Expert: Pacific Way On Mental Health Often Better

If Western psychiatric services are failing to deliver, then why scale up that model?

By Richard Moore 

RAROTONGA, Cook Islands (Cook Islands News, July 8, 2016) – Western nations should pause and reflect before telling Pacific countries how to set up their mental-health services.

That’s the belief of Professor Roger Mulder, a New Zealand mental-health expert, who believes culture has a marked influence on positive outcomes for mental-health patients.

The University of Otago professor told the Cook Islands Health Conference yesterday that studies have shown that more people had good outcomes in developing nations than in developed countries.

In fact, he says, “People in developing nations with mental-health problems are twice as likely to get better.”

He says study results have shocked health workers around the globe.

A 12-year follow-up of schizophrenia patients in Mauritius reported that 59 per cent of them were well.

Health worker responses to that study included “surprising”, “counter intuitive” and “unexpected and embarrassing”.

Professor Mulder asks whether social and cultural factors contribute to a better outcome for Pacific Islanders.

They include:

•           Extended family support.

•           Less fostering of passivity and amotivation due to minimal mental-health services.

•           Casual models of illness, such as supernatural forces may reduce burden on individuals and diminish guilt.

He says if psychiatric services in the West are failing to deliver, then caution should be exercised on scaling up similar services in developing countries.

And he questions if it is ethical to scale up treatment before doing pilot research to verify the effectiveness and acceptability of interventions.

“The better outcome for schizophrenia may reflect the multiplicity of treatment/healing options available in developing countries.”

Professor Mulder says there are far fewer patients in the islands than medical experts would expect in similarly sited New Zealand catchments.

“The patient’s symptoms are less severe – only requiring admission in a tiny minority of cases.”

And, he says, outcomes – functionally at least – appear better.

“We are not doing that well in NZ. Ten per cent of the country is taking anti-depressants and they are not working.

“In the West it is a very narrow treatment plan, but in developing nations there are multiple ways to help. That may be a better way.”

Should intervention occur it should be minimal, he says, and services should build on the strengths of Pacific people, which he lists as extended family, less stressful work, as well psychological support through communities and the church.

He adds there is a danger Western mental-health methods may produce an over-reliance on psychotropic medication and may inhibit alternative forms of support.

And, in addition, the risks from atypical anti-psychotic drugs may be worse in Pacific peoples.

They have a high base rate of metabolic abnormalities, a high propensity for weight gain, poor compliance with oral medication. Another issue includes the high cost of long-acting medications.

Cook Islands News
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As a teacher in the Pacific, I agree that people with mental health issues who are taken care of by extended family during their crisis, often return to regular life the following year healthy and happy. I have had several students do this. One is bipolar (amateur diagnosis) and one had a full mental breakdown.

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