Preparatory Mindset
This chapter covers global mental health (GBD, SDGs, disparities), family therapy (systems perspective), art/music therapy, and mindfulness-based interventions as adjuncts. The review docx (Chapters 7-8) covers the humanistic & global parts (CM exam tested); the 9 Humanistic lecture covers mindfulness/MBSR. The exam tests: global burden of disease (GBD), SDGs, urgent global health problems, family therapy basics, mindfulness interventions (MBSR, MBCT), and art/music therapy.
Exam mindset: know the 5 urgent global health problems (climate crisis, conflict, equity, access, infectious disease), SDG goals related to health, the family as a system, and mindfulness & MBSR structure.
Core Concepts
1. Global health & global mental health (MUST KNOW)
- Global health: the health of populations in the worldwide context
- Global mental health: the study, research, and practice of improving mental health for all people worldwide — includes consideration of disparities in mental health treatment and care across cultures and countries
2. Urgent global health problems (MUST KNOW)
- Climate crisis — environmental determinants of health
- Health care delivery in areas of conflict and crisis — humanitarian medicine
- Health care equity — addressing disparities
- Access to treatment — especially MH and essential medicines
- Infectious disease prevention and epidemic preparedness
- (Also: NCDs, ageing, mental health)
3. Global Burden of Disease (GBD) (MUST KNOW)
- The Global Burden of Disease study provides a comprehensive picture of mortality and disability across countries, time, age, and sex
- Quantifies health loss from hundreds of diseases, injuries, and risk factors
- Aims to improve health systems and eliminate disparities
- DALY (Disability-Adjusted Life Year): the standard metric (years of life lost + years lived with disability)
- Mental health gap: mental disorders contribute ~14% of global DALYs — second leading cause of disability worldwide
4. Sustainable Development Goals (SDGs) (MUST KNOW)
- 17 universal goals adopted by UN in 2015
- A universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity
- Key health-related: SDG 3 (Good Health and Well-being); also afflictions of poverty, inequalities, climate
- Mental health gap: explicitly addressed in SDG 3 (but largely underfunded)
5. Family therapy (MUST KNOW)
- Structural (Minuchin): family structure, boundaries, hierarchies - Strategic (Haley): problem-focused, paradox, directives - Bowenian (Bowen): differentiation of self, multigenerational transmission, triangulation - Systemic (Milan): circular questioning, neutrality - Mentalization-Based Therapy (MBT): understand one's own & others' mental states
- Family as a system — the whole is more than the sum of parts
- Identified patient — the person presenting may be the "symptom" of the family system
- Approaches:
- Indications: child/adolescent psychiatric problems, eating disorders, conflict, substance abuse, chronic illness, end-of-life
6. Group therapy (brief)
- Yalom's therapeutic factors: universality, altruism, instillation of hope, corrective emotional experience, group cohesion, catharsis, existential factors, interpersonal learning, self-understanding
- Indications: grief, addiction, PTSD, social anxiety, psychoeducation
- Contraindications: acute psychosis, severe personality disorder, suicidality
7. Art therapy, music therapy, and other expressive therapies
- Music therapy (with biofeedback): rhythm + biofeedback helps patients understand & control physiological/emotional reactions (Stress lecture reference)
- Art therapy: nonverbal expression — trauma (PTSD), pediatric, dementia
- Dance/movement therapy: body-based emotional expression
- Drama therapy: role-play, narrative
- Expressive writing: reduces stress, improves mood (Pennebaker's paradigm)
- Animal-assisted therapy: PTSD, autism, dementia
8. Mindfulness-based interventions (MUST KNOW)
- 8-week evidence-based program - Secular, intensive mindfulness training - For stress, anxiety, depression, pain - Components: body scan, sitting meditation, mindful movement (yoga), 8-week group format
- Mindfulness: non-judgmental awareness of present-moment experience
- MBSR (Mindfulness-Based Stress Reduction — Jon Kabat-Zinn):
- MBCT (Mindfulness-Based Cognitive Therapy): MBSR + CBT for depression relapse prevention (3 or more prior episodes)
- ACT (Acceptance and Commitment Therapy): acceptance of thoughts/feelings; commitment to values-based action; psychological flexibility
- DBT (Dialectical Behavior Therapy): mindfulness + emotional regulation + distress tolerance + interpersonal effectiveness (Linehan)
9. Spiritual & complementary approaches
- Spiritual assessment as part of the medical interview (FICA: Faith, Importance, Community, Address)
