Preston Garrison to Lead WFMH

September Board Meeting in London

On 8 September the Executive Committee of the Federation’s Boardof Directors met at Imperial College, London. Other committee meetingsalso took place. Following these preparatory sessions, a meetingof the Board was held at the Royal College of Psychiatry on 9-10September, chaired by WFMH President Pirkko Lahti. The major itemon the agenda was the appointment of Preston J. Garrison as SecretaryGeneral and Chief Executive Officer. A session of the MembershipAssembly was convened after the Board meeting.The Board reviewed current expenditures, the budget for next year,and other financial matters. A number of Bylaw changes were approvedfor submission to the Assembly, including one to establish a reviewprocess for those voting member organizations not having paid annualdues, which will lead to cancellation of voting status. Changes tothe Manual of Policy and Procedures included the adoption of revisedprocedures governing the submission of resolutions at the Assembly.After a discussion of the current World Mental Health Day campaign,the Board decided to adopt a theme involving children’s mental healthagain in 2003. This will be the second time a two-year theme hasbeen used.A report from the organizers of the next World Congress in Melbourne,Australia, was presented, and the Board also reviewed plans for futureCongresses after the February 2003 event.The Federation’s Main Representative to United Nations Headquartersin New York, Nancy Wallace, gave a presentation on recent activitiesthere, including the meeting of the ad hoc committee on a proposedUN convention on disability (28 July-9 August). She attended themeeting on behalf of the Federation with Board member Sylvia Caras,who also provided comments. The Board passed a resolution expressingsupport for the development of the convention, with the intentionof soliciting the active interest of the Federation’s membership.Earlier, on the afternoon of 8 September at Imperial College, Ms.Wallace had given a general briefing to Board members on the Federation’sadvocacy work at the United Nations.Seven applications for the renewal of Collaborating Center statushad been received. The following were approved:Women’s Health Program, University of Toronto, CanadaOffice for Gender and Health, University of Melbourne, AustraliaDepartment of Psychiatry and Mental Health, University of Cape Town, SouthAfricaHarvard Program in Refugee Trauma, Harvard University, USAService for the Treatment and Rehabilitation of Torture Survivors (STARTTS),Caramar, New South Wales, AustraliaInstitute for Human Ageing, University of Liverpool, UKCCPMH/IPSER, University of Maastricht, The Netherlands.A voting member application from the Suicide Prevention AdvocacyNetwork, USA, was accepted.The Board passed a resolution supporting the investigative effortsbeing undertaken by the World Psychiatric Association with regardto alleged misuses of psychiatry in China to suppress the practicesof the Falun Gong.

Edith Morgan

Promotion and Prevention Gain New Support

The Second World Conference on the Promotion of Mental Health and Preventionof Mental and Behavioral Disorders, London, September 11-13, 2002Recognition of the importance of promotion and prevention in mentalhealth continues to grow. The London conference attracted an audienceenthusiastic about the field, and speakers gave an impressive overviewof the latest developments. It is clear that a vigorous momentum is developing,and this is especially noticeable since the December 2000 inaugural conferenceat the Carter Center in Atlanta.

Rosalynn Carter (left), with UK Minister of State forHealth Jacqui Smithand WFMH Regional Vice President for the Eastern Mediteranean Ma’an Barry

Beverly Long, chair of the Biennial Conference Committee,and Clemens Hosman.chair of the Programme Committee for the London Conference.

The World Health Organization was represented by Benedetto Saraceno,M.D., Director of the Department of Mental Health and Substance Dependence,and by Shekhar Saxena, M.D., Coordinator for Mental Health Evidenceand Research. A session in the program was devoted to WHO’s currentwork in prevention and promotion. To coincide with the conference itreleased a new publication, Prevention and Promotion in Mental Health(see below for information about obtaining a copy). This will be followedby other reports, now in preparation, on prevention (2003, under thedirection of Clemens Hosman) and promotion (2004, under the directionof Helen Herrman). Professors Hosman and Herrman gave overviews oftheir work on these projects.

