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N. Shinfuku (1998)
Mental health services in Asia: International perspective and challenge for the coming yearsPsychiatry and Clinical Neurosciences, 52
P. Tor, T. Ng, E. Kua (2010)
Adequacy of Psychiatric Training: A Singaporean PerspectiveAcademic Psychiatry, 34
A. Tasman, N. Sartorius, B. Saraceno (2009)
Addressing mental health resource deficiencies in Pacific Rim countriesAsia‐Pacific Psychiatry, 1
Dear Editor, The article by Tasman (2009) comes at an opportune time to help administrators and clinicians alike to take stock of efforts in this region to improve mental health. This article gives a comprehensive overview of the stark resource limitations in Pacific Rim countries. Only patients seem to be in abundance, potentially threatening to overwhelm the psychiatrists, beds and medications available to them. The effect of stigma in limiting resources is also summarized. While these points are not new, the article highlights two other points influencing resourcing that are relatively neglected: the effect of culture on localizing Western models of care and mental health training. Culture affects the prevalence, presentation, perception and ultimately prognosis of mental illness. The complex and interdependent relationship between culture, stigma, resource allocation and accessibility of care by the mentally ill is elegantly discussed. The authors are to be commended for tantalizing us with this important topic. However, in a region with development dating back 8,000 years, history hangs heavily over everything. One wishes that they also touched on the effects of colonialism on the development of mental health services ( Shinfuku 1998 ) and how to reconcile the colonial mental health legacy with current cultural sensitivities and realities in the region. Mental health education is marginalized in this region and the downstream effects are protean. The visible effects are under diagnosis and treatment of mental illness at every level of medical care. The less visible effects include a vicious cycle of stigmatization, inadequate resources for mental health and poor advocacy for mental health. These topics are well elaborated in the article. Change is required and culture and training are essential enablers. Fortunately the authors are good psychiatrists and leave the readers with hope. They describe a new collaborative model of care that empowers the clinicians with the greatest potential to improve mental health: primary care physicians. The new generation of mental health leaders also brings with them much hope and promise if the results of a recent survey are reflective of a more regional attitudinal shift. Trainee psychiatrists in Singapore rated cultural aspects of psychiatry, research and basic neuroscience higher than psychiatrists ( Tor , in press ). As the authors state, culture is dynamic and change is constant. We have much to look forward to.
Asia-Pacific Psychiatry – Wiley
Published: Oct 1, 2009
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