global mental health & psychiatry caucus of the american psychiatric association newsletter, vol...

Global Mental Health & Psychiatry Caucuso f t h e A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n

Editor-in-Chief

Eliot Sorel, MD

Zonal Editors Africa: Prof. David M. Ndetei,

Kenya and Prof. Solomon Rataemane,

South Africa

$VLD�3DFL¿F��Prof. Yueqin Huang,

China and Prof. Roy Kallivayalil, India

Americas: Prof. Fernando Lolas, Chile

and Prof. Vincenzo Di Nicola, Canada

Europe: Prof. Gabriel Ivbijaro, United

Kingdom and Dr. Mariana Pinto da

Costa, Portugal

Associate Editors Miguel Alampay, MD

Rajeev Sharma, MD

Veronica Slootsky, MD

Mona Thapa, MD

Milangel Concepcion-Zayas, MD

Layan Zhang, MD

Dear Colleagues & Friends,Greetings from Washington, DC…!:HOFRPH�WR�WKH�¿UVW�LVVXH�RI�WKH�Global Mental Health & Psychiatry Caucus Newsletter.We are grateful to our young col-leagues, Doctors Philip Murray, Urooj Saeed, Rajeev Sharma, Veron-ica Slootsky, Mona Thapa and Mila-ngel Concepcion-Zayas who inspired E\�WKHLU�¿UVW�LQWHUQDWLRQDO�VFLHQWL¿F�experience at the WPA 2013 Bucha-rest Congress initiated, in the spring of 2013, the action paper to estab-lish the Global Mental Health and Psychiatry Caucus (GMHPC) of the American Psychiatric Associa-tion, now a reality. The Caucus is a component of the APA Council of International Psychiatry.$V�WKH�¿UVW�HOHFWHG�&KDLU�RI�WKH�GMHPC and the Editor-in-Chief of our Newsletter, I am pleased to present to you our editorial team. They are:Zonal Editors Africa: Prof. David M. Ndetei, Kenya and Prof. Solomon Ratae-mane, South Africa $VLD�3DFL¿F: Prof. Yueqin Huang, China and Prof. Roy Kallivayalil, IndiaAmericas: Prof. Fernando Lolas, Chile and Prof. Vincenzo Di Nicola, Canada

Eliot Sorel, MD Editor-in-Chief

Europe: Prof. Gabriel Ivbijaro, United Kingdom and Dr. Mariana Pinto da Costa, PortugalAssociate Editors Doctors Miguel Alampay, Rajeev Sharma, Veronica Slootsky, Mona Thapa, Milangel Concepcion-Zayas, Layan Zhang, all members of the Career, Leadership & Mentorship program of the Washington Psy-chiatric Society. We thank Anirban Chakraborty and all the Associate editors for their enthusiasm and the creative Newsletter logo design. We hope to involve other young psy-chiatrists as Associate Editors as we develop the Newsletter.The GMHPC Newsletter will be published three times a year. The ¿UVW�LVVXH�LV�SXEOLVKHG�WKLV�6HS-tember 2015. The following two issues will be published in January and May 2016. We welcome global mental health news from throughout the world coordinated by our Zonal Editors and assisted by our Associ-ate Editors. The news may include sharing of research, education and WUDLQLQJ�SURJUDPV��VFLHQWL¿F�HYHQWV��advocacy and health policy initia-tives and opinions. We thank Congressman Patrick Kennedy and former APA Presidents, Doctors Jeffrey Lieberman, Dilip Jeste and Michellle Riba and the dedicated APA staff for their support of our Caucus.

Newsletter Issue I, Volume I September 2015

2

Table of ContentsCouncil on International Psychiatry .................................................... 3 Michelle B. Riba, MD, MS ChairAfrICA ZonE: Mental Health Activities in Sub-Sahara Africa .................................... 4 Professor Solomon RataemaneASIA/PACIfIC ZonE: Earthquake in nepal and Mental Health response ............................. 5 Mona Thapa, MD and Brandon Kohrt, MD, PhDMental Health news from Asia .............................................................. 6 Yueqin Huang, MD, PhDIndian Psychiatric Society ...................................................................... 7 Roy Abraham Kallivayalilthe AMErICAS ZonE: So Much Trauma, So Close to Home: Seeing Beyond the Bidonvilles to Celebrate Porosity in Port-au-Prince ............................ 8 Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPThe WPA 2013 Bucharest Congress: A Building Block Towards the Development of the Global Mental Health and Psychiatry Caucus ............ 11 Milangel Concepción-Zayas, MD; Veronica Slootsky, MD; Mona Thapa, MDEuroPE ZonE: EfPT Psychiatry Trainees forum in Porto on Global Mental Health ........................................................................... 13 Mariana Pinto de Costa, MDHealth Workforce 2030 ........................................................................ 14 Professor Gabriel Ivbijaro MBE, JPInternational Membership Expands at APA....................................... 15 Rahn K. Bailey MD, DFAPAWPA Bucharest International Congress ............................................. 16

GLOBAL MENTAL HEALTH & PSYCHIATRY CAUCUS of the American Psychiatric Association 3

The Council on Internation-al Psychiatry is focused on international membership, education and training. The Council seeks to identify opportunities for collabora-tion with other international psychiatric organizations for the promotion of inter-