The British authorities paid significant attention to the conference:improving mental health services is one of the government’s top threehealth priorities. The Minister for Health and Social Services forWales, Jane Hutt, gave a presentation at the welcome reception on 10September. On the following day England’s Minister of State for Health,Jacqui Smith, opened the conference. That evening she hosted a governmentreception for participants at the Foreign and Commonwealth Office.

From Research to ImplementationPrevention and promotion programs operate at many levels and selectivelytarget age groups throughout the lifespan. A large number focus on prenatalhealth, effective parenting, and school-based initiatives. Others targetwomen’s mental health, workplace conditions, and issues affecting olderpeople. Moving from research to demonstration programs, and then to broad-basedgovernment policy initiatives, is a time-consuming process. Transferringthe knowledge gained from one culture to another is even more difficult.

Vikram Patel, London School of Hygiene andTropical Medicine / Sangath Society, India

Many speakers gave a Western perspective, and so the views of thosewho represented developing countries were particularly welcome. VikramPatel discussed the limited provision for general health care in India,and how difficult it is to implement services for prevention and promotionin mental health when basic programs are lacking. A WFMH Board memberfrom South Africa, Shona Sturgeon, spoke feelingly about the wide gapbetween rich and poor countries and how poor countries react when helpis offered without a realistic appreciation of their circumstances.The Federation’s Regional Vice President for Africa, Elizabeth Matareof Zimbabwe, gave a witty and energetic address about ways to campaignat grassroots level to urge governments to improve mental health servicesand meet their commitments under UN conventions.

In the closing session WFMH Board Member Janet Meagher spoke aboutthe need to close the gap between scientific research and those whoreceive services, which she saw as an essential requirement for thegeneral implementation of demonstration projects. She urged the organizersto consider broad approaches, such as involving self-help groups inpromotion and prevention.

Michael Murray, Chief Executive, The Clifford BeersFoundation

Michael Murray of The Clifford Beers Foundation was chair of theorganizing committee, and Prof. Clemens Hosman of the universitiesof Njimegen and Maastricht in The Netherlands chaired the scientificprogram committee. The members of the Biennial Conference Committeein overall charge of the conference were Beverly Long (chair), ClemensHosman, Michael Murray, Sheppard Kellam, Gregory Fricchione, ThomasBornemann, Patricia Mrazek (until 1 June 2002) and Patt Franciosi (after1 June 2002).

The conference was an integral component of the World Federationfor Mental Health global program for the promotion of mental healthand the prevention of mental and behavioral disorders. It was organizedby WFMH and The Clifford Beers Foundation of the United Kingdom incollaboration with The Carter Center, and co-sponsored by the WorldHealth Organization.

A Demonstration Project from Scotland

Many participants were already implementing demonstration programs,and described them in symposia throughout the conference. An examplewas a presentation from the leadership team of the “Starting Well HealthDemonstration Program” in Glasgow, Scotland. Glasgow has one of thepoorest health records in Europe, and this three-year program is designedto promote positive parenting and improve the outlook for childrenin disadvantaged families. It is based on an existing health visitorprogram which provides home visits in the prenatal period.

The demonstration project broadened the service offered to provideother levels of support for family members. The role of the healthvisitors continued, but was supplemented by support workers, nurserynurses and community support facilitators. The team provided servicesdirectly and also facilitated access to other programs. Local employmentwas created within the community through special training for the paidsupport positions, and an effort was made to recruit Asian workersto assist Asian families.

The presenters noted how difficult it was to mesh the new staff involvedin the demonstration program with the existing group of health visitors,and how hard it was to move the health visitor program from a medicalapproach to a wider context emphasizing social and behavioral issues.

The program was successful in targeting an increased amount of assistancefor new mothers who experience post-partum depression. It also paidattention to other mental health problems of family members and triedto find ways to help. One member of the Glasgow team observed thatthe health visitors saw many cases of depression – which individualssimply accept as normal in their lives. Domestic violence proved tobe especially difficult to address.