- Meditation, yoga, tai chi: evidence-base for stress, cardiovascular, chronic pain
- Acupuncture: evidence for nausea, pain
10. Clinical applications
- For anxiety: CBT + mindfulness or MBSR; group + individual; ESM (ecological momentary assessment)
- For depression: CBT + behavioral activation + medication; MBCT for relapse
- For PTSD: trauma-focused CBT, EMDR, plus expressive therapies as adjunct
- For chronic illness: expressive writing, music therapy, mindfulness
- For children: play therapy, art therapy, family therapy
11. Cultural humility in global mental health
- Cultural humility: openness to patient's culture; recognize power dynamics
- Cultural formulation in DSM-5: cultural identity, cultural conceptualizations of distress, cultural stressors, cultural treatments
- Adaptations: translate interventions, train local providers, use community resources
High-Yield Points
- Global mental health: improve mental health worldwide; + disparities
- 5 urgent global health problems: climate, conflict, equity, access, infectious disease
- GBD: comprehensive mortality/disability picture; DALY = years of life lost + years lived with disability
- SDG 3: Good Health and Well-being; mental health explicitly addressed
- Family therapy: system approach; identified patient; Bowen = differentiation
- Yalom's group factors: universality, altruism, hope, cohesion, catharsis
- MBSR: 8-week program for stress, anxiety, depression, pain
- MBCT: for depression relapse prevention
- Music therapy + biofeedback: rhythm + control of physiological reactions
- Art therapy: nonverbal expression; trauma, pediatric, dementia
- FICA spiritual assessment: Faith, Importance, Community, Address
- Cultural humility: patient's culture first
Topic Summary
Global mental health aims to improve mental health for all worldwide, addressing disparities across cultures and countries. The five urgent global health problems are the climate crisis, health care delivery in conflict and crisis, health care equity, access to treatment, and infectious disease prevention/epidemic preparedness. The Global Burden of Disease (GBD) study quantifies mortality and disability; the DALY (Disability-Adjusted Life Year) is the standard metric combining years of life lost with years lived with disability. Mental disorders contribute ~14% of global DALYs, the second leading cause of disability. The UN Sustainable Development Goals (SDGs) form a universal call to action; SDG 3 (Good Health and Well-being) explicitly addresses mental health. Family therapy treats the family as a system (the identified patient may be a symptom of the system); approaches include structural (Minuchin), strategic (Haley), Bowenian (differentiation), and systemic. Yalom's group therapy factors include universality, altruism, hope, and cohesion. Mindfulness-based interventions include MBSR (8-week stress reduction), MBCT (depression relapse prevention), ACT (acceptance and values-based action), and DBT (borderline personality). Expressive therapies (music, art, dance, drama) and spiritual assessment (FICA) complement traditional approaches. Cultural humility and DSM-5 cultural formulation address the cultural context of mental health.
LMCHK OSCE Practice
- Global health discussion: explain the SDG framework and how mental health fits into SDG 3; the 5 urgent global health problems.
- Cultural formulation (DSM-5): for a patient from a different culture — assess cultural identity, conceptualizations of distress, cultural stressors, and treatments.
- Family therapy case: assess the family system — identify the identified patient, the family structure, boundaries, and communication patterns.
- MBSR referral: for chronic stress, anxiety, depression, chronic pain — refer to a certified 8-week MBSR program.
- MBCT for depression: for a patient with 3+ prior depressions — MBCT prevents relapse; combine with antidepressants.
- Spiritual assessment (FICA): F — Faith; I — Importance; C — Community; A — Address in care.
- Music therapy: in palliative care, dementia, palliative care — use rhythm/melody for emotional expression and engagement.
- Art therapy: for a nonverbal trauma patient (PTSD, child, dementia) — use the project to externalize emotions.
- DALY explanation: disability-adjusted life year — the gap between current health and ideal health.
- Group therapy referral: for a grieving patient — group therapy offers universality and cohesion.
- COVID-19 mental health: describe the pandemic's mental health impact (↑ anxiety, depression, substance use) and the role of telehealth and digital interventions.
- Sustainable healthcare: discuss planetary health — co-benefits of low-carbon healthcare and active transport.
- Cultural humility: admit when you don't know; ask the patient to teach you about their culture.