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Patient choice in psychiatry in developing countries
- Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Dr. Aruni Hapangama MD , Lecturer in Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka (28 November 2007)
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Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), Professor of Psychiatry Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, Dr. Aruni Hapangama MD , Lecturer in Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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lalithkuruppu{at}lycos.com Prof.K.A.L.A. Kuruppuarachchi MD,FRCPsych(UK), et al.
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Samele C et al (2007) have highlighted the implications of patient choice in psychiatry and some of its main challenges. The importance of patient oriented approach in psychiatry has even been emphasized in the 2001 World Health Report1. Patients seem to want more say in their treatment decisions, to have appropriate information on their condition and come to a decision with regard to the management of their illness2. Psychiatry is a particularly challenging area with regard to this context, because mental illness can affect both understanding and decision making abilities. This topic has significance particularly to developing countries like Sri Lanka. The attitudes and choice of therapy of patients in developing countries may differ from those of developed countries as cultural norms and beliefs also play a major role in decision making in this part of the world 3. Also almost all the time, patients depend on the therapist to make the decisions with regard to their treatment either because they think the therapist knows the best or they are not knowledgeable enough. At present, suing by patients is still relatively less in the developing countries compared with the West. Hence the therapists are also not under pressure when making decisions compared with the West. This may contribute to the maintenance of the “therapist centred” approach in the management of patients in our part of the world. Another reason which makes patient choice less feasible in the developing countries is the limited number of therapeutic options due to lack of resources. This sometimes leads to medications being the only available option although other treatment modalities are indicated for the particular condition. Another factor which might impede the patient choice is the lack of a proper mental health act. Some of the developing countries either do not have a mental health act1 or the existing mental health acts are archaic and developed during the pre-antipsychotic era and which are not at all patient- centred. Therefore psychiatrists and the policy makers particularly in the developing countries should be aware of these important issues when health plans are made and implemented. References 1.World Health Report 2001. World Health Organization. Geneva 2.Richard L. Psychiatry in the future. The next 15 years: postmodern challenges and opportunities for psychiatry. Psychiatric Bulletin (2004) 28: 317-318 3.A Soltani, A Moayyeri, M Raza Impediments to implementing evidence-based mental health in developing countries. Evidence-Based Mental Health 2004; 7:64-66 |
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