Presentations like this during the conference showed that, whileit might be difficult to replicate exactly a program tailored to specificlocal circumstances, the underlying aims could be adopted in many otherplaces

Two Publications Released at the London Conference

Proceedings of the Atlanta Conference at the Carter Center, December2000 To obtain a copy of Toward a Strategy for Worldwide Action toPromote Mental Health and Prevent Mental and Behavioral Disorders (forthe cost of shipping and handling) contact:

WFMHP.O.Box 16810Alexandria, VA 22302-0810Fax: 703 519 7648Email: [email protected]

WHO Report: Prevention and Promotion in Mental HealthAvailable at no charge. Contact:

Dr. Shekhar SaxenaCoordinatorMental Health: Evidence and ResearchWorld Health OrganizationCH-1211, Geneva, SwitzerlandAlso, the pdf version of the report can be downloaded from the followingURL:http://www5.who.int/mental_health/main.cfm?s=0006#evidence

The Second World Conference on the Promotion of MentalHealth and Prevention of Mental and Behavioral Disorders, London, September11-13, 2002

Recognition of the importance of promotion and prevention in mentalhealth continues to grow. The London conference attracted an audienceenthusiastic about the field, and speakers gave an impressive overviewof the latest developments. It is clear that a vigorous momentum isdeveloping, and this is especially noticeable since the December 2000inaugural conference at the Carter Center in Atlanta.

Rosalynn Carter (left), with UK Minister of Statefor Health Jacqui Smithand WFMH Regional Vice President for the Eastern Mediteranean Ma’an Barry

Beverly Long, chair of the Biennial Conference Committee,and Clemens Hosman.chair of the Programme Committee for the London Conference.

The World Health Organization was represented by Benedetto Saraceno,M.D., Director of the Department of Mental Health and Substance Dependence,and by Shekhar Saxena, M.D., Coordinator for Mental Health Evidenceand Research. A session in the program was devoted to WHO’s currentwork in prevention and promotion. To coincide with the conferenceit released a new publication, Prevention and Promotion in MentalHealth (see below for information about obtaining a copy). This willbe followed by other reports, now in preparation, on prevention (2003,under the direction of Clemens Hosman) and promotion (2004, underthe direction of Helen Herrman). Professors Hosman and Herrman gaveoverviews of their work on these projects.

The British authorities paid significant attention to the conference:improving mental health services is one of the government’s top threehealth priorities. The Minister for Health and Social Services forWales, Jane Hutt, gave a presentation at the welcome reception on10 September. On the following day England’s Minister of State forHealth, Jacqui Smith, opened the conference. That evening she hosteda government reception for participants at the Foreign and CommonwealthOffice.

From Research to ImplementationPrevention and promotion programs operate at many levels and selectivelytarget age groups throughout the lifespan. A large number focus on prenatalhealth, effective parenting, and school-based initiatives. Others targetwomen’s mental health, workplace conditions, and issues affecting olderpeople. Moving from research to demonstration programs, and then to broad-basedgovernment policy initiatives, is a time-consuming process. Transferringthe knowledge gained from one culture to another is even more difficult.

Vikram Patel, London School of Hygiene andTropical Medicine / Sangath Society, India

Many speakers gave a Western perspective, and so the views of thosewho represented developing countries were particularly welcome. VikramPatel discussed the limited provision for general health care inIndia, and how difficult it is to implement services for preventionand promotion in mental health when basic programs are lacking. AWFMH Board member from South Africa, Shona Sturgeon, spoke feelinglyabout the wide gap between rich and poor countries and how poor countriesreact when help is offered without a realistic appreciation of theircircumstances. The Federation’s Regional Vice President for Africa,Elizabeth Matare of Zimbabwe, gave a witty and energetic addressabout ways to campaign at grassroots level to urge governments toimprove mental health services and meet their commitments under UNconventions.

In the closing session WFMH Board Member Janet Meagher spoke aboutthe need to close the gap between scientific research and those whoreceive services, which she saw as an essential requirement for thegeneral implementation of demonstration projects. She urged the organizersto consider broad approaches, such as involving self-help groupsin promotion and prevention.

