This document summarizes a presentation on applying social psychiatry principles to clinical practice. It reviews influential population studies on topics like adverse childhood experiences and treatment gaps. It promotes translating this research to redefine health in social terms and integrating services in communities. It provides prescriptions for prevention, including addressing common issues and integrating primary and specialty care. The presentation argues for a social psychiatry approach in clinical teaching, interventions, policy, and advocacy.

1. WORLD ASSOCIATION OF SOCIAL PSYCHIATRY
WASP SYMPOSIUM:
SOCIAL PSYCHIATRY
AND PUBLIC MENTAL HEALTH
Co-Chairs:
Profs. R.A. Kallivayalil & R.K. Chadda
Diamond Jubilee International
Conference on Mental Health
Chandigarh, India – 15 Sept 2023

2. From Populations to Patients:
The Clinical Relevance of
Populational Studies for
Social Psychiatry & Public Health
Prof. Vincenzo Di Nicola
Diamond Jubilee International
Conference on Mental Health
Chandigarh, India – 15 Sept 2023

3. Prof. Vincenzo Di Nicola
MPhil, MD, PhD, FRCPC, FCAHS, DLFAPA, DFCPA
Professor of Psychiatry
University of Montreal & The George Washington University
President
World Association of Social Psychiatry
Canadian Association of Social Psychiatry
Fellow
Canadian Academy of Health Sciences
Distinguished Fellow, Canadian Psychiatric Association
Distinguished Life Fellow, American Psychiatric Association

4. Conflicts of Interest
The presenter has no financial conflicts of
interest to declare

5. V Di Nicola
Review article –
“A person is a person
through other persons”:
A social psychiatry
manifesto for the 21st
century.
World Social Psychiatry
2019; 1(1): 8-21.

6. Introduction: Three Goals
Review social psychiatry’s powerful populational
studies on psychiatric epidemiology and Social
Determinants of Health & Mental Health (SDH/MH)
Promote translational research of social psychiatric
studies – redefining health in social terms
Provide ground-level prescriptions aimed at
prevention, promotion, intervention, and adaptation

7. Populational Studies
Epidemiological studies
the shift is away from the
individual and the clinic, and
populations became the focus of
research

8. Populational Studies
Review social psychiatry’s powerful populational
studies on psychiatric epidemiology and the Social
Determinants of Health & Mental Health (SDH/MH)
1. Adverse Childhood Events (ACE) Studies
Linear gradient between childhood adversity and poor
health outcomes (Felitti & Anda, 2010)
Identify children at risk instead of treating everybody the
same – we don’t have the resources or the mandate –
“Don’t fix it if it ain’t broke”
References: Felitti & Anda (2010), Di Nicola (2012)

9. Populational Studies
Review social psychiatry’s powerful populational
studies on psychiatric epidemiology and the Social
Determinants of Health & Mental Health (SDH/MH)
2. Global Mental Health (GMH) – Treatment Gaps
Gap between known burden of disease and access to
care (Marmot, 2015)
A key plank in the GMH Movement (Cohen, et al., 2013;
CSDH, 2008; Patel & Prince, 2010)
References: Cohen, et al. (2013), CSDH (2008), Marmot (2015), Patel &
Prince (2010), Sorel (ed., 2012)

10. Populational Studies
Review social psychiatry’s powerful populational
studies on psychiatric epidemiology and the Social
Determinants of Health & Mental Health (SDH/MH)
3. Epidemiology to reflect the burden of disease
Service allocation should be based on reliable epidemiology – “the
science of denominators” – not the “numerators” that happen to catch
our attention
Overdiagnosis and overprescription are as dangerous as poor
access to care (Frances, 2021)
This is partly a side-effect of overspecialization
Reference: Frances A (2021), Aftab (2019)

11. Redefining Health
Promote translational research of social psychiatric
studies – redefining health in social terms
4a. Translational research to redefine health
As we totter from one psychiatric revolution to another,
we always leave part of the population behind
“A serial collapse into single-message mythologies”
– Paul Hoff, German psychiatrist and historian (Fulford, 2021)
Health is broadly social, not just biological or genetic (Prince,
et al., 2007; Di Nicola, 2019, 2021)
References: Fulford (2021), Prince M, Patel V, Saxena S, et al. (2007)

12. Redefining Health
Promote translational research of social psychiatric
studies – redefining health in social terms
4b. Mental health in a social context
Just as there is no health without mental health, there is no
mental health without a healthy body in a healthy society
References: Di Nicola (2019, 2021), Prince et al. (2007)

13. Ground-level Prescriptions
Provide ground-level prescriptions aimed at
prevention, promotion, intervention, and adaptation
5. Mental health services should be delivered
where people live
Identifying access to care issues – the treatment gap – isn’t
enough
We need to build clinics and integrate services into real
communities –
Schools, workplaces, community centres, sports arenas, shopping malls

14. Ground-level Prescriptions
Provide ground-level prescriptions aimed at
prevention, promotion, intervention, and adaptation
6. Shared care/integrated care/collaborative
care
Primary care is overburdened
Specialty care is difficult to access
Communication between them is poor
References: Di Nicola (2022), Ivbijaro (ed., 2010), Kates et al. (2011)

