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Quarter 2001


Pirkko LahtiMessage
from the WFMH President

My dear readers,

Research carried out recently in Finland, my home
country, indicated that a person who has experienced
injustice once in his or her life is more susceptible to
mental ill health than others. Injustice can occur in the
childhood home, in the family, at school, within a marriage,
at the workplace, and at the government level – anywhere.
The shocking thing is that such an experience can affect
someone so strongly that his or her personal balance can be
swayed towards sickness.

This research also made me think about how our children –
the foundation of our future – can develop as healthy,
balanced children experiencing justice. One looks
automatically at the models – ourselves – offered to them at
home. The foundation upon which a child grows is formed, to
a great extent, by our own behavior as well as by our

I have tried to develop here some central themes from the
point of view of a child’s healthy upbringing. I challenge
you, the readers, to participate in the discussion. I
believe that one of the main things from a child’s viewpoint
is the guarantee of security. This means economic and social
as well as psychological security. The aim of child rearing
is to increase the child’s knowledge but to present the
information in such a way that the child can discover things
for himself or herself and gain insight.

Children can be educated about justice through rewards,
not just punishment. Currently considerable thought is given
to ways of providing discipline, but many of these ways only
serve to make children feel guilty. How can we turn
discipline into reward and support?

A start might be to respect the child as a person – in
need of sufficient protection, but also an individual
beginning a life of his or her own. People bringing up
children are expected to be sincere and genuine. I assume
that everyone rearing a child wants that child to be happy.
We, together with our children, must decide what we
understand by happiness. It is good to remember that there
is no limit to happiness. If we ourselves do not know what
is enough, we are constantly seeking more.

Raising a child requires permanent human relationships, a
safety net of loved ones who are there for the child. I also
believe that a child is good at heart. What a child becomes
is the result of its environment, as well as the hard knocks
in life. Listening carefully to a child, however, guarantees
that he or she will be understood – and increases the
chances that he or she will be treated justly.

When working with children it does not pay to give too
much too soon, in case we risk undermining their security.
Showing love and setting limits simultaneously is not an
overwhelming challenge if one bears in mind what a mother or
father does. Understanding and remembering one’s own
parents’ role is a vital guide to child rearing,
contributing to the family’s set of values and viewpoints.

There is a nursery rhyme in Finland which states that a
child is made of sugar and spice. The central theme attracts
me. It symbolizes a good child – as all children are
originally. The status of a child varies from one culture to
another, and every culture has basic principles of child
rearing. The transfer of good child-rearing principles from
one culture to another, and the adoption of sound practices,
is a great challenge. It is part of mental health work; it
provides for an enduring future for mankind.

Pirkko Lahti

WHO’s Five-Year Global Action Program for Mental Health

Towards the end of its year-long campaign in 2001 to draw attention
to mental health, the World Health Organization decided to continue its
effort in a new five-year program to “provide a clear and coherent
strategy for closing the gap between what is urgently needed, and what
is currently available to reduce the burden of mental disorders, world
wide.” Those were the words of WHO Director-General Gro Harlem
Brundtland, describing the new Global Action Program (mhGAP for short)
at a Council for Mental Health Seminar in her native Norway on 11
December 2001. She continued that “WHO will work with governments to
move mental health towards the center of health agendas.”*

In developing its new program, WHO has engaged in a broad
consultation exercise and identified four main strategies consistent
with the functions of the organization. Benedetto Saraceno, Director of
WHO’s Department of Mental Health and Substance Dependence, outlined
them in January as follows: “information generation and its wide
dissemination; provision of technical and managerial support to
countries for policy, programme and service development; research
capacity building and multiplication of research initiatives, especially
in developing countries; and lastly, promotion of advocacy and the
protection of human rights of people with mental illness.”

He added that in the next five years “WHO Headquarters, regional and
country offices will focus on providing strong technical support to
assist in the development and implementation of national mental health
goals. It is now a question of ensuring that the accumulated knowledge
and technology are rapidly put to use in the service of ALL those who
need mental health care around the world.

