<scp>WPA</scp> Action Plan 2020‐2023: a way forward
Authors: Afzal Javed
Journal: World Psychiatry (2020)

Psychiatry is currently facing several challenges, but there are also many opportunities that can help us consolidate our profession as an inspiring branch of medicine. The WPA is the umbrella organization for psychiatrists worldwide and thus has a major responsibility for leading the profession. The WPA prepares Action Plans for each triennium1, that provide directions about emerging needs and priorities for the Association's future work from a worldwide perspective. The proposed Action Plan 2020-2023 specifically looks at areas that need attention and input from various WPA components2-5. There is an outstanding need to provide access to high quality mental health care in all countries and to support psychiatrists in their important roles as policy makers, direct service providers, trainers and supporters of health care workers in primary and community health care systems. The recommended plan will work within an international perspective focusing specifically on promotion, interventions, and teaching and training of mental health professionals. It will also build on the previous Action Plan to ensure continuity in the WPA's work6. The key features of the next triennium plan include promotion of psychiatry as a medical specialty in clinical, academic and research areas; promoting public mental health as a guiding principle; high-lighting the specific role of psychiatrists in working with other professionals in health, legal and social aspects of care; and ensuring the Association's positive engagement with Member Societies and its other components. Public health is assuming a central role in the delivery of health care, including mental health care7. The Action Plan includes raising awareness, acceptance, and prioritization of public mental health in mental health intervention strategies, and ensuring the availability of public mental health training programmes in the general health care systems. Mental disorders are the single most common cause of disability in young people. First onset of mental disorders usually occurs in childhood or adolescence, although treatment typically starts several years later. The failure to address child and adolescent mental health problems, including developmental and intellectual disorders, especially in low-resource settings, adds significantly to major public health issues and inflicts far-reaching consequences8. There are significant gaps in what we know about how best to treat mental illness in children and youth. There is inadequate support for research into developmental neurobiology, the causes of mental illness-es, and the most effective, safest and best-tolerated treatments. Child and adolescent mental health will be a priority, and plans will include supporting epidemiological work exploring the prevalence of mental health problems, promoting early detection for psychosis, and developing crisis intervention centres for adolescents. Parenting interventions for preventing persistent conduct disorders in children, screening for early detection of mental health problems among the young workers, and promoting well-being in the workplace will also be guiding principles of the proposed plan. Comorbidity is another important issue facing health systems in today's world, including mental health systems. Single disease approaches cannot address this problem appropriately. Comorbidity can be due to increased life expectancy and/or more intense exposure to risk factors, particularly smoking, alcohol abuse, physical inactivity and obesity. Patients with comorbidity face complex physical, social and emotional problems. It is important to address issues of comorbidity as a priority. The Action Plan 2020-2023 will support epidemiological work exploring the prevalence of physical comorbidities in people with mental health problems, and development of guidelines for joint work with non-psychiatrist professionals, early detection of physical comorbid conditions in mentally ill patients, and early recognition of mental health problems in the context of chronic medical illnesses. Strategies for teaching and training psychiatrists and non-psychiatrist colleagues about joint work will be taken as a priority for future work. The optimal approach to building capacity in mental health care around the world requires partnerships between professional resources and promising health-related institutions. These partnerships need to be sustainable, develop quality in clinical care and research, and build a productive environment for professionals to advance their knowledge and skills. There are mutual benefits to all stakeholders working jointly if patients are the prime beneficiaries of such efforts. The WPA will, therefore, explore opportunities for partnerships with medical professionals such as general physicians, neurologists, paediatricians, geriatricians, cardiologists, diabetologists and other spe-cialists in medicine, non-governmental or-ganizations, and non-medical mental health organizations. The World Health Organization declared COVID-19 a public health emergency this year9. Since then, it has spread rapidly all over the world. It has created problems for psychiatric patients, particularly those in long-term care facilities. The WPA will work with Member Societies and other organizations to reduce suffering and promote best practice to deal with psychological sufferings in this and similar pandemics10. Fostering the continuous improve-ment of psychiatric education and training among medical students is an equally essential step in this process, and a premier objective of the WPA. Similarly, previous WPA Action Plans, particularly the Action Plan 2017-2020, set out strategies for expanding the contribution of psychiatry to improved mental health across the globe. The unfinished plans formulated in 2017-2020 will be continued through current partnerships and new partners11. All areas covered in the proposed Action Plan are of high priority. However, due to time limitations and scarcity of resources, only specific areas may be addressed. During the current triennium, expert working groups are focusing on different areas of the Action Plan12-15. Once the findings of these pilot projects are available, we will seek funding to implement these ideas in different settings and countries. It is hoped that the WPA Action Plan 2020-2023 will generate interest among all WPA components to develop guidelines and directions for future work. The WPA is optimistic that it will receive support, active input, and advice from its membership in setting these priorities and making a real difference in mental health.