The “Meet the <scp>WPA</scp> Council” Panel at the 21st World Congress of Psychiatry
Authors: Ahmed Okasha
Journal: World Psychiatry (2022)

The WPA Council is the organ including the Past Presidents of the WPA, which has the mandate to offer recommendations and advice to the WPA Executive Committee about any matters affecting the mission and strategy of the Association. It is currently chaired by me, and its other members are Profs. J.A. Costa e Silva, F. Lieh-Mak, N. Sartorius, J.E. Mezzich, M. Maj, P. Ruiz, D. Bhugra and H. Herrman. Within the 21st World Congress of Psychiatry, a “Meet the WPA Council” Panel took place virtually on October 21, 2021. It included presentations by Profs. N. Sartorius, J.E. Mezzich, M. Maj, H. Herrman, J.A. Costa e Silva, D. Bhugra and myself, plus a speech by the WPA President Elect, Prof. D. Wasserman. I welcomed the participants, and offer­ed a brief presentation about the risks in the future of digital psychiatry. How will digital psychiatry reach those most in need in community settings? How will it reach children in low-income households and their parents, who disproportionately lack access to devices and high-speed Internet? Moreover, confidentiality breaches might seriously impair public cooperation in big data projects. There is the risk of being unable to respond to psychiatric emergencies in a timely manner. Patients with schizophrenia are known to have cognitive impairment, which may hinder their ability to engage with telepsychiatry. People experiencing homelessness may also be disproportionally excluded from accessing appropriate care and interventions if largely delivered virtually. How we can proceed with telepsychiatry for legal implications and involuntary admission, forensic psychiatry and confirmation of identity? Lastly, can we practice rehabilitation by digital psychiatry? N. Sartorius’ presentation dealt with co­morbidity of mental and physical disorders as a priority issue for psychiatry. The prediction that this comorbidity will continue to be a major problem rests on the examination of two trends. The first is the in­creasing expectancy of life of people with noncommunicable diseases, for which we have treatments that prolong life but no treatments that cure them. The second is the increasing fragmentation of medicine into ever finer specialties, with practitioners who are willing to deal with the diseases of their specialty but not with others1. The various efforts to develop collaborative care, involving action of several specialists in the management of the person with several diseases, were successful in some settings due to the presence of exceptionally committed physicians linked in a well functioning system. This is unlikely to be developed in less endowed situations. The resolution of the problems of comorbidity will require changes in the education of medical practitioners and in the organization of health services. J. Mezzich’s speech focused on the future of person-centered medicine and psychiatry. He reported that, as a reaction to modern medicine's hyperbolic emphasis on or­gans and diseases and its accompany­ing neglect of the doctor-patient relationship, a worldwide programmatic movement has evolved to re-humanize medicine and public health. The epistemological definition of person-centered medicine proposes a holistic and collaborative medicine that is informed by evidence, experience and values, and aimed to health restauration and promotion of the whole person. The WPA has actively contributed to the increasing centrality of the person in medicine and health. In 2005, an Institutional Program on Psychiatry for the Person was established by the WPA General Assembly, which engaged many Member Societies and Scientific Sections in symposia and publications. The WPA Section on Classification developed the Person-centered Integrative Diagnosis model2, which was applied by the Latin American Psychiatric Association for its Latin American Guide for Psychiatric Diagnosis. So, the person centered approach is emerging as a widely recognized and respected core feature of psychiatry and medicine. M. Maj's presentation dealt with some current trends in psychiatry emerging from the latest issues of World Psychiatry. He focused on four topics. First, the structural and attitudinal barriers to the access of evidence-based psychotherapies, which have to be actively addressed worldwide, ensuring that these therapies are not only available in the private offices of psychologists and psychiatrists, but also in public mental health services, in order to avoid an unacceptable socioeconomic divide. Second, the importance of listening to patient preferences when making mental health care decisions, since users have a lot to say about the choice of pharmacotherapies (having often had a previous experience with medications), the decision to implement a psychotherapy and its choice, and their unmet social, practical and emotional needs to be addressed by psychosocial interventions. Third, the increasingly acknowledged need for a further clinical characterization of the patient who has received a given psychiatric diagnosis, in order to guide the formulation of a more personalized management plan3-5. Fourth, the participation of psychiatrists in the promotion of mental health in the community. This requires new competencies, which should however be added to psychiatrists’ skills as clinicians, rather than replacing them. Unfortunately, there are some contexts in which the clinical skills of psychiatrists are being depreciated, trivialized or marginalized. These skills should be defended and cultivated worldwide. H. Herrman’s speech dealt with future prospects for women in psychiatry. She em­phasized that deep-seated gender biases per­sist across the world. The Lancet Com­mission on Gender and Global Health 20206 contends that gender intersects with other social factors to drive health inequities. It notes that, whereas 70% of health workers globally are female, 70% of health-care lead­ers are male. In psychiatry, women are still relatively scarce in the leadership of the profession, even though they are entering in higher numbers. The full involvement of women is critical for psychiatry7. Women can bring a special contribution and different perspectives. However, professional barriers and problems for women persist. Mentoring and support of various kinds, flexible career paths, monitoring needs and experiences, and working with educators, employers, professional societies and policy makers are all needed. The WPA has worked to ensure that women colleagues are invited to participate fully and equally in the Association’s activities. It supports women in different places to share experiences and work together. Above all, it aims to foster an open and optimistic view among women of working in the profession. D. Bhugra's presentation summarized the outcome of the work of the WPA-Lancet Psychiatry Commission on the future of psy­chiatry. In six potential themes, the Commission suggested that patients’ needs and treatments are likely to change. Laws supporting patients also need to change, as a survey of laws of 193 countries showed wide­spread discrimination8. The use of dig­ital technology has been successfully demonstrated in the COVID-19 pandemic and this is likely to continue. However, ethical, confidentiality and privacy issues need to be addressed by the profession. Societal expectations will need to be taken into account when training the psychiatrists of the future. D. Wasserman's speech dealt with suicidal behaviours during the COVID-19 pan­demic. She reported that, compared to pre­vious years, suicide rates have remained largely unchanged globally or declined in the early phase of the pandemic. However, increased suicide rates have been re­ported among non-white residents and Afro-American groups in the US, as well as among adolescents in China. Among adolescents, there have been no significant changes in suicide rates during the period of school closure, but an increase has been observed in the period after coming back to schools. No change in the number of suicide-related emergency department visits has been reported in many countries in the early phase of the pandemic. However, an increase in suicide-related emergency visits by females and youths has been identified since the summer of 2020 in the US. The assessment of suicidal thoughts and attempts during the pandemic showed significant increases, particularly in females and the young. As suicide attempts are the foremost predictor of completed suicides, vigorous preventive measures should be taken, including both health care and public mental health initiatives9. Despite its brevity, the session was lively and informative. I hope that similar panels will be regularly organized within the World Congresses of Psychiatry in the future.