To do this, countries need to make mental health services available
to people as close as possible to where they live. They need to transfer
mental health care from psychiatric hospitals to communities which means
that budgets must be maintained or even increased; mental health teams
must be trained; the needs of especially vulnerable groups must be met;
crisis centers for the management of acute conditions must be available;
and there must be broad public support for creating and sustaining this

Dr. Saraceno said that such wide goals would need broad-based
support. “It is clear that such a massive effort cannot be undertaken by
the health sector alone and that partnerships with other sectors,
services and civil groups are a must. Governments and non-governmental
organizations are calling for intensive technical support from WHO and
the international community.”

World Health Report

Left to right: Richard Hunter, WFMH Deputy Secretary General; 
George A. O. Alleyne, M.D., Director, PAHO;
Benedetto Saraceno, M.D., Director, Division of Mental Health and
Substance Dependence, WHO;
and Jose Miguel Caldas de Almeida, Coordinator, Mental Health Program,

The initiatives follow the release of WHO’s World Health Report 2001
with the title “Mental Health: New Understanding, New Hope.” The Report
was launched at a series of regional events in October and November,
ending with one at the Pan American Health Organization in Washington,
D.C. The 178-page volume brings together a large amount of material to
provide a global perspective on mental health, and gives attention to
external factors ranging from the effects of social conditions to the
psychological impact of major physical diseases.

Pirkko Lahti, WFMH President, says “One of the most important aspects
of the report is its attention to the fact that many people living in
poverty experience mental health problems. There are many reasons for
this…. Poor people have less chance to obtain treatment than wealthier
groups.” The Report points out that even in rich countries, the poor are
particularly at risk, and notes that many people with mental illness can
slide into poverty because of the nature of the illness itself.

The five chapters cover a public health approach to mental health;
the burden of mental and behavioral disorders; solving mental health
problems through effective care; policy and service provision; and
recommendations for the way forward. Within these chapters the authors
summarize much recent research and set out goals for improvement, citing
evidence from around the world.

Itzhak Levav, M.D., (left) former Regional Adviser in Mental Health

at PAHO, with the current head of the mental health program,
Jose Miguel Caldas de Almeida.

Tables, figures, examples and boxed commentaries on special subects
are liberally provided throughout the text.

Of particular note are new estimates of the global burden of mental
and behavioural disorders. The disability-adjusted life year measure
(DALY) published in 1993*** showed that for 1990, mental and
neurological disorders were 10.5% of DALYs lost due to all diseases and
injuries. The estimate for 2000 has risen to 12.3%, and it is predicted
to reach 15.0% in 2020.

Major depression ranks fourth in the table of leading causes of the
overall global burden of disease for all age groups. Projections put it
in second place by 2020.

In a table of the leading causes of years lived with disability by
15-44 year-olds (estimates for 2000), four of the five leading causes
are mental disorders. In first place are unipolar depressive disorders,
followed by alcohol use disorders and schizophrenia in second and third
place, with bipolar affective disorder fifth. WHO expects to publish its
final figures for the Global Burden of Disease 2000 during 2002.


Pilot Project in Mexico

Virginia Gonzales Torres

In a significant initiative to improve mental health care, Mexico has
introduced a pilot project called the Modelo Hidalgo de Atencion en
Salud Mental. It is intended as the foundation for general reforms based
on respect for the consumer’s right to receive care delivered with
attention to quality, within a system of integrated medical and
psychiatric services. It also marks an effort to improve
often-criticized conditions in psychiatric institutions.

The Hidalgo Model won support after a change of administration in
Mexico, when Vicente Fox became president in 2000 and signaled concern
for mental health care by giving a prominent consumers’ advocate,
Virginia Gonzalez Torres, a post in the Health Ministry. She directs a
new Office of Psychosocial Rehabilitation, Citizens Participation, and
Human Rights. The model program is a joint project of the Health
Ministry and the Mexican Foundation for the Rehabilitation of Persons
with Mental Illness, together with the governments of different Mexican

The reform movement focused initially on the State of Hidalgo, where
conditions at the Ocaranza institution had attracted widespread
criticism. Ocaranza was closed down, and a group of services was put
together to provide for prevention, mental health care in the community
integrated with regular health care, hospitalization where necessary,
and social reintegration.

