ROAD MAP FOR SOCIAL PSYCHIATRY IN 21ST CENTRURY IN

SOUTH ASIA

ROLE OF INDUSTRY

Dr. Devashish KonarDirector & Consultant Psychiatrist Mental Health Care Centre Kolkata & Burdwan

PRESENTED IN WASP 2016: 22nd WORLD CONGRESS OF SOCIAL PSYCHIATRY, NEW DELHI

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ROLE OF INDUSTRY : AN OVERVIEW• Expanding horizon of Psychiatry demands greater

inclusion of industry for next level of growth. • We need to identify the areas that will really benefit

from more interaction with pharmaceutical, biomedical and digital industry. • These interactions have to be mutually enriching. • They would necessitate us to acquire new skills to

understand others’ work, purpose and design. • Psychiatrist should be in the driver’s seat because

they understand the patients’ interest best.

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LET’S COME TO THE INDIVIDUAL INDUSTRIES

•Pharmaceutical Industry•Biomedical Industry•Digital and Information Technology Industry

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PHARMACEUTICAL INDUSTRY

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THE INHERENT AMBIVALANCE IN RELATIONSHIP WITH PHARMA• Pharmaceuticals try to manipulate the

boundaries of normality and expand market for drugs. • Social and personal problems should not be

medicalised unnecessarily. •Mental health being our common target, not

collaborating will be counterproductive. • So Psychiatrists will have to work in tandem

without getting swayed by them.

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THE POSSIBLE AVENUES OF CO-OPERATION

• You need to collaborate specially in the field of research• For fighting stigma and for reaching the unreached

you may need them to have bigger impact. • Academic activities of doctors if under their own

control and sponsored by industry can be a good boost for the profession.• It is not right to presume that industry is only profit

driven.

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INFLUENCE OF THE PHARMACEUTICAL INDUSTRY

• The Medical Profession• Medical Research• The Public and Patient Groups• Political Institutions

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BIOMEDICAL INDUSTRY

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GOOD SIDE OF BIOMEDICAL INDUSTRY

• The major research of last 50 years in the field of Psychiatry have been driven with the help of biomedical industry. • They have found some important place in

day to day clinical practice too.• From diagnosis to treatment to follow up

assessment they have secured a definite place.

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BIOMEDICAL INDUSTRY

• In Psychiatry, biomedical advancement in the field of investigation like PET and treatment facilities like rTMS, still need to be confirmed by research to be useful clinically.

• Before that the companies will try to popularize them with their own

marketing strategies and Psychiatrist may fall prey to their trap causing extra expenses and harassment to patients.

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PHARMACOGENETIC TESTING IN CLINICAL PSYCHIATRY

• “Personalized Medicine” : treatments can be designed specifically for a patient, based on his or her own biological characteristics.• “Pharmaco-genetics,” : the selection of medications based on

genetic factors associated with drug response and tolerability.• Could your patient’s genetic code predict which medications

you prescribe?• It’s a promising technology, but the marketing has leap-

frogged ahead of the science.• Pharmaco-genetic testing is intriguing, but expensive, and

unlikely to be clinically useful at present, until we see better evidence.

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NEUROSTIMULATION DEVICES FOR DEPRESSION: AN OVERVIEW

• Status still remains dubious.• Started with some promise.• More sizzle than beef ?• But, of late, is there more beef? Maybe.

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DIGITAL INDUSTRY

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EMERGING DIMENSIONS• Digital revolution in mental health has already begun.

• Appointment, file keeping, data maintenance are all being taken care of digitally and transformation is pretty fast.

• They will ultimately facilitate research and connect it with big data in a huge manner.

• Educated patients will be able to self-screen for many illnesses. We are at the edge of the revolution when it comes to web-based assessment.

• Tele mental health will gain importance and we need to develop skills for that.

• With expanding use of E-mental health new issues of data security and privacy need to be mastered.

• You need new kinds of professionals, someone specializing in one may not fit into the other.

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CONNECTING WITH CLIENTS DIGITALLY

• Utility of voice and short messaging service (SMS)• Skype• Social Media & Chats• E-mail

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COMPUTER AS A THERAPIST

• The use of computer aided cognitive behavioural therapy (CCBT) in therapeutic settings.• Using forum to enhance client peer support in crisis and also

otherwise• Using websites, blogs, podcasts and wikis in mental health for

psycho-education• The role of blogging and podcasting in mental health• Meditate your way to better health through YouTube or audio

visual training programmes. • Using virtual reality immersion therapeutically, though with

caution.Research about reality immersion shows the important role of therapist supervision otherwise it could be disruptive or destructive

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LAYMEN NEED TO BE CAUTIOUS IN USING NET

• Instead of looking up for diagnoses, people can use the Internet as a positive resource for ways to stay healthy and should look for research sites that provide credible health content. • People should ask, “Who funds it? Who’s writing that

information? Are there any commercial relationships? Is there an agenda?” • As a rule of thumb, health information from ‘.gov’ website, such

as medline plus, or ‘.org’ websites that belong to hospitals or medical centers, like the Mayo Clinic. • So even the internet need to be taken with a grain of salt, and in

the case of healthcare, it’s in everyone’s interest to proceed with caution and skepticism.

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ONLY SCIENTIFICALLY TESTED APPS TO BE ADVOCATED BY PROFESSIONALS• The four NHS apps found to be clinically effective are

- Big white wall, a peer support network guided by trained professionals- Moodscope, a self-tracking and peer support network- Happyhealthy, a mindfulness App - WorkGuru, an occupational stress-management programme

• Outside of NHS endorsed apps, other mental health apps have also proved clinically effective

- Sleepio, a cognitive behavioural therapy (CBT) based App for sleep management, has been shown in several trials to help long term insomnia – one trial put efficacy at 75%.

- Wizard, a brain training app developed at the University of Cambridge, was found to improve the memory of patients with schizophrenia.

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TELEPSYCHIATRY

• The appeal of telemedicine is clear, especially for psychiatrists.

• We are in great demand, and there aren’t enough of us to meet the demand—especially for far away places.

• Since our diagnosis and treatment usually don’t necessarily require physical contact, we should be able to be quite effective via tele-psychiatry.

• And patients are increasingly realizing that tele-health can save them the expense and time.

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INFORMATION AND COMMUNICATION TECHNOLOGY

AS TOOL FOR TRAINING

• The use of video conferencing to enrich counselor training and supervision• Online training for mental health • The role of film and media in mental health

INSIGHT ABOUT SCIENCE AND TECHNOLOGY

• The phrase “science and technology” presumes an inseparability that may not be as secure as we think. • There can be science without technology, and there can be

technology without science.• That science has brought us technology does not mean that

technology will always bring us science.• For advancement and proper use of science, technology needs

to be judiciously used and restrained at times. Otherwise, science could go into retirement at any time.

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EPILOGUE:

Thanks