The WHO's Global Clinical Practice Network and the ICD‐11 implementation
Authors: Giuseppe Piegari
Journal: World Psychiatry (2021)

The WPA is one of the professional organizations collaborating with the World Health Organization (WHO)'s Global Clinical Practice Network, whose ultimate mission is improving mental health care and services in the various regions of the world (https://gcp.network). This Network now includes more than 16,000 clinicians from 159 countries (51% psychiatrists, 30% psychologists; 40% from Europe, 25% from Western Pacific, 24% from the Americas, 5% from Southeast Asia, 3% from Eastern Mediterranean, and 3% from Africa; 63% from high-income countries, 37% from middle- and low-income countries). The Network has been collaborating with the WHO Department of Mental Health and Substance Use in studies informing the development of the chapter on mental and behavioural disorders of the ICD-11. In par­ticular, the Network has been involved in the Internet field trials, which have compared the diagnostic agreement and the clinical utility for several groups of disorders in the ICD-11 vs. the ICD-10. A Network-based study focusing on the ICD-11 diagnostic guidelines for disorders specifically associated with stress1 found that the addition of complex post-traumatic stress disorder (PTSD) and prolonged grief disorder to the diagnostic system represented significant developments with respect to the ICD-10. Clinicians were able to distinguish these disorders from similar conditions and from normality. Their ability to differentiate between PTSD and adjustment disorder also improved with respect to the ICD-10. However, participants had some difficulties in making the distinction between symptoms of re-experiencing the trauma in the present and memories in PTSD. This finding brought to a revision in the diagnostic guidelines. Indeed, a very important feature of this and other ICD-11 field trials is that they were conducted before the finalization of the text of the guidelines, so that they really informed the final step of the development of the text. Another Network-based study, focusing on the ICD-11 diagnostic guidelines for feeding and eating disorders2, found that the addition of the new categories of binge eating disorder and avoidant-restrictive food intake disorder (ARFID) significantly improved diagnostic consistency with respect to the ICD-10. Furthermore, for all diagnostic categories, clinicians rated the clinical utility of ICD-11 guidelines (including ease of use, goodness of fit, diagnostic confidence, and clarity) more favourably than the ICD-10. However, the results of the study highlighted the need for, and led to, some revisions in the final version of the diagnostic guidelines, such as adding additional qualifiers related to underweight status in the definition of recovery in anorexia nervosa, and adding a clearer specification that the subjective experience of loss of control over eating and related distress is a diagnostic feature of binge eating, even when the person does not consume an objectively large amount of food. The Network is now serving as a catalyst for other research collaborations, in addition to contributing to the implementation of the ICD-11. The chapter on mental and behavioural disorders of the ICD-11 has been adopted unanimously by the 72nd World Health Assembly in Geneva on May 25, 2019, although reporting of health statistics based on the new classification will begin in Member States only on January 1, 2022. Innovations and changes in this chap­ter have been presented in detail in a pa­per published in this journal3; the involvement of the WPA in the development of the chapter has been also described in the journal4-6, and several contentious is­sues (such as the role of a dimensional ap­proach) debated in the process leading to the finalization of the chapter have been ad­dressed in the journal as well7-12. The translation of the ICD-11 chapter in several languages and the training of professionals in its use are now ongoing. Educational courses have been conducted at the 18th and 19th World Congresses of Psychiatry (Mexico City, Mexico, September 27-30, 2018; and Lisbon, Portugal, August 21-24, 2019), and a more comprehensive online 20-hr training course was conducted in relation to the 29th Congress of the European Psychiatric Association in April 2021, with the participation of 150 psychiatrists (selected from almost 500 applicants) representing 78 different countries. This training course was organized by the Naples WHO Collaborating Centre. At the 19th World Congress of Psychiatry, a plenary session dealt with the implementation of the new classification system, that will involve the interaction of the system with each country's laws, policies, health care organization and information infrastructure. K.M. Pike, from the Columbia University, New York, illustrated the multiple modalities developed for training a vast array of international health professionals. M. Maj, who chaired the session with G. Reed, the coordinator of the process of development of the new system, summarized some lessons that should be learnt from the implementation of previously developed classification systems. The session emphasized the strong collaboration between the WHO and the WPA in all the steps of the development and testing of the ICD-11 chapter on mental and behavioural disorders, and the long-term partnership that will now be established between the two organizations for the implementation of the diagnostic system.