15. Ground-level Prescriptions
Provide ground-level prescriptions aimed at
prevention, promotion, intervention, and adaptation
7. We can’t do everything – let’s address the
most common problems
Give them priority before they become urgent or chronic
and intractable
If primary prevention is a fantasy, secondary and tertiary
prevention are not

16. Social Psychiatry in the Clinic
We need to start thinking of clinical social
psychiatry where populational studies are
integrated and translated into practice in the four
domains of:
teaching and research
clinical interventions
policy-making and service planning
advocacy

17. Trauma

18. Social Psychiatry in the Clinic
Intergenerational trauma
Intergenerational transmission of trauma
Historical traumas, slavery, genocide
Trauma-informed care for individuals
(Mollica, 2006; Di Nicola, 2018)
Truth & reconciliation for community and society
Canadian example:
Pope’s visit to apologize to the Native Peoples of Canada for
abuses by Christians
References: Di Nicola (2018), Mollica (2006)

19. Pope Francis adjusts his headdress after it was given to him
by Chief Wilton “Willie” Littlechild on July 25, 2022. – TODD KOROL/Reuters

20. References
Aftab A. Conversations in Critical Psychiatry Series. Allen Frances, MD:
Relentless Warrior for Mental Health. Psychiatric Times, May 23, 2019; 36
(10): 17, 22-23. https://www.psychiatrictimes.com/view/conversations-
critical-psychiatry-allen-frances-md
Cohen A, Patel V, Minas H. A very brief history of global mental health. In:
Patel V, Minas H, Cohen A, Prince MJ, editors. Global Mental Health:
Principles and Practice. Oxford, UK: Oxford University Press; 2013. p. 3-26.
CSDH. Closing the Gap in a Generation: Health Equity through Action on
the Social Determinants of Health. Final Report of the Commission on
Social Determinants of Health. Geneva, Switzerland: World Health
Organization; 2008.
Di Nicola V. Family, psychosocial, and cultural determinants of health. In:
Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA: Jones
& Bartlett Learning; 2012. p. 119-150.

21. References
Di Nicola V. Two trauma communities: A philosophical archaeology of
cultural and clinical trauma theories. In: PT Capretto & E Boynton (Eds),
Trauma and Transcendence: Limits in Theory and Prospects in Thinking.
New York: Fordham University Press, 2018. p. 17-52.
Di Nicola V. Review Article – “A person is a person through other persons:”
A social psychiatry manifesto for the 21st century. World Social Psychiatry,
2019; 1(1): 8-21.
Di Nicola V. Review Article – The Global South: An emergent epistemology
for social psychiatry. World Social Psychiatry, 2020; 2(1): 20-26.
Di Nicola V. Perspective – “There is no such thing as society”: The
pervasive myth of the atomistic individual in psychology and psychiatry.
Follow-up and reply to commentaries on “A social psychiatry manifesto for
the 21st century.” World Social Psychiatry, 2021; 3(2): 60-64.

22. References
Di Nicola V. Beyond shared care in Child and Adolescent Psychiatry:
Collaborative care and community consultations. Special issue on Child &
Adolescent Psychiatry, World Social Psychiatry, 2022, in press.
Felitti VJ, Anda RF. The relationship of adverse childhood experiences to
adult medical disease, psychiatric disorders and sexual behavior:
implications for health care. In: Lanius RA, Vermetten E, Pain C, editors.
The Impact of Early Trauma on Health and Disease: The Hidden Epidemic.
Cambridge, UK: Cambridge University Press; 2010. p. 77-87.
Frances A. Afterword: Saving Psychiatry. In: V Di Nicola, D Stoyanov.
Psychiatry in Crisis: At the Crossroads of Social Science, The Humanities,
and Neuroscience. Cham, Switzerland: Springer Nature; 2021. p. 167-168.
Fulford KWM. Foreword: Beyond single message mythologies. In: V Di
Nicola, D Stoyanov. Psychiatry in Crisis: At the Crossroads of Social Science,
The Humanities, and Neuroscience. Cham, Switzerland: Springer Nature;
2021. p. vii-xix.

23. References
Ivbijaro G (Ed.) Companion to Primary Care Mental Health. Boca Raton, FL:
CRC Press; 2010.
Kates N, McPherson-Doe C, George L. Integrating mental health care
services within primary care settings: The Hamilton Family Health Team. J
Ambulatory Care Manage 2011;34(2):174-182.
Marmot M. The health gap: The challenge of an unequal world. Lancet
2015;386:2442-4.
Mollica R. Healing Invisible Wounds: Paths to Hope and Recovery in a
Violent World. New York, NY: Harcourt, International; 2006.

24. References
Patel V, Prince M. Global mental health: a new global health field comes of
age. JAMA May 19, 2010;303(19):1976-77.
Prince M, Patel V, Saxena S, et al. (2007). No health without mental health.
Lancet 2007;370 (9590):859-877.
Sorel E (Ed.). 21st Century Global Mental Health. Burlington, MA: Jones &
Bartlett Learning; 2012.