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August 2011
Report on the Implementation of the WPA Action Plan 2008 - 2011

Mario Maj
President, World Psychiatric Association

This report summarizes the main activities conducted by the WPA in implementation of its Action Plan 2008-2011, approved by the General Assembly in September 2008 (1,2).

WPA contribution to the development of ICD-11

WPA Member Societies have participated in the WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification, whose results have been published in World Psychiatry (3) and are expected to significantly influence the ICD revision process. Each Society has received a file with its own raw data and the results of the analysis of those data. Several Societies are producing papers based on those results.

Many WPA officers or experts have been appointed as chairpersons or members of ICD-11 Working Groups. The chairpersons include W. Gaebel (Working Group on Psychotic Disorders), M. Maj (Working Group on Mood and Anxiety Disorders), P. Tyrer (Working Group on Personality Disorders), L. Salvador-Carulla (Working Group on Intellectual Disabilities), and O. Gureje (Working Group on Somatoform Disorders).

The WPA President is a member of the ICD-11 International Advisory Board.

World Psychiatry is one of the main channels through which the international psychiatric community is following the ICD-11 development. A special article authored by the ICD-11 International Advisory Board, summarizing the philosophy of the entire process, has been published in the journal (4). A report by the Working Group on Intellectual Disabilities appears in this issue (5). Several papers produced by the Working Group on Mood and Anxiety Disorders will be collected in a special supplement to the journal. Forums on various topics relevant to ICD-11 development have been published or are scheduled for publication in the journal (e.g., 6-11).
Several WPA Member Societies and experts are being or will be involved in ICD-11 field trials and in the various translations/adaptations of the diagnostic system.

The WPA is actively contributing to the process of harmonization between the ICD-11 and the DSM-5.

WPA programme on disasters

The WPA contribution to the management of mental health consequences of major disasters has had, during the triennium, two components: a) training and sensitization of psychiatrists; b) intervention when a major disaster occurred.

The first component has been implemented through a series of train-the-trainers workshops and sensitization courses.

The train-the-trainers workshops aimed to train psychiatrists of the various regions of the world (with a special focus on those at highest risk) to address the mental health consequences of disasters, so that they can become themselves trainers for other mental health professionals in their regions and represent a resource for their countries when a new disaster occurs.

The first of these train-the-trainers workshops was co-organized with the WHO in Geneva in July 2009 (12). Among the participants were psychiatrists who subsequently had a leading role in addressing the mental health consequences of disasters in their countries, including Y. Suzuki (who is currently coordinating mental health interventions in the prefecture of Sendai, Japan) and U. Niaz (who coordinated mental health efforts on the occasion of a recent disaster in Pakistan). Further train-the-trainers workshops have been held in Bangladesh, China, Russia, Egypt, Brazil and Argentina.

The sensitization courses aimed to call the attention of psychiatrists worldwide to the mental health consequences of disasters and to update them about strategies of prevention and intervention. These courses have been held within all major WPA meetings in 2010 and 2011.

The intervention component of the WPA strategy has been implemented in different ways, depending on the peculiarities of the various disasters.

In 2010, on the occasion of the Haiti emergency, the WPA partnered with its Member Societies and relevant Scientific Sections and with the WHO in recruiting psychiatrists who were well trained, able to speak French and Creole, and willing to spend a prolonged period of time in the area of the emergency. A report by Dr. K. Ravenscroft, who was recruited through this mechanism and served for many months in Haiti, has been published in World Psychiatry (13).

In 2011, on the occasion of the Japan emergency, the WPA has partnered with the Japanese Society of Psychiatry and Neurology in building up an intervention and research project focusing on the nuclear component of the disaster, which is going to be funded by the Japanese government. Dr. E. Bromet, a prominent international expert of mental health consequences of nuclear disasters, has acted as an advisor in the preparation of the project. Two papers related to this initiative have appeared in World Psychiatry (14,15).

World Psychiatry

World Psychiatry, the WPA official journal, is the most widespread psychiatric journal in the world, reaching more than 33,000 psychiatrists in 121 countries, and being for many thousands of them the only accessible international psychiatric journal (16).