national membership through respective publications and meetings. The Council is also interested in developing and VROLFLWLQJ�UHOHYDQW�FRQWHQW�IRU�$3$�VFLHQWL¿F�SURJUDPV��Additionally, the Council seeks opportunities for increas-ing international participation in APA meetings and en-couraging participation of APA members at international meetings. The Council helps to forge an international relationship between the APA and the World Psychiatric Association. At the May 2015 meeting of the Council, the President of the WPA, Dinesh Bhugra addressed the Council. Potential opportunities for the APA and the WPA consist of work-ing more closely together in a manner that successfully OHYHUDJHV�HDFK�RUJDQL]DWLRQ¶V�JRDOV�ZLWKRXW�FRQÀLFWLQJ�with each other’s programs. Dr. Edmond Pi is the current WPA Zone 2 representative to the WPA. There are many sections of the WPA where APA members can get more involved. Dr. Pedro Ruiz, past president of the APA is also the immediate past president of the WPA. We are so fortunate that Ricardo Juarez provides staff support to our Council. The Council is working with Dr. Steve Koh, the Chairper-VRQ�RI�WKH�$3$�6FLHQWL¿F�3URJUDP�&RPPLWWHH�UHJDUGLQJ�how to help facilitate more international aspects to the Annual Meeting as well as the Institute on Psychiatric Services. We are thinking about an international poster session that might be useful for international psychiatrists to present their work and to meet others from around the world. Communication and coordination will be very important aspects of our work. We will work very closely with the APA Assembly to solicit their input and feedback as well as International Psychiatric Interest Groups, for example the Indo American Psychiatric Association and the Nige-rian American Psychiatric Association and the Association of Korean American Psychiatrists, just to name several.

COUNCIL ON INTERNATIONAL PSYCHIATRY

By Michelle B. Riba, MD, MS ChairAugust 7, 2015

There are many such groups and we are compiling a list so that we can reach out to all groups and to have their voice in our Council. One of the honors we have in our Council is to nominate a deserving individual for the Human Rights Award and the Council is trying to determine possible nominees.We are so pleased that Vivian Pender, MD, liaison to the Council, will be joining the Council. We look forward to working with Dr. Pender and other members of the UN group.We are much honored to have the Caucus on Global Men-tal Health and Psychiatry reporting and working with us. Dr. Eliot Sorel is the current chair of the Caucus. We are supportive and enthusiastic about the Caucus being a place where residents and fellows who are interested in global PHQWDO�KHDOWK�FDQ�EH�LQYROYHG�YLD�WKH�FDXFXV�DQG�FDQ�¿QG�JXLGDQFH�DQG�GLUHFWLRQ�RQ�KRZ�WR�QDYLJDWH�WKH�¿HOG��'U��Milton Wainberg, the immediate past Caucus Chair, and 'U��)UDQFLV�/X�DQG�'U��0LFKHOOH�5LED�DUH�HGLWLQJ�D�VSHFL¿F�edition of the journal, Academic Psychiatry, on training in global mental health.Members of the Council on International Psychiatry include:

Allan Tasman; Ann Becker; Bibhav Acharya; Christopher White; David Baron; Dilip V Jeste; Edmond Pi, MD; Eliot Sorel; Giuseppe Raviola; -DJDQQDWKDQ�6ULQLYDVDUDJKDYDQ��-DPHV�*ULI¿WK��-RKQ�S. McIntyre; Kenneth Busch; Mawuena Agbonyitor; Michael D. Morse; Michelle Riba; Mounir Soliman; Nalini Juthani; Pedro Ruiz; Rachel Winer; Samuel Okpaku; Solomon Rataemane; Suni Jani; UK Quang-Dang; Vera Tate

In summary, we appreciate the opportunity to work with colleagues from throughout the world, to learn from one another and to use our collective resources to help pro-mote better psychiatric care for patients and families. We are looking forward to being able to better understand how we can improve communication and membership as well as opportunities for education and training in global men-tal health. We are very appreciative of the guidance of the Assembly and look forward to input from the International Psychiatry Interest Groups, among other groups.

Table of Contents

4

MENTAL HEALTH ACTIVITIES IN SUB-SAHARA AFRICA

Africa deals with all sorts of mental health problems includ-ing sequelae of migration and disasters. The known mental illnesses such as schizophrenia and bipolar mood disorders are further compounded by head injuries, HIV/AIDS and substance abuse. It is in this context that the African Asso-ciation of Psychiatrists and Al-

lied Professions (AAPAP), collaborates with National Associations of mental health to host annual meetings in which further trends in mental health, particularly in Sub-Saharan Africa are reviewed with recommenda-tions on how to work together to reduce the morbidity associated with severe mental illness and co-occurring disorders. The 2015 annual meeting of AAPAP will be hosted in collaboration with Ghana Psychiatric As-sociation and Ghana Psychological Association at the University of Ghana 15 – 17 October in Accra, Ghana. The theme of the conference is “Mental Health in Africa: Prospects and Challenges”THEME: “Mental Health in Africa: Prospects and Challenges”This theme will address various aspects of mental health including! Neuropsychiatric aspects of mental health ! Mental health in the workplace! Consolidation of mental health research in Africa! Principles of psychosocial rehabilitation in mental health! Challenges in the assessment of children

! Scaling up mental health services in Africa! In-group/out-group issues in multicultural societies! Attitudinal challenges in African development! Effects of disaster, displacement and trauma in Africa! Advocacy for mental healthThese sub-themes focus on issues relevant to mental health in Africa. The presenters will also showcase ongoing research in various centers despite limited ¿QDQFLDO�UHVRXUFHV��7KLV�ZDV�FOHDUO\�GHPRQVWUDWHG�at a conference in Nairobi, Kenya 13 - 16 July 2015, with the theme of “Trauma through the Life Cycle.” The conference was sponsored by the Peter C Al-derman Foundation; University of Nairobi and the Mental Health Research Foundation based in Nairobi. It addressed triggers and expressions of psychologi-FDO�WUDXPD�IURP�WKH�ZRPE�WR�WKH�WRPE��ZLWK�VSHFL¿F�emphasis on assessment and management in the pri-mary health care settings. Finally, in addition to other regional meetings, The World Federation for Mental Health will host a more holistic World Congress in Cairo, Egypt 16 - 19 October 2015 addressing similar LVVXHV�LQ�WKH�FXUUHQW�FRQÀLFW�GXH�WR�HFRQRPLF��VRFLDO�and political tensions in the Mediterranean Zone.

