Search

The global demographic shift toward an aging population is predicted to result in a significant burden of mental health conditions and psychosocial disability. There has been a greater awareness of ageism and its toxic effects creating a paradigm shift to include a human right, ethical, and social justice-based approach to augment the biomedical model of mental healthcare. The concept of dignity lies at the heart of human rights and must be a central concept integrated into public health and mental healthcare. Dignity denotes the self-respect and worthiness of an individual as well as social consideration of his/her identity. Dignity in older persons is multi-dimensional and includes several factors such as privacy, independence, inclusion, autonomy, etc. There are several determinants such as frailty, dependence, sensory, cognitive impairment and socioeconomic vulnerabilities, which tend to compromise dignity in the elderly and hence their fundamental rights. One such construct is that of ageism which comprises stereotypes, prejudice and discrimination based on age. Ageism and related forms of stigma impair dignified healthcare in older persons and deprive them of their rights. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. These intersections are discussed in this paper in light of the United Nations Convention on Rights of the Older Persons.

Publisher Copyright: © 2021 The Authors. Asia-Pacific Psychiatry published by John Wiley & Sons Australia, Ltd. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. Introduction: Suicide prevention during Covid 19 has become a global priority because the current pandemic has led to societal difficulties threatening the fabric of our lifestyle with increased morbidity and mortality. Modelling studies published since the COVID 19 pandemic was declared in March 2020 estimate that suicide rates will increase by anywhere between 1% to 145% globally in response to the pandemic and action needs to be taken. Methods: A narrative literature review on high quality evidence sources limited to human studies and publications written in English language only has been used to examine the relationship of COVID 19 and existing mental illness or history of mental illness, suicide prevention strategies and changes in overall suicide rates. Results: A total of 39 papers are summarised and grouped using the headings aetiological factors, proposed interventions to increase access and national policies to provide a framework for suicide prevention during pandemics such as COVID 19. This review indicates that 1) investing in active labour market programmes will result in a decreased suicide rate during times of high unemployment 2) People in low paid and casual jobs require specific support because they are most financially vulnerable during a pandemic related crisis 3) Women require specific support during a pandemic because of the type of employment they have and because they often carry a greater proportion of the domestic burden and are at increased risk of domestic violence during lockdown and crisis 4) Mental health and substance misuse services need to be appropriately funded and prioritised during and post pandemic, due to the associated increase in substance misuse during a pandemic causing worsening mental health and increased risk of suicide 5) National Suicide Prevention Strategies should be developed by all countries and should anticipate response to a range of disasters, including a pandemic 6) Suicide prevention is everybody's business and National Suicide Prevention Strategies should adopt a whole-systems approach including mental health services, primary care, social care, NGO's and other community stakeholders 7) Suicide is preventable 8) It is essential to prioritise suicide prevention strategies in the COVID and post-COVID period to ensure that lives are saved. Discussion: Increase in suicide is not inevitable and suicide prevention during pandemics and post COVID 19 pandemics requires a collaborative whole system approach. We require real time data to inform dynamic action planning. publishersversion published

Background Suicide among older adults is a multifactorial problem with several interrelated factors involved that vary with age, gender and culture. The number of suicides is highest in those aged 70 years or older in almost all regions of the world. With the increase in life expectancy, and the decrease in mortality due to other causes of death, we could expect the absolute number of older adults' suicide continue increasing. Methods Review of the literature on suicide protective factors of suicide among older adults. Results Improvements on social determinants of health and the timely detection and early treatment of affective disorders are key interventions. Prevention based on community actions and training of gatekeepers may have positive impact. Community programs that promote a sense of usefulness, belonging and that contribute to preserve social integration should be encouraged. Governments should develop the improvement of retirement programs and the development of support systems. The access to general health and mental health services should be facilitated and Primary Care professionals should receive proper training to detect and manage older persons at risk. Actively promoting a culture of coping to different stages of life and to the changes imposed by the advancing of age should form the essential part of a process bringing to better successful aging avenues. Conclusions Suicide prevention in older adults should broaden its focus and pay attention to the many socio-environmental conditions that may be relevant in older age, especially social isolation, financial security and physical health.