The journal is published regularly in seven languages: English, Spanish, Chinese, Russian, French, Arabic and Turkish. Individual papers or abstracts are translated in further languages, including Japanese, Polish, Romanian and Italian, and posted on the WPA website (www.wpanet.org) and/or those of the relevant WPA Member Societies.

The journal has now an impact factor of 5.562, ranking 9 out of 126 psychiatric journals.

All issues of the journal can be freely downloaded from PubMed Central and the WPA website.

WPA guidance papers

The WPA has produced during the triennium four guidance papers on issues of great practical interest to psychiatrists worldwide, never covered in the past by international guidelines. Each guidance paper has been developed by an international task force, translated into several languages, posted on the WPA website and published in World Psychiatry.

The papers deal with steps, obstacles and mistakes to avoid in the implementation of community mental health care (17); how to combat stigmatization of psychiatry and psychiatrists (18); mental health and mental health care in migrants (19); and protection and promotion of mental health in children of persons with severe mental disorders (20).

WPA research fellowships

The WPA has implemented during the triennium a programme of one-year research fellowships for early-career psychiatrists from low or lower-middle income countries, in collaboration with internationally recognized centers of excellence in psychiatry.

These centers included the Department of Psychiatry and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; the Institute of Psychiatry, King’s College, London, UK; the University of Maryland School of Medicine, Baltimore, MD, USA; the Orygen Youth Health Research Centre, University of Melbourne, Australia; and the Mood Disorders Programme, Case Western Reserve School of Medicine, Cleveland, OH, USA.

Six early-career psychiatrists (three from Asia, two from Africa and one from Latin America) have been selected on the basis of calls for applications posted on the WPA website. They have committed themselves to apply in their country of origin what they learn through this initiative. Interim or final reports by these fellows about their experience are available on the WPA website.

WPA-funded research projects

The WPA has funded during the triennium several collaborative research projects, selected on the basis of international calls posted on the Association’s website.

These projects deal with the factors facilitating or hampering the choice of psychiatry as a career by medical students; stigmatization of psychiatry and psychiatrists; depression, demoralization and functional impairment in cancer patients; intensive metabolic monitoring and care of patients with schizophrenia; and social inclusion of patients with severe mental illness.

Interim reports on the progress of these projects are available on the WPA website.

WPA educational products and sets of recommendations

The WPA has produced with Wiley-Blackwell, during the triennium, a series of books dealing with the recognition, epidemiology, pathogenesis, cultural aspects, medical costs and management of the comorbidity of depression with diabetes, heart disease and cancer (21-23).

Three sets of slides based on these books have been produced and disseminated to Member Societies. The slides on depression and diabetes are available on the WPA website in 17 languages (English, French, Portuguese, Spanish, Italian, Estonian, Croatian, German, Swedish, Azeri, Bosnian, Romanian, Czech, Russian, Indonesian, Bangla and Japanese). The slides on depression and heart disease and those on depression and cancer are available in 8 languages.

The WPA has also developed an educational module on physical illness in patients with severe mental disorders, which has been published in two parts in World Psychiatry (24,25) and posted on the Association’s website. The module has been or is being translated into several languages. Two sets of slides based on this educational module have been produced and posted on the Association’s website.

An international task force has developed during the triennium a WPA template for undergraduate and postgraduate education in psychiatry and mental health, which has been posted on the WPA website and is being translated in several languages.

Special sections of the Association’s website have been devoted to continuing education of psychiatrists, education of the general public on mental health issues, and description of successful experiences in the mental health field.

The WPA Committee on Ethics has developed a set of recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry. This document has been published in World Psychiatry (26) and posted on the WPA website.

An international task force has produced a set of WPA recommendations on best practices in working with service users and family carers. This document appears in this issue of the journal (27).

WPA train-the-trainers workshops and educational courses

The WPA organized in 2009 and 2010 a series of train-the-trainers workshops aimed to contribute to the integration of mental health care into primary care in Nigeria and Sri Lanka. These workshops were conducted in collaboration with the national governments. They targeted nurses and clinical officers working in dispensaries and health centers, and were followed by a phase of supervision of participants (28). Detailed reports on the workshops are available on the WPA website.

Educational courses dealing with issues of great relevance to psychiatric practice have been organized by the WPA in Abuja, Nigeria; Sao Paulo, Brazil; Dhaka, Bangladesh; St. Petersburg, Russia; Beijing, China; Cairo, Egypt; Yerevan, Armenia; and Istanbul, Turkey.

