General psychiatry and suicide prevention

Jacob (2001) successfully highlights the problems of community care of people with mental disorders in developing countries. Both he and the Journal are to be commended for addressing the mental health issues of the vast populations of such countries, a topic generally overlooked in the literature. The author is right to point out that most programmes have failed to deliver and that the success of local model projects has not been repeated at a national level. From personal experience as both a trainee and a trainer and from discussion with colleagues in a similar situation, I believe the most important reason for this is the inappropriate training of psychiatrists in developing countries.

The suitability of the training in developed countries for psychiatrists who will ultimately work in developing countries is increasingly being questioned (Mubbashar & Humayun, 1999), but questions have rarely been asked about the training in their own countries. Unfortunately, the training in most developing countries is still based on models of psychiatric services and theories derived from developed nations. An obvious example is the concept of community psychiatry. This concept and its enactment, derived from the history of modern Western psychiatry, cannot be applied in developing countries (Farooq & Minhas, 2001). Young psychiatrists from developing nations who trained in this model of community psychiatry will find the realities of psychiatric services in their own countries totally different from what they have learnt in training.

Moreover, the training in many developing countries remains narrowly focused on acquiring clinical skills. This is despite the fact that a World Health Organization expert committee recommended long ago that trained mental health professionals should devote “only part of their working hours” to the clinical care of patients (World Health Organization, 1975). As Jacob points out, the realities of mental health care in the community in developing countries demand that training is broad-based and equips the psychiatrist to work effectively with other disciplines, particularly primary care. This, however, is rarely the case in many developing countries.

The training of psychiatrists in developing countries needs a total paradigm shift to address the problems raised by Jacob. Both the mental health professionals and the policy makers need to address this as a priority. If they do not, most of the mental health initiatives in these countries will fail.