Call for mental health activism

This is the second in a series of posts reporting on the World Psychiatric Association (WPA) International Congress 2016, which I attended in Cape Town in November.

African Union Commission chair Nkosazana Dlamini-Zuma pulled no punches at the opening ceremony of the Congress, urging the World Health Organisation (WHO) to back them in a bid to see the World Bank switch from loans to grants to fund health projects globally.

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“The World Bank shouldn’t give loans for health, they should give grants for health. And we hope the WHO shares that view,” Dlamini-Zuma told hundreds of delegates at the conference which was held at the CTICC in Cape Town in November 2016.

Her comments followed an address by Dr Shekhar Saxena, director of mental health and substance abuse at the WHO, who announced that the World Bank had committed, following a meeting with the WHO in April, to supporting mental health in a far bigger way.

The main message was that any country applying for World Bank loans for health projects would have to ensure a mental health component was included.

Continuing the call for activism for the mental health cause, Professor Dinesh Bhugra, president of the World Psychiatric Association, told the audience they had launched a Bill of Rights for those with mental illness in the House of Lords in London two weeks earlier.

A of total 61 organisations around the world had signed it, and the South African Society of Psychiatrists had indicated it too would sign the document.

“I need every bit of help from everyone here to change the way we treat our patients, who are the most vulnerable,” Bhugra said.

Earlier in his speech, Bhugra revealed the World Psychiatric Association had just completed a global survey of 193 countries, which threw up shocking results. These included that people with mental illness could vote in just 11 percent of the countries surveyed, that they enjoyed no employment rights in more than half the countries, and that 42 percent of the nations prevented those with mental illness from entering into any kind of contract, including signing a will or inheriting property.

“There are people from 92 countries here, more than half the number of countries that participated in the survey. I appeal to you all to use any power you have to change attitudes, to make sure those with mental illness are able to lead fully functional lives in communities without discrimination and stigma. Let the movement begin here,” the professor urged.

Saxena added, meanwhile, that the WHO had the necessary ammunition in the form of research and statistics, to back anyone fighting the battle for better mental health services and facilities.

They had proved, he told delegates, that any investment in mental health was just that – an investment, rather than a drain on resources.

“Every effort in mental health pays back much more than the investment. We have evidence of that and we will give you that ammunition you need,” he said.

Addressing the case for Africa specifically, Dlamini-Zuma pointed to WHO statistics which indicated that 40.5 percent of countries globally had no mental health policy, in spite of estimates that one in every four people would suffer a mental health condition.

While there were an average nine psychiatrists to every 100 000 people in the west, the comparative figure for the African region was just 0,05 per 100 000 people.

“We need a pan-African movement to ensure there is no discrimination against mental health patients, and we need to develop programmes and proper policies around mental health,” she warned.

As a continent, Africa needed to not only update existing mental health policies and community-based interventions, but to see these formalised at AU level.

With the enormous lack of human resources, Africa also had to find other ways of helping improve mental health, without relying exclusively on psychiatrists.

“In Africa we cannot rely on Western models where there are abundant resources. We need to look at creative ways of using what we have,” Dlamini-Zuma said.

But what should never be lost sight of was the importance of treating mental health patients with dignity, and working to break down the stigma hindering treatment across the globe.

“With health, the economy can’t grow … We can’t do anything without health,” she said.

Psychiatrists’ social contract

Last weekend I had the opportunity to attend the annual World Psychiatric Association (WPA) Congress, which was hosted in Cape Town this year. Over the next few weeks I will be sharing some of the keynote addresses from the Congress.

The Contract between Psychiatrists and Society

In Gujarat, Western India, there is a holy place where many people with mental illnesses go to pray because they believe if they do so they will get better. Some years back, a team of psychiatrists and other medical and health experts set up an initiative where they worked closely with the faith healers at the site with a view to sharing their expertise and helping heal the patients.

The healers engaged closely with the religious leaders, and slowly started administering medical assistance through them. By building up the relationship, the patients, through the healers, started trusting them and accepting their medical input and, in some cases, medication. This co-operative arrangement had yielded great results.

This touching anecdote formed part of the opening address at the World Psychiatric Association Conference by WPA President Dinesh Bhugra, on the contract between Psychiatry and Society.

“The key message to be taken from this is that psychatrists should work together with communities and respect patients,” said Professor Bhugra.
“We should not feel threatened or criticise people for being different. Those are individuals who believe in what they do. We need to find ways of working with them to deliver what our patients would expect.”

In other words, said Professor Bhugra, a key resource in working in this tumultuous and changing world is for psychiatrists to “think out of the box”.
“In Gujarat, they spent two years working with faith healers, getting rid of their fears and concerns, working out, ‘This is what I can do, this is what you can do, let’s work together.’
“People feel threatened by the unknown so co-operation and understanding are essential.”

The same principle applies in Africa, where many people consult traditional healers before seeking medical assistance.

A key part of the contract between Psychiatrists and Society, said Professor Bhugra, is to work out where the boundaries are. We need to ask ourselves, what is it that society expects me to do in treating mental illness, and in return, I, as the Psychiatrist, want the professional freedom to be able to get on with the work, be able to self-regulate, to have sufficient resources and to have respect for what we do.

“The point is that we need to think about services … and that, rather than patients coming to us, we need to be where the patients are. If patients go to a temple or holy mosque, we must be there, rather than saying, ‘come to us’.
“But, both sides should be clear as to what is expected of each other. While we advocate for our patients, similarly, society should listen to me, and say, ‘Here is a person with expertise’.”

Are you trained in emotional first aid?

An article published in the February 2015 issue of Molecular Psychology discussed a research study which found that the brains of people with major depressive disorder (MDD) produce less natural painkillers in response to rejection.

The brain’s μ-opioid receptor (MOR) system dampens physical pain and is believed to also dampen “social pain”. In the research, which compared the responses of medication-free MDD patients with those of healthy people, it was found that during social rejection, the MDD patients showed not only reduced MOR activity, but also slower emotional recovery. During acceptance, only healthy people showed increased social motivation, which was associated with a reward structure in the brain.

In conclusion, the study proposed that these weakened brain functions in MDD patients reduce enjoyment of positive interactions and impede emotional recovery from negative social experiences, thus reinforcing depression.

Our attitudes and beliefs shape our thoughts, so if we perpetuate them over time we will change the way our brain functions and behaves, thus influencing processes like that of the MOR system in the research above. We should all therefore take care of our minds by encouraging good thought patterns and curtailing bad ones. It is also vital that we teach our children from a young age to care for their psychological well-being as conscientiously as they would their physical health.

I highly recommend watching the TED Talk below, by a psychologist who explains how to practise emotional first aid and why we should take our emotional hygiene seriously.