Professor Solomon rataemane International Fellow of the APA &KDLUSHUVRQ�RI�:3$�6HFWLRQ�RQ�&RQÀLFW�0DQDJHPHQW�DQG� &RQÀLFW�5HVROXWLRQ Chief Psychiatrist: Sefako MakgathoHealth Sciences University (SMU), South Africa

by Professor Solomon Rataemane

AFRICA


EARTHQUAKE IN NEPAL AND MENTAL HEALTH RESPONSE by Mona Thapa, MD and Brandon Kohrt, MD, PhD

April 25th, 2015: An earthquake of huge magnitude hit Nepal. Since then there have been hun-dreds of aftershocks and second TXDNH�QHDUO\�PDWFKLQJ�WKH�¿UVW�in magnitude. This has been the most devastating natural disaster Nepal had seen in more than 80 years. More than 9,000 people were killed, more than 25,000 people were injured and almost

half a million were displaced as many people lost their homes and livelihoods. The quakes destroyed world heri-tage sites, which provide both a connection to Nepal’s history and a draw for tourists from around the globe. Nepal as a country wasn’t prepared to face and overcome that huge magnitude of loss. Immediate relief for food, shelter, and physical injuries was provided with the help of many volunteers. Nepalese responded immediately to help their neighbors and organized relief trips to remote villages in the affected areas. International workers are also providing support and services.Services are now transitioning from acute relief to long-term recovery in all areas of life, including mental health. Psychological distress from the disaster and the ongoing challenges resulting the quakes can have long-lasting effects even after the physical infrastructure is rebuilt. There are daily stories in the press and on social media of people continuing to suffer from insomnia, anxiety, and disturbing bodily sensations (headaches and other pains, feeling that the earth is continuously mov-ing). A Nepal police report shows a rise in suicide by 25 percent in the Kathmandu valley after the earthquake.

Amidst all these chaos, mental health specialists (though limited in numbers) have done some interven-tions like providing psychoeducation in small groups in affected area or via radio and television shows. Organized activities are being conducted by the World Health Organization, UNICEF, the Nepal Red Cross, and many non-governmental organizations. Within the disaster response network there are subclusters for both mental health and psychosocial services. Materials such as Nepali version of Psychological First Aid manuals and the mental health Gap Action Programme — Hu-manitarian Intervention Guide (mhGAP-HIG) and desk review of mental health and psychosocial needs and services in Nepal have been completed. Training local health workers in earthquake-affected is areas is a main priority, and research projects are being initi-ated to study impacts of the quake and effectiveness of services. In low and middle income countries like Nepal, aware-ness of mental illness is very poor among the general population, availability of treatment facilities are count-DEOH�DQG�¿QDQFLDO�UHVRXUFHV�DUH�VR�VFDUFH��WKH�DOORFDWLRQ�of resources for mental health can be disproportionate as more tangible issues takes precedence. However, it can be addressed by integrating mental health with primary care and other longitudinal post-earthquake rebuilding services. If properly organized and executed, current crisis can actually be an opportunity to cre-ate more awareness about mental health to the public, expand more services and improve current status of mental health treatment throughout the country.

references: 1) Landry, M. D., Raman, S. R., & Kohrt, B. A. (2015). Disability as an Emerging Public Health Crisis in Postearthquake Nepal. American journal of public health,105(8), 1515-1517.2) E. Sorel, 21st Century Global Mental Health, 20133) KWWS��PKLQQRYDWLRQ�QHW�VLWHV�GHIDXOW�¿OHV�GRZQORDGV�UHVRXUFH�1HSDO��HDUWKTXDNHV�� 0+366��GHVN��UHYLHZB��B��SGI

Mona Thapa, MD

ASIA/PACIFIC

6

MENTAL HEALTH NEWS FROM ASIA

1. facing mental health issues resulting from change of socioeconomic and increasing population in AsiaWith a population exceeding 4.1 billion, Asia is by no means a homogeneous continent. Asia is also a veritable chest of economic treasures and a collection of some of the poorest areas of the world. As a result of these highly varied political systems, Asia also spawns a wide variety of health care systems. Over 500 million persons are reported to suffer from mental or neurological disorders in the continent. Remarkable improvements in economic conditions and a considerable upgrade in the quality of life have been observed in many parts of Asia during the past several decades. Meantime, many mental health challenges face the people of Asia. Common trends in mental health issues associated with rapid socio-cultural change ob-served in different Asian societies are discussed, as well as the relative shortage of mental health personnel avail-able in many Asian societies. 7KH�XQGH¿QHG�EXUGHQ�RI�PHQWDO�SUREOHPV�UHIHUV�WR�WKH�economic and social burden for families, communities and countries. Although obviously substantial, the bur-GHQ�KDV�QRW�EHHQ�HI¿FLHQWO\�PHDVXUHG��7KLV�LV�EHFDXVH�RI�WKH�ODFN�RI�TXDQWLWDWLYH�GDWD�DQG�GLI¿FXOWLHV�LQ�PHDVXULQJ�and evaluating. The hidden burden refers to the burden associated with stigma and violations of human rights and freedoms. 2. Improving mental health care in Asian countriesMental health care is therefore by no means standard-ized and extremely varied. These are important points to note, as the many so-called norms of psychiatric care in many economically highly developed countries may not

only be not applicable but highly detrimental to mental health care in many parts of Asia. This is particularly true of some aspects of mental health care that are taken for granted in many developed countries, such as com-munity care for the mentally ill, social security for the disabled, hostels for discharged mental patients in the community, and free treatment for the mentally ill. These and many other aspects of mental health care are not available in vast areas of Asia and often substituted by a remarkably resilient, but not always highly successful, family care alternative and a strong heritage of tradi-tional medical care for the mentally ill, that is very often the norm.3. Increasing resource of mental health services in Asian countriesThe ratio of mental health personnel to population is nowhere near the WHO recommended levels in the less developed countries of the continent. In China there are about 20,000 psychiatrists for 1.3 billion people. In India, with 1.2 billion people, there are but 3000 psy-chiatrists. Indonesia has about 500 psychiatrists for 237 million people in over 13,000 islands. But numbers of psychiatrists alone do not tell the whole story, as the distribution of the psychiatrists is so heavily weighted in favor of the large and prosperous cities that the rural poor are not able to access even basic mental health care. The story is not much different in India, Philippines or Thailand. Mental health should become a high priority in most Asian countries, with the recent emphasis at inter-national level.

