Improving the mental health of women and girls: psychiatrists as partners for change

The WPA was established to promote the advancement of psychiatry and mental health for all citizens of the world. As a global association, it is in a unique position to support the initiatives of its Member Societies and work in partnership with regional societies and other international organizations.

Its ability to promote sustainable change and improvement depends on two main factors. One is its capacity to collaborate successfully with other organizations. The other is its potential to engage psychiatrists from around the world in new challenges. The expertise of psychiatrists is essential to promote good health and offer comprehensive health care. Our patients and their families need us to work alongside them and other partners in clinical practice, teaching, research and advocacy1. The WPA and its Member Societies need to be centrally involved in national and international debates, policies and initiatives in mental health.

Every three years the WPA reassesses priorities within its strategy. Recent action plans have focused on defining the needs for advancement in psychiatry and mental health, on education and psychiatry, and on social justice and mental health2, 3. Building on all these initiatives, the priority for action in 2017‐2020 will be the mental health of women and girls, particularly those living in adversity caused by poverty, war, natural disasters, and exposure to interpersonal violence and human rights abuse4. Mental health is integral to women's overall health, and connected closely with their central roles in the development of civil societies and the health and functioning of their families. It is a neglected priority in health, child development and economic development, especially but not exclusively in low‐ and middle‐income countries5.

The mental health of women and girls is intimately and intricately interwoven with their social status, economic status and hence their participation as valued members of society. From conception, the life experiences of women and girls differ from those of men and boys. The biggest differences reflect disparities in opportunities, responsibilities and roles through life. These have consequences for all aspects of health, including mental health5. Overlooking the mental health needs of women has significant, deleterious effects on the functioning of women and their families and the wellbeing of the next generation, and on social cohesion. M. French Gates wrote recently in the journal Science that “the development field needs to be more serious about gender inequities and women’s empowerment …  helping women and girls realize their own power to advance the wellbeing of their families, their communities, and their societies”6.

Participation and the empowerment underlying it, as advocated also by UN Women, are components of good mental health7 and wellbeing8. The strategies for promoting mental health in women and girls and tackling mental health problems include a strong focus on changing social attitudes and investment9, which require involvement of multiple stakeholders.

The WPA program will support mental health promotion among women and girls as well as the prevention and treatment of mental illnesses. It will take necessarily a cross‐sectoral approach10. It will collaborate in local and international initiatives to address human rights, education, social and economic participation, safety and freedom from discrimination, as an essential first step to improving mental health. The WPA will work with partners to provide unbiased information about the magnitude and nature of the problems in different settings and globally and the interventions that can be used by health and social services and other sectors to promote mental health. In the health sector, it will support gender‐sensitive clinical and public health services, and gender‐informed research to gather local evidence and monitor and evaluate interventions.

The WPA will work with local and international partners in specific disadvantaged regions to identify needs, develop projects and evaluate the outcomes and their sustainability. The settings for action include community groups, schools, primary health care, and maternal and child health services. The WPA will encourage psychiatrists and other mental health professionals to use their expertise in diverse settings to promote participatory approaches to health and mental health and facilitate the mental health work of non‐specialists across a range of community settings11. Important needs are: the psychological consequences of violence, including violence in the home, genital mutilation, rape and the trafficking of women and girls for prostitution; improving mental health in the perinatal period; the isolation of women as caregivers; deaths from suicide among young women in low‐ and middle‐income countries; and the needs of women and girls in displaced populations and in emergencies.

The mental health challenges facing women and men are different. The needs of women and girls are considered separately for this reason. The fact that the WPA is developing a program on women's mental health does not neglect the mental health needs of men and boys. On the contrary, we wish to understand and exploit the interconnected needs of women and girls, men and boys and develop interventions that work across genders as well as those that are gender specific.

This program will be complemented by another one that focuses on improving the conditions for people living with long‐standing mental illnesses and disabilities, and their caregivers, in mental hospitals and other settings. Both will be built on a set of principles for the prevention and treatment of mental ill health and the promotion of mental health12, matched with the purposes of WPA. They will be supported by activities in a range of topics important to the future of psychiatry and improved mental health for women, men and children around the world.

These plans gain momentum from the international attention focused on the need to include both the health of women (and children)8 and mental health13 among the new sustainable development goals. The WPA can contribute to the establishment and achievement of these goals in low‐ and middle‐income countries, and equivalent initiatives among disadvantaged groups in high‐income settings. My colleagues and I are eager to receive comments and suggestions about how, together, we can develop these programs.

Helen Herrman
President Elect, World Psychiatric Association