A Critical Examination of the Movement toward Evidence-Based Mental Health Treatments in the US Department of Veterans Affairs (original) (raw)
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Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care
The Permanente Journal
Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. James Lake, MD, was a Staff Psychiatrist at the Oakland Medical Center in CA at the time this article was written, and is a founding member and former Chair of the American Psychiatric Association Caucus on Complementary and Alternative Medicine. He is the author of four books on integrative mental health care.
GLOBAL PSYCHIATRY, 2020
Introduction: The present is the future of the past, and the past of the future. This journal as well as this paper endeavour to document the lives and practices of psychiatrists and other mental health care professionals for the future mental health community and to help the clinicians of the future to understand the history and practice of psychiatry and mental health care in 2019/20. We, therefore, report the current days in the lives of psychiatrists and other mental health care professionals. Material and Methods: To obtain reports of days in the lives of psychiatrists and other mental health professionals, we published the request on eight occasions from May 2019 to May 2020. We invited the prospective respondents/participants to send a relevant report of their psychiatric practice in a day with a maximum word count of 750 words. Results: We received 20 reports of variable lengths from 10 countries from six continents, including from psychiatrists, psychiatrists in training, clinical psychologists and from medical students about their psychiatric training. The reports revealed a wide and highly variable range of psychiatric and mental health practices, experiences and expectations. Last but not least, the reports we received were informative and provided much information to reflect on. Conclusions: There is a common strong commitment to support patients with mental health problems, but the ways this is achieved are so diverse that generalisations about a typical common practice seem impossible. Future studies should focus more systematically on the procedures and practices applied in helping patients with mental health problems in different countries and communities. This knowledge might eventually help identify the procedures and services that are most efficient and helpful in various clinical contexts.
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Frontiers in public health, 2014
Although mental ill health constitutes a huge portion of the Global Burden of Disease (GBD), the majority of people with mental health problems do not receive any treatment, a scenario much worse in developing countries where mental health personnel are in gross short supply. The mhGAP was launched to address this gap, especially by training non-mental health professionals to deliver effective services for selected priority mental health problems. Especially in developing countries, many people with mental health problems consult traditional healers either as a first step in the pathway to biomedical mental health care or as the sole mental health service providers. Bridging the gap between mental health needs and available services in developing countries needs to incorporate traditional healers, who are ubiquitously available, easily accessible, and acceptable to the natives. Even though there are barriers in forging collaborations between traditional and biomedical mental health ...