Mainstreaming psychiatry: implementing the WPA Action Plan 2017‐2020

The vision of the WPA is a world in which people live in conditions that promote mental health and have access to mental health treatment and care that meet appropriate professional and ethical standards, integrate public health principles and respect human rights. The Action Plan sets out a strategy for expanding the contribution of psychiatry to improved mental health for people across the globe1, 2. It proposes working with partners to reach people who face adversity and disadvantage.

The WPA's Action Plan has two areas of strategic focus. Its institutional work, supported by the Executive Committee and dedicated colleagues, aims to strengthen the capacity of psychiatry through accelerating the adoption worldwide of quality approaches and advances in scientific, educational, service development and advocacy activities. Its development work includes the signature initiatives for the triennium. These focus on mainstreaming the contributions of psychiatry to meet the mental health needs of children, young women and young men living with adversity or in the midst of emergencies3.

The first step for the development work was WPA's pivotal role in shaping the citiesRISE platform4 and its successful launch in 2017. The platform is a collective action program seeking to promote the mental health of children and young people in adverse settings. The work is being implemented in six cities, called “nodes”. The six nodes provide a foundation for broader uptake in new locations.

The WPA works through the platform with multiple partners including the World Bank, International Medical Corps (IMC), King's College London, Harvard University, Grand Challenges Canada, local and national civic and government organizations, and others. Working alongside the partnership, the World Health Organization (WHO) has a key technical role in sharing knowledge and practice. WPA and citiesRISE emphasize the prevention and early treatment of mental illness and the promotion of mental health, as well as partnerships with innovators in the development and use of digital technologies in mental health.

Major international donors have committed to support the development of the citiesRISE platform and the implementation of several projects in the WPA Action Plan, beginning with its signature initiative: the Alliance for Mental Health Responses to Emergencies, Conflicts and Adversity (the Alliance).

The second step in the development work was convening a WPA workshop in Madrid in March 2018, hosted and supported by the Juan José López‐Ibor Foundation, in collaboration with citiesRISE. The Foundation has had a catalytic role in the development of the Alliance initiative. This role will continue as the work becomes operational globally.

During the workshop we defined that WPA's Alliance initiative will operate through the citiesRISE platform as a central program of the WPA Action Plan 2017‐2020. It will have an initial reporting period of two years. There is also an invitation from citiesRISE to make a six‐year plan to work together on the platform. The work will start in Bogotá and Chennai, two of the citiesRISE nodes. It is expected to extend to two other cities in the citiesRISE network – in Africa and the USA – during the triennium. Support will come from citiesRISE, WPA and the Foundation.

The Alliance initiative will begin with building a coalition of mental health professionals in Bogotá and Chennai. It will build on previous work with WPA5 and existing experiences6 to develop and implement a program of capacity building that will support and sustain the readiness of psychiatrists and other mental health professionals to respond to conflict, emergency and adversity. The work in Bogotá will be directed towards the needs of people affected by displacement from their homes, as well as uncertainty, insecurity, poverty and the physical impacts of emergencies and conflicts. The work in Chennai is expected to focus on young women and young men living in slums and facing similar conditions. In each case the local collective action groups – including young people, experts and researchers – will work with the WPA and global research partners to refine the choice, implementation and evaluation of the initiatives.

Large numbers of people are exposed to extreme stressors. Supporting the bonds between people within communities can promote resilient responses and mitigate the psychological impact of emergencies7. However, tackling community recovery needs mental health and psychosocial support interventions8. The challenge now is to evaluate and refine programs and good practice in mental health promotion in emergencies. It is equally important to add a graded response to the needs of people with mental ill health. Psychiatrists have vital roles as part of the response, as advocates, facilitators, trainers and clinicians.

The Alliance initiative aims to support psychiatrists to: work with partners to perform their roles in emergency responses, and by analogy in other situations of adversity such as slums, with a special focus on human rights and cultural competencies; train their peers and other clinicians and community‐based workers in their own countries and regions; and support the development of new and existing community‐based services in innovative and community‐directed ways. The work will align with international protocols on mental health and psychosocial support in humanitarian emergencies9.

We anticipate working with partners including IMC and WHO to adapt resources, guidelines and protocols that will become a lasting source of support for the initiative in these regions and eventually elsewhere. The initiative will include support for the development of new and existing community‐based services. It will aim to demonstrate and disseminate best practice in the role of psychiatrists supporting appropriate responses to conflicts, emergencies and adversity.

The Alliance initiative is the first example of work to be implemented through the WPA‐citiesRISE platform. In 2018‐2019 we will work towards incorporating the other Action Plan initiatives that focus on the mental health needs of people in adversity. These initiatives include suicide prevention, with a focus on the needs of young women and young men in low income and emergency settings; support for human rights and quality care in institutional and other mental health care settings; and further development of capacity building projects with community mental health and primary care providers, in partnership with other organizations. Continuing the work to describe and disseminate examples of best practice in working between practitioners, service users and carers10 will remain a focus.

The work we are commencing is a critical priority for a world in which threats to the mental health and well‐being of people in adverse situations remain high. Many organizations have worked for a long time to tackle global challenges in mental health that also concern WPA. Working together and choosing the best way to contribute to these efforts, we are beginning to leverage new resources to serve our collective goals. We welcome the growing involvement of WPA components and our other partners in the expansion of this effort over the next six months and the years to come.

Helen Herrman
President, World Psychiatric Association