Workshops on leadership and professional skills for young psychiatrists have been co-sponsored by the WPA in Singapore, Nigeria and Turkey.

WPA Early Career Psychiatrists Council

A WPA Early Career Psychiatrists Council has been established during the triennium. Its members have been appointed by WPA Member Societies and subdivided into five geographic areas (Europe I, Europe II, Asia/Australasia, Africa and Middle East, Americas), each with a coordinator.

The Council has produced papers and documents for World Psychiatry (29) and the WPA website; organized symposia on the occasion of several scientific meetings; carried out surveys; participated in the translation and adaptation of the WPA slides on depression and physical diseases.

The first personal meeting of the Council will take place during the 15th World Congress of Psychiatry.

WPA press releases

During the triennium, the WPA has produced periodically press releases on topics relevant to mental health. Among those which have resulted in a wide media coverage are the releases focusing on two papers published in World Psychiatry: the report on the Iraq Mental Health Survey (30), covered in articles appearing in the International Herald Tribune, the New York Times and the Washington Post, and the paper on income-related inequalities in the prevalence of depression and suicide behaviour (31), covered in an article in USA Today.

One more press release which led to a significant media coverage was that related to the WPA International Congress held in Florence in April 2009, focusing on the relationship between sleep problems and suicide, and resulting in articles published in the Guardian and the Daily Telegraph.

Other WPA-WHO collaborative activities

The WPA has implemented during the triennium several other initiatives in collaboration with the WHO (32).

In October 2009, the WPA and the WHO co-organized in Abuja, Nigeria a Policy Roundtable bringing together ministers of health, senior policy makers and professional leaders of the nine African countries identified in the WHO’s Mental Health Gap Action Programme (mhGAP) as needing intensified support to scale up mental health services: Burundi, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Malawi and Nigeria. The outcome of the roundtable was the development of road maps for mental health care in those countries.
WPA experts contributed to the production of the WHO’s mhGAP Intervention Guide and the WHO’s Atlas of Resources for the Prevention and Treatment of Substance Abuse.

Other activities in partnership with Member Societies

Many WPA Member Societies participated in the WPA Survey on Strategies to Reduce the Treatment Gap for Mental Disorders, whose results were published in full in World Psychiatry (33) and will be summarized in a paper in The Lancet (34).

The WPA has assisted during the triennium many of its Member Societies in their interactions with national institutions concerning policy matters or refinement of educational curricula. Papers describing this collaboration have been published in partnership with the Czech Psychiatric Association, the Hungarian Psychiatric Association, the Brazilian Association of Psychiatry and the Portuguese Association of Psychiatry.

The WPA has organized during the triennium scientific meetings in all continents, always in partnership with its Member Societies (35). The 15th World Congress of Psychiatry, organized in partnership with WPA Member Societies in Argentina, is going to be the most attended congress in the history of the Association.

Many Congresses of Member Societies have been co-sponsored by the WPA and/or have included Symposia or CME Courses co-organized with the WPA. WPA leaders have met officially with leaders and/or members of Member Societies on the occasion of many national congresses, to discuss local priorities and provide advice. On several occasions, WPA leaders and leaders of Member Societies have held joint press conferences or participated in talk shows.

In several WPA scientific meetings, seminars were organized in which leaders of selected Member Societies illustrated the structure and activities of their associations to representatives of other Member Societies, answered their questions and provided advice on specific issues.

The WPA has implemented during the triennium an initiative to support the development of national psychiatric journals in low- and middle-income countries. A task force has worked with editors of selected journals to strengthen their chances of being indexed in international databases (36). Several journals whose editors participated in this project have recently achieved indexation.

Financial support to the Action Plan

The activities of the Action Plan have been supported by a consortium of industry and non-industry donors. The donors have had no input on the contents of the Plan and the selection of people participating in its implementation. No activity within the Action Plan has been mono-sponsored.