A variety of service formats are now used, including mental health
services in clinics and community centers, general hospitals,
psychiatric hospitals for people in the acute stages of illness, and
new, very small hospital units called “villas.” The network includes
various residential arrangements including halfway houses, residences
for senior citizens, independent housing and group housing. Social
reintegration is offered through clubs and employment opportunities at
sponsored workshops and business cooperatives.

The Governor of Hidalgo attended the Pan American Health
Organization’s mental health conference in Washington, D.C. on 6
November 2001, to present his state government’s mental health policy
reforms and its commitment to press on with them. Virginia Gonzalez
Torres was also there to describe the national government’s support for
the Hidalgo Model and her personal support for consumer involvement in
its development. Her staff distributed material describing the project,
in Spanish and English, to health ministry representatives from other
South American countries.

One of the main objectives of her office in the Health Ministry is to
promote the development of the Hidalgo Model in other Mexican states,
and to request sufficient funding allocations from the federal and state
authorities to make this possible.

  Project Atlas

To provide information
about the current status of mental health systems and to highlight the
great variations among countries, WHO collected basic information from
181 countries for a “Project Atlas of Mental Health Resources.” This
important survey revealed that roughly four out of ten countries have no
defined mental health policy; approximately one-third have no drug and
alcohol policy; one-third have no specific budget for mental health and
half of the remainder allocate under 1% of their public health budget to
mental health. One-third of the countries reporting had no mental health
program at all. WHO finds the lack of policy related to children and
adolescents particularly significant.

  1. Dr. Gro Harlem Brundtland, WHO Director-General, speech at the
    Council for Mental Health Seminar, Oslo, Norway, 11 December 2001.

  2. World Health Report 2001, Mental Health: New Understanding, New
    Hope. Geneva, WHO 2001. To order, email
    [email protected]
  3. World Development Report 1993: Investing in Health. New York,
    Oxford University Press for the World Bank, 1993.


top   United Nations
UN New York

The NGO Committee on Mental Health presented a
program on 13 December 2001 to mark the UN Human Rights Day and the Ten
Year Anniversary of UN Resolution 46/119 – “The Protection of Persons
with Mental Illness and the Improvement of Mental Health Care.” The
panel was organized and chaired by Nancy Wallace, WFMH Main
Representative at the UN and Past Chair of the NGO Committee.

The three speakers were Tina Minkowitz, J.D., a member of the World
Network of Users and Survivors of Psychiatry (“What does Disability
Rights have to do with the MI Principles? A Perspective from the
User/Survivor Movement”); Laura Prescott, President of Sister Witness
International, Inc.(“Shattering the Silence: Protecting the Rights of
Institutionalized Women across the Spectrum”); and Maribel Derjani-Bayeh,
Social Affairs Officer in the Programme on Disability in the UN’s
Department of Economic and Social Affairs (“Update on the General
Assembly Resolution calling for an International Convention to Protect
and Promote the Rights and Dignity of Persons with Disabilities”).

Ms. Derjani-Bayeh reported on an important new development at the
United Nations of special interest to NGOs concerned with disabilities.
On Friday, 30 November, the UN General Assembly approved, by consensus,
a Resolution put forward by the Government of Mexico calling for a
comprehensive international convention to protect the rights and dignity
of people with disabilities.

An Ad Hoc Committee will be established by the General Assembly to
consider proposals for the convention, taking into account
recommendations of the UN Commission on Human Rights and the UN
Commission on Social Development. The two Commissions will play a
leading role in developing the content of the convention. In 2002 the
consultative process of creating the convention is expected to occupy a
central place in the work of UN bodies and NGOs concerned with
disabilities and human rights, including the NGO Committee for Mental

Ms. Wallace is convening a new Working Group on Human Rights and
Mental Health that will focus on this new UN initiative.