Michael Murray, Chief Executive, The Clifford BeersFoundation

Michael Murray of The Clifford Beers Foundation was chair of theorganizing committee, and Prof. Clemens Hosman of the universitiesof Njimegen and Maastricht in The Netherlands chaired the scientificprogram committee. The members of the Biennial Conference Committeein overall charge of the conference were Beverly Long (chair), ClemensHosman, Michael Murray, Sheppard Kellam, Gregory Fricchione, ThomasBornemann, Patricia Mrazek (until 1 June 2002) and Patt Franciosi(after 1 June 2002).

The conference was an integral component of the World Federationfor Mental Health global program for the promotion of mental healthand the prevention of mental and behavioral disorders. It was organizedby WFMH and The Clifford Beers Foundation of the United Kingdom incollaboration with The Carter Center, and co-sponsored by the WorldHealth Organization.

A Demonstration Project from Scotland

Many participants were already implementing demonstration programs,and described them in symposia throughout the conference. An examplewas a presentation from the leadership team of the “Starting WellHealth Demonstration Program” in Glasgow, Scotland. Glasgow has oneof the poorest health records in Europe, and this three-year programis designed to promote positive parenting and improve the outlookfor children in disadvantaged families. It is based on an existinghealth visitor program which provides home visits in the prenatalperiod.

The demonstration project broadened the service offered to provideother levels of support for family members. The role of the healthvisitors continued, but was supplemented by support workers, nurserynurses and community support facilitators. The team provided servicesdirectly and also facilitated access to other programs. Local employmentwas created within the community through special training for thepaid support positions, and an effort was made to recruit Asian workersto assist Asian families.

The presenters noted how difficult it was to mesh the new staffinvolved in the demonstration program with the existing group ofhealth visitors, and how hard it was to move the health visitor programfrom a medical approach to a wider context emphasizing social andbehavioral issues.

The program was successful in targeting an increased amount ofassistance for new mothers who experience post-partum depression.It also paid attention to other mental health problems of familymembers and tried to find ways to help. One member of the Glasgowteam observed that the health visitors saw many cases of depression – whichindividuals simply accept as normal in their lives. Domestic violenceproved to be especially difficult to address.

Presentations like this during the conference showed that, whileit might be difficult to replicate exactly a program tailored tospecific local circumstances, the underlying aims could be adoptedin many other places

Two Publications Released at the London Conference

Proceedings of the Atlanta Conference at the Carter Center, December2000 To obtain a copy of Toward a Strategy for Worldwide Action toPromote Mental Health and Prevent Mental and Behavioral Disorders(for the cost of shipping and handling) contact:

WFMHP.O.Box 16810Alexandria, VA 22302-0810Fax: 703 519 7648Email: [email protected]WHO Report: Prevention and Promotion in Mental HealthAvailable at no charge. Contact:Dr. Shekhar SaxenaCoordinatorMental Health: Evidence and ResearchWorld Health OrganizationCH-1211, Geneva, SwitzerlandAlso, the pdf version of the report can be downloaded from the followingURL:http://www5.who.int/mental_health/main.cfm?s=0006#evidence 

