The practice of psychiatry in health care and sustainable development: progress on the WPA Action Plan 2017‐2020

The founding of the WPA 70 years ago marked a movement towards an internationally valued professional identity and the description of a broad purpose for the Association: the advancement of mental health and psychiatry across the world.

Based on this remarkably modern statement of purpose that is elaborated in the statutes of the Association and evident in the work accomplished in its 70‐year history, the WPA vision 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” ¹ .

How the practice of psychiatry contributes to realizing this vision is the focus now: psychiatry as a discipline central to medicine and health care and vital to sustainable development in each country. We are working with Member Societies and partners to demonstrate how psychiatry can contribute to strengthening communities to meet mental health needs, especially for people living in adversity.

In common with a number of its Member Societies, the WPA now recognizes that advancement of mental health and the provision of appropriate and acceptable mental health services cannot be truly achieved without the involvement of service users and family carers. Their advice is needed on the actions proposed, including the development, implementation and evaluation of the care services, and advocacy at national and international levels.

The WPA has given priority in this triennium to best practice in engaging with service users and family carers. This builds on earlier work, when the Association es­tablished a taskforce on best practices in working with service users and family car­ers, which developed a set of ten recommendations for good practice ² . This became the basis for a worldwide consultation of stakeholders, including the WPA officers and over 200 national and international civil society organizations. Several of the recommendations were included as a new paragraph in the Declaration of Madrid in 2011.

A service user and family carer advisory group to the President is now established. The purpose of this group is to revive and refresh the conversation with the range of people involved. M. Amering has agreed to coordinate the group, that includes four people with lived experience of service use and four people with experience as family carers.

The WPA Congress programs are an op­portunity to bring this advisory group together to start a new phase of practical work, as at the World Congress of Psychiatry in Lisbon in 2019, and the forthcoming World Congress of Psychiatry in Bangkok.

As well as advising WPA on organizational and scientific aspects of its congresses, the initial focus of this work is participation in and advice to the WPA taskforce on minimizing coercion in mental health care ³ . This taskforce has been appointed and begun work. A workshop supported by the Royal Australian and New Zealand College of Psychiatrists was held in Melbourne in February 2020. It brought together the chairs of the taskforce, S. Galderisi and J. Allan, a representative from the service user and family care advisory group, and research and project consultants.

The workshop considered comments from the taskforce on a discussion paper developed over preceding months, and the design of case studies on programs that have supported alternatives to coercion and quality rights in various parts of the world. The taskforce will next ask Member Societies for comments on the discussion paper and develop the case studies.

The plan before the end of the triennium is to prepare a position paper with recommendations for action and an optional protocol designed to support Member Societies to engage with this work in ways that suit their local circumstances. The aim is to promote continuing work critical to the quality of mental health care for patients and their families, and support psychiatrists to contribute to practical ways of implementing the positive provisions of the United Nations Convention on the Rights of People with Disabilities.

The Lancet‐WPA Commission on De­pres­sion ⁴ is finalizing its report and plans for dissemination of the messages and rec­ommendations. The Wellcome Trust in Lon­don is continuing its support for the Commission and combining with the United Nations Children's Fund (UNICEF) to engage young people with lived experience of depression in the development of recommendations and the dissemination of the findings. The WPA is well positioned to have an important role in the afterlife of this Commission.

The program of work with young women and men in cities, especially those living with adversity, continues actively. The WPA, along with citiesRISE ⁵ , has engaged in Chennai and Nairobi with local communities and professional groups – including the WPA Member Societies and their branches – to prepare psychiatrists and other practitioners for mental health work in schools and gathering places in informal community settings.

The WPA is actively engaged in planning and providing materials for these programs of work, especially support for psychiatrists and other practitioners to use their expertise to promote participatory approaches to health across these settings. In January 2020, the Association participated in a practice workshop for mental health professionals in Chennai, together with the Schizophrenia Research Foundation and citiesRISE, that demonstrated the eagerness of psychiatrists and other practitioners for this work. The workshop was over‐subscribed, with local psychiatrists on a waiting list for the next edition. Strengthening perinatal mental health systems is an important related area of work with partners.

The use of technology and mental health is another important theme for the triennium, both in this program with young people in cities ⁶ and with the World Economic Forum (WEF), as well as through activities of the WPA Scientific Sections. As President of the WPA, I co‐chair the WEF Global Future Council on Technology for Mental Health, that convened at the Annual Meeting of the Global Future Councils in Dubai in November 2019.

Quickly developing technology will change industries, governments and societies in the future. The Council's mandate is to address the potential and pitfalls of these developments for mental health, particularly concentrating on youth suicide prevention. Its program for 2020 follows the report of its predecessor in 2018‐19, which emphasized the need to outline ethical principles in using data and technology for early diagnostics and prevention of mental illness ⁷ . The WPA is positioned to contribute to constructive debate on these topics with Member Societies, service user and family care advisors, as well as other partners.

A range of other programs and projects that contribute to progress on the Action Plan is underway with support from WPA officers and components. These include our education, publications and scientific programs8, 9, 10, 11, and the meetings program, with the Regional Congress in St. Petersburg and the 20th World Congress of Psychiatry in Bangkok. The active work of many of the Scientific Sections, and the early career psychiatrists, is a tribute to the power of collective action12, 13, 14.

Collaborative work with the World Organization of Family Doctors (WONCA) on competencies in mental health for family doctors, and a survey of the demography and training of psychiatrists worldwide are in progress through Member Societies and with the work of Secretary for Education R. Ng, the WPA Secretariat, and WPA consultants Community Works.

My colleagues and I in the WPA Executive Committee welcome the suggestions and engagement of our Member Societies as we endeavour to support psychiatry and its positive impact on mental health globally.