UN World Assembly on Ageing
The UN Second World Assembly on Ageing will take place on 8-12 April
2002 in Madrid. An NGO Forum will accompany the official government
conference. The purpose of this meeting is to update the 1982
International Plan of Action on Ageing. The First World Assembly on
Ageing took place in 1982 in Vienna. The revised Plan will take account
of the population shift towards expansion in the numbers of older
persons in many societies, and the changing needs of developing

  Retirement of Josee Van Remoortel

Josee Van Remoortel

Josee Van Remoortel, the first Executive Director of Mental Health
Europe (formerly known as the European Regional Council of WFMH),
retired at the end of October. She has served in this position as a
volunteer since 1993, having previously been Chair of the ERC-WFMH from
1989 to 1993. She was a founding member of the ERC and is a life member
of WFMH, which she joined in 1975.

After qualifying with a Master’s degree in Community Nursing and
Social Work, she held a position in the community mental health service
attached to the Department of Psychiatry at the State University of
Gent, Belgium, for several years. She then served as Deputy Director of
the Belgian National Association for Mental Health and as Director of
the Flemish Association for Mental Health. At Mental Health Europe she
became involved in many activities of the European Union and served on
the boards of numerous organizations.

Mental Health Europe arranged a concert and reception in Brussels on
27 October in Josee’s honor, to recognize her exceptional service in the
cause of mental health promotion and her leadership in trying to improve
the situation of socially disadvantaged people with mental health

In appreciation of Josee Van Remoortel’s work, Mental Health Europe
has created a special fund to benefit low-income members, to allow them
to participate fully in MHE activities. Contributions can be made to the
MHE account 442-8026622-96, swift code: KRED BE 99, Banque: KBC Potuit,
Antwerpsesteenweb 465, directed to the “Josee Van Remoortel Farewell

New MHE Director

Pascale Van den Heede, Executive Director MHE-SME

Mental Health Europe has now made a transition to a paid Executive
Director. Pascale Van den Heede started in the post part-time on 1
April, and took over full time on 1 November. She has a degree in
Pharmaceutical Sciences from the University of Gent, Belgium, and
postgraduate qualifications in Women’s Studies and in Human Ecology. Her
work experience is in marketing and communications.


News from the Regions

WHO’s World Health Report was launched in Africa at an event in Harare,
Zimbabwe, on 23 October attended by Benedetto Saraceno, M.D., Director
of the Department of Mental Health and Substance Dependence at WHO, Mary
Petevi, Advisor in the Department of Humanitarian Action, and Dr.
Custodia Mandlhate, Regional Adviser for Mental Health. This was
followed on 24-26 October by the Third Inter-Country Meeting on
Community-based Psychosocial Rehabilitation Programs in Emergency
Situations. WFMH’s Regional Vice President for Africa, Elizabeth Matare,
gave the opening address at the conference.

Mental Health Europe
The next annual conference of MHE will be held in Tallinn, Estonia, on
7-9 November 2002. The theme of the meeting is “Policy Developments and
Strategies in Mental Health.” MHE’s next General Assembly will be held
in Brussels on 9 March. Board meetings will be held in March in
Brussels, in June in Spain, and in November in Tallinn.

MHE has issued a six-page brochure called “Social Inclusion – A
Challenge for the European Union!” The brochure contains specific,
concise guidelines for policy-makers and service providers to improve
the social inclusion of people with mental health problems. The
attention of policy-makers is directed to employment, education and
training, welfare benefits, family life issues, human rights and
housing. Matters for consideration by service providers include access
to treatment, housing issues, confidentiality of personal data, and the
need for public education. This should include employers, the media, and
even health and social workers. The brochure is available from:

Mental Health Europe
7 boulevard Clovis
B-1000 Brussels, Belgium
Tel: 32 2 280 04 68
Fax: 32 2 280 16 04
Email: [email protected] 

At the end of a long period of information gathering, MHE has also
produced a directory of projects concerned with “Mental Health Promotion
of Adolescents and Young People.” This catalogues a wide range of
initiatives in European Union countries to promote positive mental
health and prevent mental illness among adolescents and young people up
to the age of 25. To obtain the directory contact the project co-ordinator,
Kirsten Zenzinger, at the MHE address above or
[email protected] 

