WPA International Congress Prague,
October 17-20, 2012
The recent international congress of the World Psychiatric Association had much to offer in the field of transcultural psychiatry. The focus of the congress was ‘Access, Quality and Human Care’, which is an important item in the care for ethnic minorities and in International Psychiatry. The congress was relatively large with about 1800 participants, mostly from Europe, but also with 125 colleagues from the U.S.A. and even 65 from Australia. Psychiatrists from German speaking countries were underrepresented, with by example not more then 42 Germans. This is a pity because the congress offered a lot of interesting lectures and workshops, particularly for young professionals.
The German Wolfgang Gaebel reported about a large international survey on stigma in the psychiatric profession. Stigma in psychiatric care and in psychiatrists prevents good care, is the general idea. It increases patient delay, and makes the risk of early drop out greater. Psychiatry is viewed as not scientific enough and too remote from other medical specialties.
Many others, including psychiatrists themselves, regard psychiatric treatments as having limited success. Gaebel showed comparisons in which these ideas are clearly proven to be wrong. His take home message was that we should stop discriminating against ourselves, and regard ourselves as valuable colleagues in relation to other doctors. According to Norman Sartorius, the former president of the WHO, we should also stop devaluing our patients, and start focusing on the positive sides of their lives. Of interest in this respect is that younger psychiatrists experience more stigmatization and a higher burden. Staying longer in the profession makes psychiatrists probably less vulnerable! Or have vulnerable colleagues left the profession already?
V. Svab from Slovenia reported on a study of discrimination in schizophrenia, in different countries. Surprisingly, there is less discrimination in the developing countries then in the developed ones. Reasons for that are still unclear, but probably the assumed exogenous origin of schizophrenia in developing countries, for instance the influence of ghosts or witchcraft, are central to this phenomenon.
The other side of stigmatisation is that patients once they have arrived in mental health care are quite satisfied with the help they get. A. Nawka from the Czech Republic showed that inpatients from different countries are quite satisfied with the staff, and with the treatment they get, without great differences between the countries. There is a need for more information on how effective psychiatric help is and on how great is the satisfaction. Involving more former patients might be a good idea?
Apart from international comparisons there was much attention on the psychiatric care for patients from ethnic minorities in Western countries. Ron Wintrob (U.S.A.) stated that in the case of refugees, practical needs are generally met, but emotional needs are not. Psychoeducation is a starting point for psychiatric care, and should be offered to all refugees, given the great percentages of psychopathology among them. This should have a place in language courses and other courses on immigration.
Marianne Kastrup (Denmark) gave a lecture about Cultural Psychiatry in the Scandinavian region. She pointed out that there is a common issue in Scandinavian countries about the relations between people, based on fairness, equality and solidarity. This is also the case for immigrants. Migrants in Scandinavia generally have a lower use of mental health services, but have greater numbers of voluntary admissions and forensic sentences. In the second generation there are relatively more suicides. She remarked that post-migratory stress in refugees was higher in those who stayed in Denmark than in those who went back (to Kosovo). Sixty five percent of the refugees were dealing with pain complaints, probably connected with psychopathology. And apathy was very frequently found in children of refugees, most presumably connected to depression in their mothers.
Hans Rohlof demonstrated similarities in The Netherlands. In this country 11 % of the population is of non-Western background. He mentioned research in which perceived discrimination and less social support is connected with more psychopathology. Mental health care use is increasing among migrants, but thresholds are remaining. In refugees the use of mental health care is very low, and even lower in asylum seekers. There are some experiences with special programs for migrants. An adaptation of Interpersonal Therapy for migrants lowered the dropout rate. EMDR for refugees seems feasible, but if the effects are higher than stabilization is not yet clear. Specialised services for migrant patients by migrant therapists exist in the Netherlands, but till now there is no evidence that patients do better with that kind of help.
There is not much similarity with the mental health care provision in Sub Saharan Africa, where about 700 psychiatrists (of which 500 in South Africa) have to take care of about 870 million people. Solomon Rateamane from South Africa spoke about this. A vicious cycle of poverty, war and lack of health care makes life hard for the population. Governments are however beginning to put mental health care on the agenda, since they notice that proper care can have a positive influence on morale.
Sections of the World Psychiatric Association, including the Transcultural Section, are starting to combine their efforts in organising courses and conferences. Afzal Javed, the Sections Secretary, is a great supporter of this. The Transcultural Section is preparing a conference on Religion, Culture and Psychiatry together with the Section on Religion and Psychiatry. The WPA is a large organisation but made out of some enthusiastic individuals who are willing to educate, and propagate their research, programs and insights.