The world is ageing fast with a renewed emphasis on comprehensive healthcare for older people. This has created a paradigm shift towards rights and social justice-based approach to augment the medical model of mental healthcare. Dignity is one such construct embedded into the human-rights approach. It comprises of self-respect and worthiness of an individual as well as social acceptance of his/her identity. Dignity is a multi-faceted concept and consists of privacy, independence, inclusion, autonomy, etc. It includes community participation, functional abilities, rights to sexuality and oral healthcare, outcomes which are often neglected in conventional psychogeriatric care. Ageism and fear of ageing can exacerbate social stereotypes thereby compromising dignity in older people and risk of elder abuse.Geriatric psychiatry is uniquely positioned to equip mental healthcare with a ‘dignity-based’ approach promoting social connectedness and health equality. This further needs integration into all levels of public health for better access and holistic psychosocial management.With this background and on the backdrop on the unique psychosocial challenges posed by the COVID- 19 pandemic, this symposium glances at various dimensions of dignity-based psychogeriatric care: –Practical approach towards dignity promotion in healthcare using an attributional model–Perspectives, healthcare challenges and research from LMIC like Brazil and India related to dignity among older people and its impact on ageism and human rights–Rights-based geriatric mental healthcare in the developed nations–Finally, an urgent call for Convention on human rights of older persons for promoting dignity in healthcare and combatting ageism

Suicide is a major public health problem, with 817,000 cases worldwide in 2016. The incidence is highest in those aged 70 years or older, among both men and women, in almost all regions of the world1.

Since December 2019, the coronavirus (COVID19) outbreak has impacted everyone's daily lives globally, especially those experiencing mental health issues. The well-being and mental healthcare of patients, families, and health-care professionals who have been directly or indirectly affected by this pandemic has not been well addressed. Governments have asked their citizens to take actions, some of which include making sacrifices that may result in dignity violations and moral injury, a term originating in the military to describe the psychological distress that results from actions, or the lack of them, which violate a person's moral or ethical code. Health professionals, individuals, and communities have changed their way of life and working to decrease coronavirus infectivity, causing additional stress and increasing potential for moral injury. It is important to hear the first-hand experience of people affected to understand the new psychosocial stressors that they face in their day to day lives and what they found helpful in managing these. This global survey carried out by the World Dignity Project in collaboration with the Global Mental Health Peer Network is to ensure that the voices of people with lived experience of mental health, their families, and professionals that work with them are heard. Aims: To understand the impact of the coronavirus pandemic on mental health, well-being, and dignity, what has helped and what lessons can be learned to support coping in future. Materials and Methods: Online qualitative and quantitative survey (April 15–June 15, 2020) Participants gave narrative responses to several questions, posting photos or images. Analysis: Narrative responses were analyzed using the Gioia approach, a systematic inductive approach to develop concepts that help make sense of socially constructed worlds. Visual ethnographic data was used to give insight into the participant's socio-cultural context.

Suicide continues to be a major health concern globally despite many initiatives to identify risk factors and methods for suicide prevention. We have carried out a detailed narrative review of the literature from 2016 to 2019 using the headings of Personal resilience (P1), People (P2), Places (P3), Prevention (P4), Promoting collaboration (P5), and Promoting research (P6) in order to support an integrated approach to suicide prevention and the promotion of personal and population resilience. We have made 10 key recommendations on how this can be moved forward.

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The multifaceted intertwined nature of optimal health, mental health, and well-being requires operational, sustainable interdisciplinary partnerships in order to improve personal and global well-being and happiness. The initial step must be the assessment of the nature and magnitude of local problems in the global context. The WHO annual reports may be an adequate departure point as they can demonstrate the global nature of stressful situations and their association with physical and mental stress-related disorders. Therein, mental health professionals should spearhead change and progress. Attitudes need to be pro-active and partnerships are essential. Pertinent data should be evaluated by local experts who will determine the needs and how best to face them and achieve solutions. Hopefully, common regional denominators will lead to the formation of Regional Interdisciplinary Collaborative Alliances (RICAs) who will share needed resources and focus particularly on vulnerable populations. The RICAs would be supported by experts and technological facilities located in developed economy centers. The long-term goal is to turn the concept of pursuit of happiness into a well-perceived reality.

This chapter considers the importance of dignity in the care of older people. It starts with a case vignette to illustrate that dignity is not simply a medical input but a holistic approach to life. It considers the definition of dignity and how this is related to all aspects of care in older people with special reference to clinical syndromes including frailty and dementia and the need for evidence-based care delivery to avoid violations of an individual’s dignity. Technology has an increasing role to play in care delivery to older adults, and this is considered through the lens of dignity. Recommendations include: Maintaining older adults’ independence as much as possible should always be at the centre of their care plans. This can be facilitated by giving older adults choice and involving them and their carers in developing and implementing care plans. For frail older adults and those with dementia, for example, caregivers should always balance the need for safety with the older adult’s independence and autonomy. All staff caring for older adults must be suitably trained and supported to maintain dignity in older adults. They must be aware of the older adult’s cultural background and respect any cultural sensitivity, demonstrating empathy, respect and kindness while caring for the older adult. Older adults are more likely to be receiving care from different agencies due to co-morbidities, personal care and social needs. Collaborative care is a good model to ensure that all the agencies/caregivers work together with the older adult at the centre. Services that provide care for older adults such as care homes, sheltered housing and hospitals should embrace and invest in new technology to help enhance older adults’ independence and quality of life. Social isolation is a risk factor for poor mental health, which can affect older adults’ self-esteem. Health and social care commissioners should ensure there are facilities in place to identify and help older adults at risk of social isolation such as befriending schemes and day centres.