by Yueqin Huang, MD, PhDProfessor of Psychiatric EpidemiologyInstitute of Mental Health, Peking University


The 67th Annual Conference of Indian Psychiatric Society — a Member Society of World Psychiatric As-sociation — held at Hyderabad on January 8 -11, 2015 was a grand success. The conference theme was “Mental Illness — Recovery and Social Inclusion.”The event held at the Hyderabad International Conven-tion Centre (HICC) was inaugurated by Hon B. Datta-treya (Union Minister, Govt of India). Prof TV Asokan presided. Representing WPA, President Prof Dinesh Bhugra, President Elect Prof Helen Herrman and Secre-tary General WPA Roy Abraham Kallivayalil spoke at the Conference. Other overseas speakers included Prof Paul Summergrad (President, APA) and Prof Murray Pat-ton (President, RANZCP).

INDIAN PSYCHIATRIC SOCIETYby Roy Abraham Kallivayalil

CME Sessions, Presidential Address, Workshops, Sym-posia, Award Sessions, Theme Symposium, Invited Lec-tures, Free Papers, Posters, IAPA/ BIPA/ SPF Sessions, Annual General Body Meeting and Cultural events were some of the highlights. The Conference made history being the largest ever, with nearly 4,500 delegates from India, and several countries from all over the world par-ticipating. A committed and dedicated team led by Dr. M.S. Reddy and Dr. G. Prasad Rao organised the event in an outstanding manner. Hearty congratulations to them!A new team with Dr. Vidyadhar Watve, President; Dr. G. Prasad Rao, Vice-President; Prof N.N. Raju, Sec-retary General; Dr. Vinay Kumar (Treasurer) and Prof 7�6�6��5DR��(GLWRU��KDYH�DVVXPHG�RI¿FH��2XU�EHVW�ZLVKHV�to them.

ASIA/PACIFIC

8

AS A LIfE-LonG STuDEnT of trauma and as a francophone psychiatrist working in Montreal, a sojourn in Haiti’s devastated capital, Port-au-Prince, beckoned me for many years. Whenever I asked a Haitian col-league about visiting Haiti, he would say, wait for things to settle down. First it was due to politics, following the ouster of President Aristide in 2004, later it was the dev-astation in the wake of the earthquake that fairly leveled the capital city in 2010. Almost no one encouraged such a visit! Neither Haitians themselves, nor my colleagues in health care supported it. Their message conveyed a perfect storm of devasta-tion, destitution and danger. Those who survived the earthquake and those who worked there in its aftermath transmitted lessons about “trauma”—traumatic events (poverty, violence, disasters), a traumatized population in survival mode, and traumatizing experiences (alienat-ing experiences on the streets and with the health care system). Finally, with support from three sources – the University of Montreal’s Department of Psychiatry, APA’s Global Mental Health & Psychiatry Caucus, and the Harvard Program for Refugee Trauma – I was on my way. When the Global Mental Health Caucus meeting was held at the APA Annual Meeting in Toronto this year, I spoke to the disabling notion that we come to other places as experts with knowledge and skills, diagnoses DQG�VROXWLRQV��2Q�WKH�HYH�RI�P\�¿UVW�YLVLW�WR�+DLWL��,�VHW�

myself the challenge to learn from my hosts and my encounters with Haitians.So, what did I learn during my Haitian sojourn?“LA KAY SE LA KAY.” First, it would be foolish to deny the problems that are evident everywhere in Haiti. To adapt the title of Raymond Carver’s short stories, in Haiti there is so much trauma, so close to home. And yet, I believe that as psychiatrists, we see trauma after the fact, like an ambulance arriving after the accident. It’s a crucial point: we often see effects and consequences, not the trauma itself. We do not have direct access to the hu-man experience that we call trauma. And these impacts are not always traumatizing, which I understand to mean limiting or disabling. In Port-au-Prince, signs of physical disaster are more evident than signs of disabling human trauma. While the walls of the city declare in Creole, LA VI PA FACIL��/LIH�,VQ¶W�(DV\��WKH\�DOVR�DI¿UP�WKDW��LA KAY SE LA KAY, Home Sweet Home. “This Too Shall Pass!” Second, there is the question of state structures, resources and solutions. In geopolitical circles, the concepts of failed states, collapsed states and IUDJLOH�VWDWHV�KDYH�EHHQ�ÀRDWHG��'R�WKH\�DSSO\�WR�+DLWL"�Well, it depends. While I prefer the nuances of fragility rather than failure, it depends on whether the concept applies strictly to a state’s sovereignty or to the people. If it’s true that the state has failed or is fragile, it’s equally important to witness that the people have not! One of my hosts taught me a Haitian saying, “CAP—Cela aussi

SO MUCH TRAUMA, SO CLOSE TO HOME:Seeing Beyond the Bidonvilles to Celebrate Porosity in Port-au-Princeby Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPA


passera!” This too shall pass! Several of my Haitian hosts understand this attitude not as fatalistic but as pragmatic resignation. What would trigger a strike in the neighboring Dominican Republic, over bus fares, for example, is met with weary resignation by Haitians, according to my Haitian host, psychiatrist Dr. Hans Lamarre, President-Elect of our APA District Branch in Quebec and Eastern Canada. Haitians are at once both resigned and guardedly hopeful! A palpable spirituality pervades the entire public experi-ence of Port-au-Prince! I asked this question many times: 'LG�WKH�HDUWKTXDNH�FKDQJH�WKH�SHRSOH¶V�IDLWK"�7KH�XQDQL-mous answer, declared on the buses and walls of the city ZLWK�VXFK�DI¿UPDWLRQV�DV�²�DIEU TOUT PUISSANCE, All Power Is God’s, and BON DIEU AVANT TOUT, God Is Good, Above All — is that disasters fortify rather than shake the people’s faith.Porosity. Finally, my visits to other places helped me see beyond half-destroyed, half-rebuilt buildings, to witness material poverty abutting cultural richness. I avoided the “disaster tourism” that I experienced in Rio de Janeiro, New Orleans, and Buenos Aires. Ghettos, favelas, bidon-villes—whatever we call them, from Portugal’s barrios de lata (shanty towns) to the ciudades perdidas (lost cit-ies) of Mexico, slums dot the world, residing within, on top of, beside or below the world’s major cities. Port-au-Prince, in mountainous Haiti, is one big Rio de Janeiro with bidonvilles clinging precariously to the mountains while the government buildings, hospitals, schools and churches that still stand after the 2010 earth-quake crowd the city’s plateau. But it is also a Caribbean Naples. Walter Benjamin’s essay on Naples captured its most abundant quality — porosity. And like Naples, 3RUW�DX�3ULQFH�LV�SRURXV��LQFRPSOHWH��XQ¿QLVKHG��ZLWK�boundaries and categories bleeding into each other, over-ÀRZLQJ�ZLWK�MDUULQJ�MX[WDSRVLWLRQV��IXQN\�DUW�JDOOHULHV�beside “Gingerbread” ruins, street slogans and banners in the people’s Créole amid a panoply of ads for private VFKRROV�LQ�SURXGO\�UH¿QHG�FRORQLDO�)UHQFK��V\PEROV�RI�

African Vaudoun that we know as “Voodoo,” intermin-gled with French Catholicism, and everything for sale on the streets in a city suffused with spirituality. Port-au-3ULQFH�LV�YXOJDU�DQG�UH¿QHG��VDFUHG�DQG�SURIDQH��LPSRY-erished and privileged — much as Naples, New Orleans, and Salvador, Bahia, port cities of the world where the culture rises from the sea and the ground up.In sum, as a cultural psychiatrist, I observe everywhere that the work of culture — dialogues and relations, knowledge and solutions — is acquired and constructed, QRW�PHUHO\�KDUG�ZLUHG��7KLV�ZDV�PDJQL¿FHQWO\�PDQLIHVW�during my sojourn among Haitians through the beauty of their poetry, their art and sculpture, their adaptability, and their unshakeable faith. And the Creole art of living porously is what will bring me back to learn more about the culture of Ayiti, Haiti.

Haiti Mission report and Strategic PlanIn the spirit of the above carnet de voyage or travel diary, here is a partial list of activities, contacts and projects GXULQJ�P\�¿UVW�PLVVLRQ�LQ�+DLWL�LQ�0D\�RI�� ,QDXJXUDO�OHFWXUHV�RQ�FKLOG�SV\FKLDWU\�DW�WKH�Faculté de Médecine et des Sciences de la Santé, Université Notre Dame d’Haïti (FMSS-UNDH), supported by the Dean, Dr. Jean Hugues Henrys, and the Vice-Dean for Teaching, Dr. Audie Metayer, of FMSS-UNDH. These ZHUH�WKH�¿UVW�OHFWXUHV�RQ�FKLOGUHQ¶V�PHQWDO�KHDOWK�QHHGV�in Haiti. Furthermore, there are no child psychiatrists in Haiti and no child psychiatry services there. �� 9LVLW�WR�WKH�0DUV�DQG�.OLQH�3V\FKLDWULF�+RVSLWDO��3RUW�au-Prince, where I participated with Dr. Hans Lamarre in a clinical seminar with psychiatry residents and medical students.�� &ROORTXLXP�DW�85$0(/��Unité de Recherche et d’Action Médico Légale – Fondation de France/Unit for Research and Forensic Action, Port-au-Prince, on “Our Youth at Risk,” attended by psychiatry residents, psy-

the AMERICAS

10

chologists and a variety of local health care professionals and medical leaders.�� 0HHWLQJ�ZLWK�SV\FKLDWULF�DQG�EXVLQHVV�OHDGHUV��'U��Claude Manigat and Mr. Oswald Brun, who have recent-ly founded the Fondation Haïtienne de la Santé Mentale/Haitian Foundation for Mental Health. I offered to work with them concerning youth and families in Haiti.�� 0HHWLQJ�ZLWK�3DVWRU�&OpPHQW�-RVHSK¶V�LQWHUIDLWK�JURXS�– Mission Sociale des Églises/Pastoral Social Mission – to help them build a plan for psychosocial support in the wake of disasters, natural and man-made. Pastor Joseph is a strong leader with charisma, an ecumenical mission and an established community resource base. We have reached out to Dr. Eliot Sorel, the Chair of the Global Mental Health & Psychiatry Caucus, and U.S. Gen. Rus-VHOO�+RQRUp��D�GLVWLQJXLVKHG�OHDGHU�LQ�WKH�¿HOG�RI�GLVDVWHU�planning, both of whom have offered their assistance to this group. Pastor Joseph invited me to work with two groups – the interfaith coalition and a group of 25 pas-tors to sensitize them on children and family issues.�� 0HHWLQJ�ZLWK�+DLWLDQ�SV\FKRORJLVWV�ZKR�DUH�IRUHLJQ�trained (France and Belgium) and in private practice seeking training, supervision and support in couples and family therapy. They could be the founding group for Haitian marital and family therapy with our support. They plan to bring me back to Haiti for advanced train-ing, supervision and professional support.There are too few psychiatrists and no child psychiatrists in Haiti, a country of an estimated population of 9.446 million people in 2006. A WHO study published in 2011 LGHQWL¿HG��SV\FKLDWULVWV�WKHUH��EXW�WKH�OHDGHUV�,�PHW�informed me that the number is perhaps only half of that! More critical than the limited human resources is the “treatment gap” in children’s mental health care. Even where there are epidemiological studies that establish WKH�SUHYDOHQFH�RI�LGHQWL¿DEOH�PHQWDO�KHDOWK�FKDOOHQJHV��VLJQL¿FDQW�WUHDWPHQW�JDSV�H[LVW�EHWZHHQ�WKRVH�FKDOOHQJHV�and access to care, including in much better resourced nations such as the USA! In the light of these observations, I want to identify people who are already working with youth, families, DQG�FRPPXQLWLHV�LQ�RUGHU�WR�¿QG�ORFDO�SDUWQHUV�IRU�P\�mission. I believe we can identify four distinct groups: 1. fMSS-unDH for preparing future physicians and planting seeds. Dr. Richard Mollica, Director of the