Conference in Israel
WFMH is a cosponsor of the Second International Seminar on “Violence and
Adolescence: Adolescent Violence in Violent Times,” to be held in
Jerusalem, Israel, on 2-4 July 2002. For information contact the Seminar

ISAS International Seminars
P.O.Box 34001
Jerusalem 91340, Israel
Email: [email protected]

Southeast Asia

Regina G. de Jesus (center), WFMH Regional Vice
President for Southeast Asia,
receives a Certificate of Appreciation as the Guest of Honor during
World Mental Health Day celebration in Bacolod City on 10 October 2001

The Philippine Mental Health Association opened its 51st National
Mental Health Week, and its observance of World Mental Health Day, on
8-9 October 2001 with a national conference on “Mental Health and Work.”
The meeting took place in Bacalod City on the island of Negros. In
addition to general workplace concerns the topics included child labor,
life after work, and the workplace as a center of wellness. Special
World Mental Health Day celebrations involving a number of private
schools in Bacalod City were also arranged for 10 October. WFMH Regional
Vice President for Southeast Asia, Regina de Jesus, was the guest
speaker for the day’s program.

South America

En la Región Andina, especialmente en Colombia, se ha logrado
desarrollar actividades de Salud Mental, particularmente en los temas
que afectan a los enfermos psiquiátricos. La población general de ese
país vive un stress permanente por motivos conocidos, los problemas de
los secuestros, la lucha contra el narcotráfico y las guerrillas están
afectando más y más a la población. La Asociación Colombiana de Salud
Mental realiza esfuerzos para desarrollar planes de prevención y
atención al stress.

En el Cono Sur de Sud América se han producido varias reuniones
regionales sobre Salud Mental y Trabajo. La última, realizada en
diciembre en Montevideo, tuvo representantes de Argentina y Uruguay. Ya
existen propuestas para un plan de trabajo para el año 2002 que incluyen
una extensión a otros países. Se preve el fomento de la investigación y
también la cuantificación de los costos por causas atribuibles a la
pérdida de la Salud Mental.

La Federación y la ILO están impulsando la sensibilización de los
sindicatos, empleadores y los gobiernos. Necesitamos acumular
información sobre la situación de la Salud Mental y el Trabajo en los
países de la región. Por ello, agradecemos de antemano envíen a la Vice-Presidencia
Regional la información disponible, en especial estudios y datos de lo
que está aconteciendo en los restantes países.

En diciembre del 2001 se ha realizado una nueva reunión sobre Mass
Media y Salud Mental. Esta fue coorganizada por varias Fundaciones de
Argentina y Uruguay y convocada por la Sección correspondiente de la
Asociación Mundial de Psiquiatría (WPA) y nuestra Federación. Fue un
verdadero encuentro interdisciplinario, en el cual participaron
profesionales de amplia diversidad, representantes de Facultades, de la
Universidad de Buenos Aires (Argentina) y de Uruguay. Es destacable que
en ella participaron activamente empresarios de los medios de
comunicación y periodistas.

Prof. Dr. Paulo Alterwain
Vice-Presidente Regional para Sud América

Western Pacific

WHO Regional Meeting for the Wester Pacific, Brunei,
10-14 September;
WFMH representative Kazuyoshi Yamamoto is second from right.

A group of WFMH leaders met at the Asai Hospital in Chiba, Japan, on
4-5 November to discuss the development of regional activities. Honorary
President Tsung-yi Lin attended, together with WFMH Regional
Vice-President Kazuyoshi Yamamoto, former Board members Kunihiko Asai
and Shimpei Inoue, and Board member-at-large Chueh Chang. The group
intends to organize a WFMH Asia-Pacific symposium on mental health and
human rights in conjunction with the World Psychiatric Association’s
conference in Yokohama in August 2002. They also discussed progress
towards the establishment of a Regional Council, which they hope can be
inaugurated at the WFMH World Congress in Melbourne in February 2003.

WFMH regional planning meeting in Chiba, Japan:
(front row, left to right) Board member Chueh Chang, Honorary President
Tsung-yi Lin,
Mei Chen Lin; (back row, left to right) former Board member Kunihiko
Regional Vice President Kazuyoshi Yamamoto, and former Board member
Shimpei Inoue.

