The WPA has recently finalized with the World Health Organization (WHO) a Work Plan for the triennium 2009-2011, covering five items: a) the revision of the chapter on mental and behavioural disorders of the ICD-10; b) collaboration in the Mental Health Gap Action Programme (mhGAP); c) partnership on mental health care in emergencies; d) collaboration in the area of substance abuse; e) partnership on involvement of users and carers. I will focus here on the first three of these items.
WHO-WPA collaboration in the revision of the ICD-10
The process of revision of the ICD-10 is ongoing, and WPA Member Societies and Scientific Sections are going to be formally involved in this process.
One of the aspects of this involvement will be the participation of WPA Member Societies in one or more surveys and field trials aiming to provide a cross-cultural perspective on the following issues: a) what is a mental disorder; mental disorders vs. homeostatic responses to adverse life events (e.g., how to differentiate between normal grief, complicated grief and major depression, or between normal vs. pathological responses to trauma); b) the stigmatizing potential of psychiatric nomenclature (several terms we use in international classifications sound odd or even offensive in some languages, and we have only partial information on this matter at the moment); c) the utility of national vs. international classifications, and the need for national adaptations of diagnostic systems (several countries and regions still have their own classifications or use adaptations of international classifications: what are the main reasons why these national classifications or adaptations may be needed?); d) the use of current diagnostic systems; the main barriers to their use (we have only partial information about the use of the ICD-10 in the various contexts in the different countries, and about the main reasons why the system is not adopted); e) the relevance of specific ICD-10 categories or criteria to various cultures (e.g., of the category of post-traumatic stress disorder, or of current criteria for the identification of the various degrees of severity of a depressive episode); f) the relevance and applicability of proposed new diagnostic approaches, categories or criteria in various cultural contexts (e.g., of prototypes, dimensions or rating scales incorporated in the system; or of the inclusion of a cognitive impairment criterion in the diagnosis of schizophrenia); g) the conceptual equivalence of syndromes and symptoms across cultures (e.g., is the meaning of the term “depression” the same across cultures?); h) the assessment of “severity”, “impairment” and “distress” (how this assessment should be made and what should be its place in the diagnostic system); i) the applicability of diagnostic categories or criteria by non-psychiatrists in specific settings (especially in low-income countries); j) gender and age issues (what modifications are needed in the system in order to make it more sensitive to gender and age differences in the various cultures?).
WHO-WPA collaboration in the mhGAP
The WPA is committed to provide assistance to the WHO in the preparation of the mhGAP intervention packages and to support the WHO in the country implementation of the programme.
Along the first line, we are carrying out a survey on the availability and feasibility of evidence-based interventions for priority mental disorders in the various countries and regions of the world, with the participation of WPA Zonal Representatives and Member Societies. The results of this survey will be used for a paper to be published in the Lancet.
Along the second line, we have started an effort to strengthen human resources in some countries in which the resource gap is large, but the WPA Member Society is active and there is an interest of the government to collaborate. The first country in which this effort is ongoing is Nigeria. WPA ongoing activities in this country include: a) a train-the-trainers programme focusing on the integration of mental health into primary care and targeting nurses and clinical officers working in community health centers (a first workshop, targeting the six south-western and the two Yoruba-speaking north-central states of Nigeria, took place in Ibadan last January, and is being followed now by a phase of supervision of the participants, in collaboration with the government); b) a programme of continuing education of psychiatrists (a CME event on improving psychosocial functioning in people with severe mental illness, led by T. Burns, will take place next October); c) a programme aimed to foster leadership and professional skills in young psychiatrists (the WPA will co-sponsor a workshop in Abuja, led by N. Sartorius); d) a plan to reinforce partnership with health authorities in the country (we are organizing with the AFRO office of the WHO an event with the participation of the Minister of Health and other relevant health authorities); e) an effort to better understand and address the issue of psychiatric brain drain.
WHO-WPA partnership on mental health care in emergencies
The WPA-WHO partnership on mental health care in emergencies includes two components.
The first is represented by train-the-trainers activities on prevention and management of mental health consequences of disasters and conflicts. A WPA-WHO workshop took place at the WHO headquarters in Geneva in July. This will be followed by a workshop in Dhaka, Bangladesh in January 2010. Our aim is to create a group of well-trained, highly qualified psychiatrists who will become themselves trainers for other psychiatrists in their regions, and will represent a resource for the WPA, the WHO and other relevant United Nations agencies when a new emergency occurs.
The second component of the partnership is the coordination of intervention of psychiatrists when an emergency occurs in a country or region in which external help is needed. We already implemented this coordination recently on the occasion of the Gaza emergency. The collaboration has two elements, a short-term and a medium-term one. The short-term element is the recruitment of psychiatrists who are able to speak the local language, are well trained and are willing to serve in the area of the emergency. The medium-term element consists in a partnership with relevant governments and Member Societies aimed to strengthen the national/regional mental health system. In fact, one of the lessons we have learnt from the experience of the past is that disasters are indeed very unfortunate events, but they also represent an opportunity for strengthening local mental health services, because they mobilize resources and call the attention of policy makers on mental health issues.
These are some of the activities that the WPA is implementing in collaboration with the WHO, having in mind two objectives: to help as much as possible some countries in need, and to enhance the image and increase the political influence of our discipline and profession in the international health arena.
President, World Psychiatric Association