Non-pharmacological treatments for schizophrenia in Southeast Europe: An expert survey

Background: Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in South-East European countries (SEE). Objective: To explore mental health care experts’ opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE. Methods: An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo†, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received non-pharmacological interventions, type of services delivering these interventions, and expert views of availability barriers. Results: In eight countries, the estimated percentage of people with schizophrenia who receive non-pharmacological treatments was below 35%. The primary explanations for the low availability of non-pharmacological treatments were: lack of human and financial resources, lack of training for clinicians, and pharmacotherapy dominance in the treatment for schizophrenia. Conclusion: Lack of personal and institutional resources and state support were identified as primary obstacles to staff training and delivering non-pharmacological treatments to people with schizophrenia on individual and systemic levels, respectively. This evidence can be used to improve holistic, evidence-based treatment for schizophrenia in the SEE countries.

Towards improving community pharmacy-based mental health services in Nigeria

In Nigeria, there is a prevalence of aversive life circumstances that frequently assail the mental health and well-being of the citizens, mitigating the impact of which necessitates the institution of psychotherapy and other mental health care methods. These responsibilities, however, appear to be much more for pharmacists in low-resource settings where they are the most accessible healthcare professional. Some of these responsibilities include patient confidentiality as well as counseling patients on medication use, lifestyle as well as other personal matters that may arise in relation to their health. Mental health services including psychotherapy provide a range of therapeutic techniques that enable the patients (individual or groups) to develop effective coping strategies towards emotional and psychological difficulties, via methodic interactions with a mental health expert. In this commentary, we share suggestions on how to improve community pharmacy-based mental health services in Nigeria. With the expanding roles and responsibility for pharmacists beyond medication-related concerns comes the challenge of matching up the training of pharmacists with the broadening scope of practice in Nigeria. However, as pertinent as that might be, there are existing knowledge and competency gaps in keeping up with this trend. To correct these shortfalls, we contend that the training curricula for pharmacists in Nigeria be reviewed and/or expanded to provide adequate knowledge for pharmacy undergraduates and pharmacists about non-drug mental health care which will also impact psychotherapy services during their practice especially in the community settings.

A Historical Overview of the Mental Health Expert in England Until the Nineteenth Century

Throughout history, the use of mental health professionals as expert witnesses has elicited criticism. The criticism stemmed from the alleged lack of scientific rigour in mental health sciences and the accompanying bias of expert witnesses. As the use of mental health professionals in court increased, so did the associated problems, with bias remaining at the forefront. The same challenges plague the South African courts today and despite various evidentiary and procedural rules2 aimed at addressing the problems, these have not achieved much success. The contribution traces the origins of the expert witness, in particular the mental health expert, in the English legal system until the nineteenth century. By examining the shift in the position of the expert witness from a neutral informant in the eighteenth century to a partisan witness in the nineteenth century, a parallel is drawn between the historical position in England and the current position in South Africa. Drawing on the past failures and successes of the English legal system in this regard, and briefly considering the current position in England, recommendations are made to address the problem of partisan mental health experts within the South African context.

Social media markers to identify fathers at risk of postpartum depression

Postpartum depression is a significant mental health issue in mothers and fathers alike; yet at-risk fathers often come to the attention of healthcare professionals late due to low awareness of symptoms and reluctance to seek help. The present study aimed to examine whether passive social media markers are effective for identifying fathers at risk of postpartum depression. We collected 67,796 Reddit posts from 365 fathers, spanning a six-month period around the birth of their child. A list of ‘at risk’ words was developed in collaboration with a perinatal mental health expert. Postpartum depression was assessed by evaluating the change in fathers’ use of words indicating depressive symptomatology after childbirth. Predictive models were developed as a series of Support Vector Machine (SVM) classifiers using behaviour, emotion, linguistic style and discussion topics as features. The performance of these classifiers indicates that fathers at risk of postpartum depression can be predicted from their prepartum data alone. Overall, the best performing model used discussion topic features only with a recall score of 0.82. These findings could assist in the development of support and intervention tools for fathers during the prepartum period, with specific applicability to personalized and preventative support tools for at-risk fathers.