Harvard Program for Refugee Trauma (HPRT), has been working with Fr. Jean-Charles Wismick, Ph.D., Vice-5HFWRU�IRU�$FDGHPLF�DQG�6FLHQWL¿F�$IIDLUV�DW�81'+��WR�establish a mental health program with both teaching and clinical components. 2. urAMEL for their broad NGO-style mandate to work with medico-legal issues but also a wider vision that includes mental health.3. Mission Sociale des Églises/Pastoral Social Mission – community-based and outreach-focused interfaith group with a mission and a vision.4. High-level professionals with training and experience at international standards who are in private practice and who serve a certain class while taking part in planning and support to other organisms with a broader reach; my hope is that supporting this group will establish new ideas and practices in Haiti, that eventually, through ³WULFNOH�GRZQ´�DQG�³WUDFNLQJ�WKURXJK�´�ZLOO�EHQH¿W�PRUH�of Haitian society.In short, the local and national human resources in Haiti are solid, creative and inspiring! They have the leader-ship, drive and task-orientation that is needed for build-ing a better society. My own limited mission is part of a larger one that involves colleagues in pediatrics and will soon include obstetrics-gynecology and surgery. Our mission in global mental health involves Dr. Hans Lamarre, Haiti Mission Director, and Dr. Emmanuel Stip, Chair of the Dept. of Psychiatry at the Université de Montréal/University of Montreal, working closely with Fr. Wismick at the UNDH and Dr. Mollica at the HPRT, and the support of Dr. Sorel, Chair of the APA GMH&P Caucus. Together, we are participating in a historic op-portunity to build sustainable programs for integrated, total health of children, families, and communities in Haiti.

Vincenzo Di nicola, MPhil, MD, PhD, frCPC, fAPAProfessor of Psychiatry, University of MontrealRepresentative to the APA AssemblyPast-President of the Quebec & Eastern Canada District BranchNewsletter Zonal Co-Editor for the Americas


The disci-pline of global mental health is an area that has emerged in the contrast-ing context of increased recognition of mental illness

across cultures, a body of grow-LQJ�HYLGHQFH�UHÀHFWLQJ�WKH�XQHTXDO�share of mental disorders within socially disadvantage communities, the big burden it poses to society due to its emergence early in life, and the amount of disability and early mortality , the development RI�HI¿FDFLRXV�DQG�FRVW�HIIHFWLYH�treatments for mental disorders in

low-and middle-income countries (LAMICs) and the recognition of human rights violations and infrahu-man conditions1��7KHUH�KDV�EHHQ�VLJQL¿FDQW�DGYDQFHV�LQ�WKH�¿HOG��KRZHYHU�WKHUH�DUH�VWLOO�FKDOOHQJHV�LQ�WHUPV�RI�knowledge, translation, the eradication of stigma and the lack of integration among the mental health, primary care and public health sectors2, among others. The Global Mental Health and Psychiatry Caucus (GMHPC) was the result of a process of a vision, ongoing GLVFXVVLRQV��WLPHO\�HQFRXQWHUV�DQG�VFLHQWL¿F�NQRZOHGJH�exchange. The vision: The passion and of our mentor Dr. Elliot Sorel for the global mental health topic and the in-creased interest and cultural diversity within our group of forming psychiatrists in the Washington DC area3, were the perfect fusion for the discussion of topics around the education and practice of psychiatry in a glo-balized world and culturally diverse transforming health

care system. Ongoing discussions on topics such as the mental health action plan, travel psychiatry, childhood PTSD, primary FDUH�LQWHJUDWLRQ�LQ�JOREDO�KHDOWK��KXPDQ�WUDI¿FNLQJ�DQG�projects such as and a depression screening in China were addressed within the global mental health scope a were an important primer to the conceptualization. Timely Encounters: In one of our quarterly activities we also had the opportunity to hear from one of the world global mental health expert Dr. Pamela Collins the study Grand Challenges in Global Mental Health. Our discussions and meetings felt like a responsibility for action. With the nurturing guidance of our mentors, who had foster our interests, we had the opportunity to present at the World Psychiatry Association 2013 Bucha-rest Congress: Integrating primary care, mental health & public health: the catalytic role of information & com-munication technology. 6FLHQWL¿F�.QRZOHGJH�([FKDQJH��The WPA 2013 Con-gress was an amazing experience of sharing knowledge. While enjoying ourselves in the beautiful Bucharest, we we were invited by leaders to think about possibilities to bring, in a systemized and responsible way, an opportu-nity to catalyze open and interdisciplinary discussions addressing global mental health needs within an integra-tive context, while at the same time addressing issues of stigma.This was pivotal and propulsive to the decision of proposing a Global Mental Health Caucus within the American Psychiatric Association. The WPA 2013 Bucharest Congress was the consolida-tion of shared ideals into a reality that represents a space for collaboration, expanding the horizon in mental health exchanges among professionals. The GMHPC aims to connect mental health professionals help guide the pres-ent knowledge and actions in Mental Health domesti-cally and around the globe.

1 Patel V. Global Mental Health: From Science to Action. Harvard Review of Psychiatry. 2012;20(1):6-12. doi:10.3109/10673229.2012.649108.2 Sorel. E. (2013). 21ST Century Global Mental Health Challenges. Jones and Barlett, Publishers.3The Career Leadership Mentorship program from the Washington Psychiatry Society http://dcpsych.org/clm/

THE WPA 2013 BUCHAREST CONGRESS: A Building Block Towards the Development of the

Global Mental Health and Psychiatry Caucus by Milangel Concepción-Zayas, MD; Veronica Slootsky, MD; Mona Thapa, MD

Veronica SlootskyMilangel Concepción-Zayas

the AMERICAS

Mona Thapa, MD

12

The Global Mental Health & Psychiatry Caucus at the APA Annual meeting in Toronto in May 2015.