Visit to Kissy Mental Hospital, Sierra Leone

By Florence BainganaSenior Health Specialist, The World Bank

Human Rights Abuses in Kosovo

“While conditions at all inpatient facilities we observed are poor – andraise serious human rights concerns – conditions at Shtime are the worst.In part, this is because detention in Shtime usually means segregation from societyand detention in the institution for life…. People spend their days ininactivity, without any semblance of privacy, living in filth….There areno clocks to orient people as to the time of day. Many people spend their dayssitting on benches, wandering the grounds, or sleeping on bare concrete floors.”Mental Disability Rights International has released a strong reportabout deplorable conditions in three institutions for people withpsychiatric and mental disabilities in Kosovo – the Shtime institution,the Elderly Home (which housed people of all ages at the time ofMDRI’s investigation) and the psychiatric ward of PrishtinaUniversity Hospital. The report examines serious abuses, includingunhygienic conditions, inadequate staffing levels for general andmedical care, and inappropriate placements.Of special concern were reports from patients and local and foreignstaff about cases of sexual harassment, rape and other types of violenceat the three institutions. “Kosovo’s social care facilitiesand psychiatric wards are not safe places. In addition to violatingthe rights of patients, the lack of protections against violenceor sexual exploitation undermines the function of psychiatric wardsto assist people in need of acute mental health care.” Therewas no system to conduct independent investigations of alleged incidents,considerable fear of making such reports, and little effort to protectpatients from violence.The report contains a careful review of the difficulties of post-conflictinternational intervention, and problems caused by short-term foreignaid and its gradual withdrawal. It is highly critical of policiesadopted by the United Nations Mission in Kosovo (UNMIK) which failedto address reforms and permitted abuses to continue. It points outthat UNMIK’s programs in Kosovo do not conform to the UN’sown disability rights standards.A list of recommendations is offered for urgently needed fundingand policy changes to provide major improvements in care. About theShtime institution, where the report says “many residents livein filth, surrounded by the smell of urine or feces,” the recommendationis that the place “is so dangerous and destructive to the mentaland physical health of its residents that the UN should plan forits closure at the soonest possible date – as soon as alternativescan be created in the community.”The report “Not on the Agenda: Human Rights of People withDisabilities” was released in August after six site visitsto Kosovo by MDRI teams. It was written by MDRI Executive DirectorEric Rosenthal, and Eva Szeli, MDRI Director for European Programs.The text is available online at www.mdri.org.Contact:Mental Disability Rights International1156 15th Street NW, Suite 1001Washington, DC 20005, USATel: 202 296 6550Fax: 202 728 3053Email: [email protected] 

South America’s SeriousProblems

SUD AMERICAY SUS GRAVES PROBLEMAS DE HOY

Sud América está atravesando dificultades importantes en toda su extensión.A los problemas ya conocidos y a su necesidad general de desarrollo,se han agregado hoy numerosos problemas y crisis prácticamente en todasu extensión.Corren peligro los progresos realizados en la Atención de los EnfermosMentales en aquellos países donde las dificultades económicas y financierashan obligado a reducir los presupuestos, incluso los de Salud. Argentina,Brasil y Uruguay, países con desarrollos importantes en Salud y SaludMental, están enfrentando problemas en este sentido. Existe gran preocupaciónpor fenómenos que han agravado y aumentado la fragilidad de la población,que vive en incertidumbre continua. Surgen permanentemente alertaspor el aumento de los ingresos en los hospitales públicos.La “nueva probreza” está generando sufrimiento y patologías que superanla depresión. Se está apreciando un incremento de los suicidio, loshomicidios y actos violentos e incluso muertes súbitas por crisishipertensivas, ataques cardíacos y accidentes cerebro vasculares. Comienzana aparecer muchas necesidades respecto a la atención del estrés y losTrastornos de Personalidad Post Traumáticos.Sud América requiere de la cooperación internacional y una más activaincidencia sobre los gobiernos, que seguramente están alarmados porlos problemas socio-económicos y deben tomar medidas en lo referentea las reacciones psico-sociales y otros problemas psiquiátricos ligadoscon ellas.Los esfuerzos para mejorar los Sistemas de Atención de Base Comunitariay la descentralización desde el Hospital Psiquiátrico continúan. Lasorganizaciones de usuarios prosiguen con su esfuerzo, pero se advierteel riesgo de enlentecimiento y deterioro de los Servicios Comunitarios.Es altamente recomendable que aparezcan más y más planteos a travésde los medios masivos de comunicación y se enfatice que la nueva pobrezay el deterioro social ya están en países como Argentina, Brasil, Paraguayy Uruguay, generando crisis, depresión e intentos de suicidio que díaa día aumentan las demandas de atención y los ingresos hospitalarios.Queremos destacar que aún en estas condiciones, nuestras afiliadasde Argentina y Chile desarrollan importantes actividades. Los días6 y 7 de setiembre se realizó en la ciudad de Córdoba, Argentina,una reunión subregional (Argentina, Paraguay y Uruguay) sobre “SaludMental y Trabajo en período de crisis”.Y también en la ciudad de Valdivia, Chile, un Curso de Psiquiatríapara médicos y profesionales sobre Atención Primaria en Salud organizadopor la Sociedad Chilena de Salud Mental.FUERZA Y SALUD. CONTINUAMOS TRABAJANDO.