The recognition that “there is no health without mental health” has advanced significantly over the past two decades. However, such slogans issued by the World Health Organization have not been effectively translated into practical terms in the curricula of most medical schools in our country. Mental health and psychiatry contents and skills occupy a very marginal space in the training of physicians, as they are approached, if any, within the logic of specialization rather than the large area effectively constituted by mental health which we consider essential to the general education of physicians.
The prevalence of mental disorders is high, and in addition to the enormous direct burden they involve, in terms of psychological distress, social and work deficits, they have a strong influence on other diseases, especially chronic ones, and on their treatments. People with severe mental disorders, in turn, have neglected their physical health and do not receive health care in an equitable manner. They have a lower life expectancy of at least a decade compared to the general population.
How can we explain the blatant mismatch between the prevailing perception of the increasing social burden of mental disorders, in a rapidly changing world, which is most evident since the onset of the Covid-19 epidemic, and the shyness of initiatives related to training professionals to meet challenges in mental health?
The stigma attached to a mental disorder, and thus to the medical specialty that treats it, and psychiatry, certainly plays an important role in this. The recent reinforcement of the medical identity of psychiatry does not seem to have been enough to erase much of the biases that have always surrounded the specialty. In hospital settings, it is not uncommon to refer to a so-called “psychopath,” as if suffering from a mental disorder is the hallmark of a type of person, less valuable and therefore undesirable. Nothing short of a deeply rooted and ominous bias.
We have observed that medical students, upon initiating contact with the clinic, usually show a deep interest in the people and not only in their illnesses. But this tends to get lost during their training, because the primary message they receive is that this attention, though desirable, is not at the heart of a physician’s performance. More so, the patient’s subjectivity often, throughout the medical course, becomes a noise that must be discarded. The disease gains prominence and the patient gradually disappears. We understand that this needs to change.
Taking care of mental health is the task of many professionals and not just those who work in the so-called “psi” fields. Physicians, regardless of their specialty, play a very important role, as they are often (especially in primary care) the first contact and an essential factor in the care of people in distress. But, of course, your performance must qualify. Therefore, we advocate that training in mental health and psychiatry should accompany physician training longitudinally, from the first steps in the early years to the practice of supervised clinical care in the internship.
The population’s vast mental health care needs will not be met by training more psychiatrists or referring patients to “psychiatric” specialists. The challenge for medical schools is to overcome inertia and make their curricula more consistently reflect the health requirements that exist today, while recognizing the large field that is mental health.
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