Dr. Eliot Sorel and former Congressman Patrick Kennedy. We are grateful to former Congress-man Patrick Kennedy for addressing our caucus in Toronto and challenging us to advocate for mental health parity and non-discrimination nationally and globally.

the AMERICAS


EFPT PSYCHIATRY TRAINEES FORUM IN PORTO ON GLOBAL MENTAL HEALTH

The 23rd Forum of the European Federation of Psychi-atric Trainees (EFPT) occurred between 22 and 27 June 2015 in the city of Porto in Portugal, being preceded for WKH�¿UVW�WLPH�E\�D�3UH�)RUXP�&RXUVH�EFPT is the independent federation of psychiatric train-ees associations of more than 30 countries, representing and supporting thousands of junior doctors training in SV\FKLDWU\�LQ�(XURSH��DQG�LW�KDV�EHHQ�WKH�¿UVW�LQWHUQD-tional organization of trainees in any branch of medicine, created in 1992. The Leadership and Professional Skills Course that took place between 19 and 22 June, directed by Prof. Norman Sartorius and Prof. Sir David Goldberg, was an excel-lent opportunity for the selected young psychiatrists to strengthen their competencies.7KH�6FLHQWL¿F�3URJUDPPH�RI�WKH�)RUXP�KDV�EHHQ�RSHQ�to all junior doctors, medical students and mental health professionals from the different regions of the world, interested in contributing for a multidisciplinary discus-sion, under the motto of “Global mental health,” pro-moting the maxim: “there is no health, without mental health.” The best e-posters and the best oral presentations were distinguished and awarded with prizes.

I am delighted that so many world-renowned profession-als have supported and participated in our EFPT Forum in Porto, bringing life to dialogues and offering a new overview to the conclusions. We are very proud and pleased with the feedback and outcomes of this event as successful, providing plenty of networking opportunities under an enjoyable atmosphere.Quoting a Portuguese writer and poet Fernando Pessoa: “The value of things is not in the time they last, but in the intensity with which they occur. That is why there are unforgettable moments and unique people!”We are grateful to all of those that have contributed for this global endeavor.

Mariana Pinto da Costa, MD President of the 23rd Forum of the European Federation of Psychiatric Trainees (EFPT) Contact: [email protected]

EUROPE

by Mariana Pinto de Costa, MD

14

Since the last meeting of the Caucus in May 2015 there have been a range of ongoing initiatives including some new ones that I would like to share with you.Health Workforce 2030 In May 2014, the 67th World Health Assembly requested the development of a new global strategy on human resources for health to be considered by the 69th World Health Assembly in May 2016. The WHO is currently consulting on a global strategy on human resources for health entitled Health Workforce 2030. It is important for our members to participate fully in this debate and I am urging GMHPC Caucus members to respond to the online public consultation towards the development of a Global Strategy on Human resources for Health. The draft strategy is now open for consultation until 31 August 2015. To access the online consultation, please visit KWWS��ZKR�LQW�KUK�UHVRXUFHV�RQOLQHBFRQVXOW�JORE-VWUDWBKUK�HQ� When providing feedback for this initia-tive think about the population changes and the need for collaborative care and not just what you do now. The World Dignity Project As you already know, many people with mental health issues continue to be marginalised and we need to come together to make a difference. Every human interaction represents an opportunity for one person to treat another with dignity — a dignity encounter. Individuals and fam-ilies affected by mental illness can often describe what dignity should look like. Sadly, however, most experi-ence something wholly different. The stigmas of mental illness can no longer be tolerated. We can no longer be bystanders. We must do something. The World Dignity Project aims to identify one million individuals, organisations, countries and states to become Foundation Members by adopting the World Dignity Project Symbol so that we can form a global movement to address the stigma related to mental health. Please visit the website http://worlddignityproject.com/

WfMH World Congress Cairo 2015 The XXth WFMH World Congress will take place at the Intercontinental Citystars, Cairo Egypt from 16-19 October 2015. 7KH�¿UVW�:RUOG�&RQJUHVV�LQ��KHOG�LQ�/RQGRQ�MXVW�after the end of the Second World War faced the issue of ‘Mental health and world citizenship’ posing the ques-tion: ‘Can the peoples of the world learn to co-operate IRU�WKH�JRRG�RI�DOO"¶�:H�DUH�QRZ�IDFLQJ�DQRWKHU�JOREDO�crisis of identity and issues related to global governance and during such periods mental health can be relegated to the background. The WFMH World Congress in Cairo provides an opportunity for advocates, service users, car-ers and professionals from around the world will gather in Cairo to voice a message of harmony at this congress entitled ‘Mental health in times of crisis- building com-prehensive health care systems’ and to welcome the 42nd WFMH President, Professor Gabriel Ivbijaro MBE who has promised to make Dignity and Mental Health par-ity the theme of his two year Presidency. Please come to join us http://www.wfmh2015.com/. World Mental Health Day 2015 The 2015 World Mental Health Day theme is on dignity and mental health. Promotional materials and concept papers are available from the WFMH website http://wfmh.com/world-mental-health-day/wmhd-2015/. We have excellent contributions from a variety of global stakeholders including patients, carers, Colleges and members of our Caucus including Eliot Sorel entitled ‘Total health for all in the 21st century: integrating pri-mary care, mental health and public health.’ We need to make mental health visible and I urge you to download the dignity symbol free of charge and display it in September and October to raise awareness of mental health http://worlddignityproject.com/wp-content/up-ORDGV��:RUOGB'LJQLW\B3URMHFW�MSJhttp://worlddignityproject.com/wp-content/up-ORDGV��6WLJPDB6KHOWHUB��[��SGIRemember, symptoms are not a barrier to recovery but attitude is.

