhancing the quality of life and protecting patient’s rights have gained in proximity. Courts are giving decisions comparing mental pain with incurable cancer. Quality of life has become an important factor in medicine.

Trends affecting psychiatry

Globalization has lead to disruption of traditional strategies and family care is diminishing. If the best brain go out because of brain drain, it will be bad for the country. Economic, social and human capital of the country is all important. Globalization has lead to faster development of technology for science, healthcare and other purposes. Now there is recognition of human rights and better information about abuse of psychiatry. Then we have seen the emergence of many self help movements. Outsourcing of research is going on because conducting research is much economical in developing third world countries as compared to the West. Moral rules, ethical principles and legal provisions all Prof. Norman Sartorius opined should be interlinked. All our actions should be ethical, moral and legal.

Continuing Prof. Norman Sartorius said that attitude towards mental illness has not changed. Stigma is pervasive and mental patients, families, mental healthcare professionals and mental healthcare facilities all have to suffer. Stigma leads to severe discrimination. There is a change in attitude about mental illnesses but not in Behaviour which is also patchy and unstable.

He then referred to some new diseases which he described as dromopathies, iatrogenies and toxicopathies, HIV related problems, long lasting co-morbidities. He also talked about sub threshold status and disease produced by doctors, consequences of success of medicine. For example dementia due to AIDS will cost more than the total budget of Africa... Drug interactions are another serious problem. We also see old diseases in new grab like Schizophrenia and other psychoses in elderly. Mild cognitive disorders are an issue in more demanding world. If child is not doing better in school, people are quick to label him as mentally retarded. Developing countries are facing double burden of the disease. They have not yet controlled infectious and communicable diseases but also have to face the menace of non-communicable diseases. It is said that drug prices decrease after they have been in the market for some years but it is not so simple. With the discovery and availability of newer drugs which are much more expensive, the total cost of treatment goes up rather than showing any downward trend. While prices of old drugs come down, the new drugs are much more expensive. The concept of community care has changed as it is a different society since people do not know each other. Prof. Norman Sartorius was of the view that the concept of community care has to change with change in the society. The burn out syndrome is vicious in peripheral areas. It affects patients, families and healthcare personnel. This can introduce a vicious circle. Deterioration of services leads to corruption, poor reputation and discrimination. He concluded his presentation by stating that mental healthcare is gaining importance because of public health importance. We have better drugs, better care. The modes through which we apply are obsolete. The gap in service provision is growing. A reform of mental healthcare will be successful if it meets challenges of synthesize evidence and experience. We should strive to develop consensus among all stake holders behaving ethically meeting moral and legal requirements.

Responding to various questions Prof. Norman Sartorius said that the reasons for poor mental healthcare in developing countries is the attention to doctors doing something quickly, efficiently and competently managing difficult diseases. All this has alienated psychiatry. There is fear and uncertainty. One of the participants pointed out that the NICE guidelines do not exist in practice. What we say should be done but it is difficult. Doctors are also contributing to stigmatization of mental illnesses. Participating in the discussion Dr. Farrukh Hussain remarked that people are moving away from moral values and religion. Humanizing humanity is more important. We must improve cohesion in society which will be much better. The patients are and can be contributing. Those who are employed are not the only one who is contributing members of the society. Those who work at home are also contributing. But today having some employment is considered important. All people work and contribute. Stigma towards mental illness can diminish but we have to work hard.

Commenting on the presentation by Prof. Norman Sartorius Dr. Afzal Javed the man behind this regular academic activity of Midland Psychiatric Research Group remarked that it is the best talk from a professional who has done a lot strengthening mental healthcare all around the world. He has rightly highlighted the gap in developed and developing countries. Hence we all must give back to our countries whatever we can utilizing the resources we have.

Earlier welcoming the participants to the meeting and the guest speaker Dr. Asaf Khan another important member of the organizing committee said that this is our seventh annual meeting. It all started as a social get-together of a few but now it has become an important academic event in the Diary with excellent scientific programme every year. The guest speaker Prof. Norman Sartorius, Dr. Asaf Khan said has done so much for mental health in WHO that his contributions are praiseworthy. He is a mentor of many mental healthcare professionals all over the world. He is a man of high intellect, vision, thinker and the one who believes in serving the humanity. We are also delighted to have Prof. Pedro Ruiz President of American Psychiatric Association and Prof. Hamid Ghodse from UK, again both eminent names in the field of mental health and psychiatry, chairing this inaugural session. There are over fifty thousand psychiatrists in United States of which about thirty eight thousand are members of APA which are represented by Prof. Pedro Ruiz.

Scientific programme spread over the next two days included plenary talks and state of the art lectures from various guest speakers. Dr. Pierre Chue from Canada discussed the compliance and long term outcome in Schizophrenia while Prof. Mohan from UK highlighted the recent law changes and its implications for clinical practice. Prof. Pedro Ruiz President APA from United States talked about the role of migration and acculturation on mental health and mental illnesses while Dr. Hamish Mcallister Williams from UK spoke on Challenges in the management of depression. His other presentation was on understanding the relative toxicity of antidepressants. Evolving guidelines for the management of bip9lar disorders was discussed in the afternoon session. This was followed by an interesting interactive session on issues and priorities for psychiatric research in developing countries. It was jointly chaired by Prof. S. Sharma from India, Prof. Varma from USA, Prof. Swaran Singh from UK, Prof. I. A. K. Tareen from Pakistan and Prof. Marinas from Greece. The speakers included Prof. Russel De’Souza from Australia, Dr. Anbgelo Barbato from Italy, Prof. S. Sharma from India and Prof. V.K. Varma from USA and Prof Gittelman also from USA. On June 10th the concluding day there were two workshops ,one on Mental Health Act while the other was on Skill Management. Detailed reports of scientific sessions to follow.