Outsourced Psychiatry: Experts Still Relevant

Abstract

The News Focus story on global mental health, “Who needs psychiatrists?” (G. Miller, 16 March, p. [1294][1]), implied that the answer is “no one.” This is not the case. It is true that clinical trials have demonstrated the efficacy of talking therapies for depression, anxiety, and other common mental disorders, when delivered by nonpsychiatrist health workers trained by professionals. Severely ill individuals (such as those with refractory depression, bipolar disorder, or schizophrenia) require medication, which can be administered safely by nurses, family doctors, and even health workers supervised by medical personnel. Investing in community health workers as mental health gatekeepers is the safest national strategy for sustainable mental health programs, for the reasons mentioned in the News Focus story as well as an additional one: Community health workers are not as susceptible to “brain drain”—the emigration of skilled workers for better working conditions—as health professionals. For quality care, however, psychiatrists are needed for overall direction/supervision and training in differential diagnosis and medication management, especially when addressing complex comorbidities (mental as well as physical). Psychiatrists play a crucial role as consultants in these inter national projects. [1]: pending:yes