Social contracts and treating mental illness

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In other words, there needs to be a contract between psychiatry and society, says World Psychiatric Association president, Professor Dinesh Bhugra, says.

Building trust

He shares an anecdote about a holy place in Gujarat, Western India, where many people with mental illnesses go to pray because they believe if they do so they will get better.

Some years back, a team of psychiatrists and other medical and health experts set up an initiative where they worked closely with the faith healers at the site with a view to sharing their expertise and helping heal the patients.

The healers engaged closely with the religious leaders, and slowly started administering medical assistance through them. By building up the relationship, the patients, through the healers started trusting them and accepting their medical input and, in some cases, medication. This co-operative arrangement had yielded great results.

“We should not feel threatened or criticise people for being different. Those are individuals who believe in what they do. We need to find ways of working with them to deliver what our patients would expect,” he explains.

Working out boundaries

A key part of the contract between psychiatrists and society, says Bhugra is to work out where the boundaries are. “We need to ask ourselves, ‘what is it that society expects me to do in treating mental illness? And in return, I, as the psychiatrist, want the professional freedom to be able to get on with the work, be able to self-regulate, to have sufficient resources and to have respect for what we do’.

“The point is that we need to think about services … and that, rather than patients coming to us, we need to be where the patients, are. If patients go to a temple or holy mosque, we must be there, rather than saying, ‘come to us’.

“But, both sides should be clear as to what is expected of each other. While we advocate for our patients, similarly, society should listen to me, and say, ‘here is a person with expertise’.”