Professor Gabriel Ivbijaro MBE, JP MBBS, FRCGP, FWACPsych, MMedSci, MA, IDFAPA Medical Director The Wood Street Medical Centre, 6 Linford Road, Walthamstow, London E17 3LA, UK E-mail: [email protected] President Elect WFMH (World Federation for Mental Health) www.worlddignityproject.com

by Professor Gabriel Ivbijaro MBE, JP

EUROPE


INTERNATIONAL MEMBERSHIP EXPANDS AT APA

International Membership grew by an average of 18% a year for the last two years, due in part to the introduction of three program initiatives and their related activities at the Annual Meeting. Designed to increase and sustain international membership and improve member experi-ence, we have a newly created member category of International Fellow (IFAPA), host a Welcome Re-ception for New International Members, Fellows and Distinguished Fellows each year at the annual meeting, and launched the International Membership Ambassador Program.In December 2014, 290 internationals advanced to International Fellow and Distinguished Fellow catego-ries, and 240 international members joined or reinstated their memberships in APA through May 2015. We held a Welcome Reception at the Annual Meeting in Toronto with 200 honorees and guests attending, celebrating the collegial spirit of psychiatrists from 50 countries. A slide VKRZ�ORRSHG�ZLWK�KRQRUHH�QDPHV�DQG�FRXQWU\�ÀDJV��DQG�welcoming remarks made by APA administration and board members. One attendee traveled 36 hours after a family emergency to arrive in time for the reception; several others indicated it was their main reason to attend the conference.

The Ambassador Program launched in mid-2013 inviting international members to be our in-country representa-tives and encourage their colleagues to join APA resulted in 11 new members in 2014. Changing the approach this year, we selected potential ambassadors from in-ternational members registered for the annual meeting. Four days of personal meetings answering questions and orienting prospective ambassadors resulted in 33 mem-bers committing to the program. Eight new ambassadors brought in 17 new members from by meeting’s end; that’s a 65% increase over 2014.APA’s nearly 2,000 international members from 100 countries represent 6% of our membership. We strive to reach our membership potential with relevant opportuni-ties and recognition for worldwide participation. This year internationals who joined APA at the Annual Meet-LQJ�UHFHLYHG�D�JLIW�FHUWL¿FDWH�IURP�$PHULFDQ�3V\FKLDWULF�Publishing as a Thank You to use at the book store dur-ing the meeting. We must continue to foster efforts that make APA a truly global community, and encourage international psychia-trists to join APA by visiting the website at www.psy-chiatry.org/internationalmember.

by Rahn K. Bailey, MD, DFAPAChair, Membership Committee

Dr. Binder speaks at the International Welcome and Networking Reception in Toronto.

Three of 33 new International Ambassadors, from left to right: Dr. Mahmoud El-Wasify and Dr. Khaled Helmy, Egypt; and Dr. Pedro Sanchez, Spain.

16

CLM gathering at WPA 2013 Bucharest Congress

The WPA Bucharest Statement on Collaborative and Integrated CareThe World Psychiatric Association, 2015 Bucharest International Congress

3DODFH�RI�3DUOLDPHQW�%XFKDUHVW��520$1,$��-XQH��

WHErEAS, cardiovascular and mental disorders lead in the global burden of non-communicable diseases;WHErEAS, most mental disorders are attended to in primary care;WHErEAS, mental disorders account for 30-45% of the global burden of disability;WHErEAS, 50% of mental disorders exist by age 14, and 75% by age 24;WHErEAS, these disorders result in billions of dollars of negative economic consequences across low-, middle-, and high-income nations;WHErEAS,�VLJQL¿FDQW�JOREDO�KHDOWK�V\VWHPV�IUDJPHQWDWLRQ�GLPLQLVKHV�DFFHVV�WR�FDUH�DQG�LWV�HIIHFWLYHQHVV��WHErEAS, more research into the brain and into the determinants of health is needed; WHErEAS, effective treatments for mental disorders exist for most cases; andWHErEAS, the collaboration and integration of primary care, mental health, and public health is proven to enhance access, quality, and sustainability; NOW BE IT RESOLVED THAT

United Nations member states adopt collaborative and integrated care as a means toward achieving total health for all in the 21st Century; and be it further resolved thatThis goal be included in the updated United Nations Sustainable Development Goals; and be it further resolved that,8QLWHG�1DWLRQV�PHPEHU�VWDWHV�DOORFDWH�WKH�QHFHVVDU\�KXPDQ��¿QDQFLDO��DQG�WHFKQRORJLFDO�UHVRXUFHV�IRU� training, education, and implementation of this resolution.

Prof. Dinesh Bhugra Prof. Helen Herrman Prof. Roy Kallivayalil WPA President & WPA President Elect WPA Secretary General &RQJUHVV�3UHVLGHQW� � &R�&KDLU��6FLHQWL¿F�&RPPLWWHH

Prof. Eliot Sorel Prof. Aurel Nirestean &R�&KDLU�6FLHQWL¿F�&RPPLWWHH� �� 3UHVLGHQW�5RPDQLDQ�3V\FKLDWULF��3V\FKRWKHUDS\�$VVRFLDWLRQ

The recently concluded WPA 2015 Bucharest International Congress with the theme Primary Care Mental Health: Innovation �7UDQVGLVFLSOLQDULW\�ZDV�D�JUHDW�VFLHQWL¿F�VXFFHVV�DWWHQGHG�E\�colleagues from 60 countries.Among the many innovative features of this memorable congress was a dedicated Young Health Professionals Track and a mini course on collaborative & integrated care for residents in family PHGLFLQH��SV\FKLDWU\�DQG�SXEOLF�KHDOWK��7KH�FRPSOHWH�VFLHQWL¿F�program is still accessible at www.wpa2015bucharest.org.Under the leadership of WPA President, Professor Dinesh Bhugra, the Executive Committee of the WPA unanimously adopted the historic WPA Bucharest Statement on Collaborative & Integrated Care addressed to United Nations’ member states. Please see text below.

global mental health & psychiatry caucus of the american psychiatric association newsletter, vol...

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