References

  1. Maj M. The WPA Action Plan 2008-2011. World Psychiatry 2008;7:129-30.
  2. Maj M. The WPA Action Plan is in progress. World Psychiatry 2009;8:65-6.
  3. Reed GM, Correia JM, Esparza P et al. The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification. World Psychiatry 2011; 10:118-131.
  4. International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders. World Psychiatry 2011; 10:86-92.
  5. Salvador-Carulla L, Reed GM, Vaez-Azizi LM et al. Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11. World Psychiatry 2011; 10:   .
  6. Krueger RF, Bezdjian S. Enhancing research and treatment of mental disorders with dimensional concepts: toward DSM-V and ICD-11. World Psychiatry 2009; 8:3-6.
  7. Ustun B, Kennedy C. What is “functional impairment”? Disentangling disability from clinical significance. World Psychiatry 2009; 8:82-85.
  8. Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry 2009; 8:67-74.
  9. Alarcon RD. Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry 2009; 8:131-139. 
  10. Strakowski SM, Fleck DE, Maj M. Broadening the diagnosis of bipolar disorder: benefits vs. risks. World Psychiatry 2011; 10:   .
  11. Westen D. Prototype diagnosis of psychiatric syndromes. World Psychiatry (in press).
  12. van Ommeren M, Jones L, Mears J. Orienting psychiatrists to working in emergencies: a WPA-WHO workshop. World Psychiatry 2010;9:121-122.
  13. Ravenscroft K. My experience in Haiti: a brief report. World Psychiatry 2010;9:191-192.
  14. Bromet EJ. Lessons learned from radiation disasters. World Psychiatry 2011; 10:83-84.
  15. Akiyama T. Addressing the mental health consequences of the Japan triple catastrophe. World Psychiatry 2011; 10:85.
  16. Maj M. The new impact factor of World Psychiatry. World Psychiatry 2010; 9:129-130.
  17. Thornicroft G, Alem A, Dos Santos RA et al. WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 2010;9:67-77.
  18. Sartorius N, Gaebel W, Cleveland HR et al. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2010;9:131-44.
  19. Bhugra D, Gupta S, Bhui K et al. WPA guidance on mental health and mental health care in migrants. World Psychiatry 2011;10:2-10.
  20. Brockington I, Chandra P, Dubowitz H et al. WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders. World Psychiatry 2011; 10:93-102.
  21. Katon W, Maj M, Sartorius N (eds). Depression and diabetes. Chichester: Wiley-Blackwell, 2010.
  22. Glassman A, Maj M, Sartorius N (eds). Depression and heart disease. Chichester: Wiley-Blackwell, 2011.
  23. Kissane DW, Maj M, Sartorius N (eds). Depression and cancer. Chichester: Wiley-Blackwell, 2011.
  24. De Hert M, Correll CU, Bobes J et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52-77.
  25. De Hert M, Cohen D, Bobes J et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011; 10:138-151.
  26. Appelbaum P, Arboleda-Florez J, Javed A et al. WPA recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry. World Psychiatry 2011; 10:155-158.
  27. Wallcraft J, Amering M, Freidin J et al. Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry 2011; 10.
  28. Gureje O. The WPA Train-the-Trainers Workshop on Mental Health in Primary Care (Ibadan, Nigeria, January 26-30, 2009). World Psychiatry 2009; 8:190.
  29. Fiorillo A, Lattova Z, Brahmbhatt P et al. The Action Plan 2010 of the WPA Early Career Psychiatrists Council. World Psychiatry 2010; 9:62-62.
  30. Alhasnawi S, Sadik S, Rasheed M et al. The prevalence and correlates of DSM-IV disorders in the Iraq Mental Health Survey (IMHS). World Psychiatry 2009; 8:97-109.
  31. Hong J, Knapp M, McGuire A. Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis. World Psychiatry 2011; 10:40-44.
  32. Maj M. WPA-WHO collaborative activities 2009-2011. World Psychiatry 2009; 8:129-130.
  33. Patel V, Maj M, Flisher AJ et al., Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry 2010; 9:169-176.
  34. Maj M. The rights of persons with mental disorders: the perspective of the World Psychiatric Association. Lancet (in press).
  35. Okasha T. WPA forthcoming scientific meetings. World Psychiatry 2009; 8:191-192.
  36. Kieling C, Herrman H, Patel V et al. Indexation of psychiatric journals from low- and middle-income countries: a survey and a case study. World Psychiatry.

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