The Subtle yet Essential Paradigm Shift: From “Social Psychiatry” to “Public Mental Health”

This is the authors' abstract. We don't add key points for this paper.

It was in NCIASP, Bhubaneshwar, November 2019, where I was passed the baton and handed the responsibility of Editor-Indian Association for Social Psychiatry (IASP) (and the Indian Journal of Social Psychiatry; IndJSP) from my erstwhile predecessor, Dr. Debasish Basu. It was a monumental responsibility as alluded in my earlier editorial of 2020[1] and on retrospect, I had apparently “bitten off more than I could chew.” As had been quoted a long time back by Robert Burns (To a Mouse; Poem, November, 1785) “The best laid schemes of Mice and Men oft go awry, And leave us nothing but grief and pain, For promised joy.” The assumption of the responsibility as Editor of the IndJSP coincided with the onset of the COVID-19 pandemic along with its social and mental health ramifications. And that is where both the framework and pathway for IndJSP which had been conceptualised by me went off-track (i.e., best-laid plans went awry). The COVID-19 pandemic does not need much discussion as we all are aware about its association with mortality, and a significant impact on multiple physical morbidities. More importantly and pertinent for mental health professionals was the high degree of psychological and psychiatric morbidity. In fact, much more important and relevant were the various psychosocial ramifications; to exemplify social isolation, loneliness, stigma, and poor quality of life; amongst others. We as a human race have been continuously evolving over centuries and found ways of handling adversities, calamities, and disasters (natural or man-made). The management of the psychosocial impact and ramifications of the COVID-19 pandemic was no different and it led to the rapid advent and utilization of the digital technology for ensuring connectivity and connections between people across the world. Instead of interpersonal/social intercourse, social events, hugs, and kisses (including the simple phenomena of “touch”) as ways of “meetings and greetings,” people were introduced to digital connectivity (Zoom, Microsoft groups, GoMeet, and Google Meet) with an exponential usage of the same. There were undoubted benefits of digital technology, but it came with its own risks too; behavioural addiction being one such. The reader may be wondering as to why is all this relevant, and how is it connected, to the initial part of this editorial. For this, I will draw the attention to an excerpt from the policy of IndJSP: “The journal will cover technical and clinical studies related to health, ethical and social issues in field of social and community psychiatry and related areas. Articles with clinical interest and implications will be given preference.” In keeping with Journal policy, manuscripts being submitted to IndJSP were processed with the focus being on the field of social and community psychiatry. However, COVID-19 made us think differently and two special issues dedicated solely to COVID-19 were brought out in end-2020 and early 2021. Not only that, but an attempt was also made to focus on different themes namely behavioral addictions, community and rehabilitation psychiatry, student wellness and societal changes, and perinatal psychiatry over the years 2021–2023. The ideology behind these themes was to focus on areas and issues which though of relevance to the field of social psychiatry but were not entirely related to secondary prevention of mental illnesses (which has somehow tended to be the focus of most of us mental health professionals), and also were linked with COVID-19 in some aspect or the other. More on this later! The term “Public Mental Health (PMH)” has been around for a very long time,[2] but countries across the world have adopted it or started to give it due importance, at varying times due to various socio-political and professional reasons.[2,3] PMH is defined as a population approach to mental health and includes treatment of mental disorders, prevention of associated impacts, prevention of mental disorder, and promotion of mental well-being, including for those people recovering from mental disorder.[2,4] Hence, it is a holistic approach towards primary, secondary, and tertiary prevention of mental disorders.[3] The IASP has outlined the following purposes and objectives as per its constitution: (a) to study the nature of man and his cultures and the prevention and treatment of his vicissitudes and behavioral disorders, (b) to promote national and international collaboration among professionals and societies in fields related to social psychiatry, (c) to make the knowledge and practice of social psychiatry available to professionals in social psychiatry and other sciences and to the public by such methods as scientific meetings and publications, (d) to advance the physical, social, psychological, and philosophic well-being of humankind by such methods as promotion of research and deliberations into it, (e) to extend consultations and carry out charitable and voluntary work for the furtherance of the objectives mentioned above, and (f) to do all such things and matters that are incidental or conducive to the attainment of the above objectives.[5] In their editorial in the International Journal of Social Psychiatry, Bhugra and Till (2013)[3] had made some pertinent arguments namely re-emphasizing the concept of Leff (2010)[6] that social psychiatry is the branch of psychiatry that is concerned with the effects of social environment on the mental health of the individual, and with the effects of the mentally ill person on his/her social environment, and that social psychiatry is best placed in developing mental health promotion and preventing certain mental illnesses. They further emphasized that educating individuals, families, and societies was at the core of social psychiatry as well as that of public health.[3] PMH has gained immense importance due to the COVID-19 pandemic exposing our psychosocial and health-inequality frailties in the worst possible way.[2] In line with this, as alluded to earlier, over the past 2–3 years, myself as the Editor had serendipitously shown a minor yet perceptible shift toward PMH by taking up themes and topics for IndJSP. I consciously claim no credit for it, but somewhere, somehow the aspect of prevention and promotion of mental health seemed to have struck a chord with me during the COVID-19 pandemic and beyond (after it not being a public health emergency since May 2023).[7] Although IndJSP still continues to receive submissions predominantly centered around social and community psychiatry, but the preference for submissions related to (or touching aspects of) PMH has increased. It is as if “an awakening has occurred;” “a switch has flipped internally” (if any of the readers have seen the latest web series Kaala Paani on Netflix, they will relate to this analogy). PMH in one way is a key objective of social psychiatry and an important task of social psychiatrists. Looking closely at the objectives of IASP, objective (a) and possibly objective (d) are aligned toward meeting the requirements and concept of PMH. Hence, it is important and timely that IASP has taken up PMH as its theme for the upcoming Annual Conference being held at Raipur, November 24–26, 2023. This, in my opinion, is one small step, in the right direction but the focus should be to translate the theory into practice and to lead the vision for PMH onto implementation research and clinical delivery at ground level. Developing collaborations with key stakeholders and reaching the grassroots are important. Involving the public and the sensitizing the Government remain the cornerstone. IASP, as an association, along with its journal (IndJSP) needs to continue the same journey but with a shift of emphasis on other objectives too. An achievable blueprint having goals with long-term sustainable effort over the next few years can be set out. This editorial team has tried to highlight some of the PMH issues: One was published on behavioral addictions in the previous issue,[8] and two others on aspects related to geriatric mental health and children (and families) accompany in this issue.[9,10] These serve not only as a precursor to the Theme of the National Conference but also as a reminder for the forthcoming torchbearers of the association regarding the importance of PMH. We, as social mental health professionals, have a duty related to PMH! The essential thing to remember is that social and community psychiatry still remains the key vehicle to achieve the goal of PMH.