Disorders of bodily distress or bodily experience occur across all age groups including older adults. Understanding this condition in older adults particularly in primary care is very important because over 25% of primary care consultations are accounted for by people who are aged 65 years and older and it significantly impacts caregivers. Treatment of BDS requires professionals from multiple disciplines who can effectively collaborate to optimize care.

A possible negative consequence of the rapid aging of the world population is the increase of the number of older adults with mental disorders. More than 20% of people aged 55 and more may suffer from mental health problems. Mental health problems have a significant impact on an older adult’s ability to carry out the basic activities of everyday life and reduce the person’s independence, autonomy, and quality of life. Despite the already significant and increasing number of well-prepared professionals, a well-developed body of knowledge, and a large number of caregivers, it is becoming more and more difficult to persuade the authorities to invest in the overall older adults’ mental health. It is the responsibility of all mental health professionals, together with those involved, to advocate and to act to ensure that the distribution of available mental health resources is done in an equitable manner to adequately meet the needs of all. One of the ways to bring about a real change in the older adults’ mental health care is to rely on the local, national, and international associations and organizations of the persons concerned by this theme. This chapter reviews some of these international organizations and their current projects.

One of the consequences of an ageing population is the increasing prevalence of people living with more than one long-term condition (multi-morbidity). The coexistence of more than one long-term condition often has poorer outcomes for older adults and makes them more likely to access care from different health and social care providers concurrently. As a result, the overall cost of managing these individuals increases. Collaborative care is a useful way of providing care for such patients, utilising the skills and expertise of different disciplines in primary, secondary care and other settings in a coordinated way. Stepped care ensures that interventions match the severity and complexity of presentation so that effort is not wasted.

Primary care mental health in older adults: a global perspective is a resource to support improved care for a growing population of older adults with mental health difficulties that recognises innovative solutions to support the dignity of older adults whilst embracing new technology.

The Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria is a publication of the Intercollegiate Committee of the Royal College of Psychiatrists. The overall goal of the Good Practice Guidelines is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynaecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counselling, psychotherapy), and hormonal and surgical treatments. The Good Practice Guidelines are based on the best available science and expert professional consensus. The Good Practice Guidelines articulate standards of care while acknowledging the role of making informed choices and the value of ...

In England, general practice vocational training schemes (GP VTS) have traditionally lasted for three years. Many commentators have suggested that such a short period of structured training is inadequate to prepare GPs for the variety of experiences and challenges that they encounter within the first years of their practice. The education of GPs in all regions of England is administered by the local Deanery whose task is to commission postgraduate medical and dental education and to implement national policies on postgraduate dental and medical education. Deaneries have developed higher professional education (HPE) programmes to address further training needs for newly qualified GPs. This report is the first of a series evaluating the experience of HPE participants in the London area and focuses on the area of self and professional development.

Patients with co-morbidity and multi-morbidity have worse outcomes and greater healthcare needs. Co-morbid depression and other long-term conditions present health services with challenges in delivering effective care for patients. We provide some recent evidence from the literature to support the need for collaborative care, illustrated by practical examples of how to deliver a collaborative/integrated care continuum by presenting data collected between 2011 and 2012 from a London Borough clinical improvement programme that compared co-morbid diagnosis of depression and other long-term conditions and Accident and Emergency use. We have provided some practical steps for developing collaborative care within primary care and suggest that primary care family practices should adopt closer collaboration with other services in order to improve clinical outcomes and cost-effectiveness.

Medically unexplained symptoms (MUS) are among the most common and frustrating in primary care. Our goal was to review published evidence to guide busy general practitioners working with a culturally diverse, challenging patient population coping with MUS. A search of PubMed and PsycINFO from 1985 to the present was conducted using MUS and related terms.The literature was then organised into subcategories based on its relevance to primary care. We conclude with a description of gaps in the literature based on the literature review and the clinical experience of the authors.

(2005). WONCA's Culturally Sensitive Depression Guideline. European Journal of General Practice: Vol. 11, No. 2, pp. 46-47.