Regional Vice-President Kazuyoshi Yamamoto attended the 52nd Session
of the WHO Regional Committee for the Western Pacific in Brunei
Darussalam on 10-14 September 2002, and read a statement on behalf of
the Federation.

top   The Impact of September 11 on Refugees Applying for

Solvig Ekblad

By Solvig Ekblad, co-chair of WFMH’s International Committee on
Refugees and Other Migrants (ICROM)

Eighty days after the terrorist attacks in the United States, I was
walking at “Ground Zero” in New York. Christmas decorations were hanging
in the streets at the edge of the site, but I was aware of the sticky
smell of fire which not only induced stress but was also unhealthy to
inhale. For all those directly and indirectly effected by the terror
attacks, recovery from long-term psychological scars will take time.
This was one of the main topics at the 17th Annual International Society
for Traumatic Stress Studies Meeting in New Orleans in December, which
mainly focused on trauma produced by terrorism and mass disaster.
However, I have been thinking recently that the mental health impact of
detention among asylum seekers must not be neglected, especially as our
alertness against terrorism now encourages suspiciousness and hostility
toward foreigners. That is the topic of my column, and I will draw on
experiences as a visiting researcher in Australia earlier this year, at
the department of my Committee co-chair, Professor Derrick Silove.

In supporting the war against terrorism, we should not forget that
one of the most certain outcomes is a large flow of refugees seeking
asylum. We should all remember the lessons of history, and the purpose
of the Refugee Convention, a landmark international instrument
committing ratifying countries to providing humane protection to persons
fleeing persecution worldwide . But “instead of providing special care
for the most traumatised individuals fleeing persecution, Western
countries may be subjecting them to the very conditions that are likely
to hinder psychosocial recovery” (Silove, Steel, Mollica, 2001, p.1437).
Contemporary refugee policies in Western countries have been thrown into
stark relief by the effects of the terror attacks in the US.

Detention of asylum seekers
Increasingly, industrialized countries are building or extending
facilities to detain asylum seekers. In 2000, the USA had about 5000
asylum seekers in detention at any one time (Silove, Steel, Mollica,
2001). Before September 11, Australia stood alone in mandating the
detention of all individuals entering Australia without valid visas,
irrespective of whether or not they were seeking asylum. According to a
UNCHR report in 2000, Australia ranked 17th out of 21 industrialised
countries in terms of the absolute number of asylum applications
received during 1999. In a review of research studies in Australia and
elsewhere, Steel and Silove (2001) suggested that detained asylum
seekers may have suffered greater levels of past trauma than other
refugees, and this may contribute to their mental health problems, with
detention providing a retraumatising environment.

After the 11 September terror attacks, there was bipartisan political
support in Australia for an international war against terrorism. At the
same time, those fleeing from terrorist States are treated as criminals
when they reach Australia. Recent asylum seekers are mainly confined in
detention centres in remote areas and in economically poor island
countries to the north of Australia, a policy which has been criticized
by UN and other international agencies.

A visit to the Villawood Detention Centre
Last August, together with Dr Zachary Steel, I visited the Villawood
Detention Centre in Sydney to meet Aamer Sultan, a medical practitioner
who fled persecution in Iraq after providing casualty medical care to
Shiite Muslim rebels. He has been detained since May 1999. He is a
bilingual Arab/English speaker and as a health professional he is a
confidant of many detainees. Sultan, writing in a recent issue of
Medical Journal Australia with a mental health professional (K.
O’Sullivan) who had worked at Villawood, provided a unique picture of
the daily difficulties of detained asylum seekers. A commentary in the
same issue by Zachary Steel and Derrick Silove described how the policy
of mandatory detention of asylum seekers is leading to serious
psychological harm.

During my hour of conversation with Aamer Sultan I was deeply
impressed by his courage and the way he retained his world view in spite
of losing his liberty for an indeterminate period of time. To me the
physical environment at Villawood was intimidating, even during a short
visit. The compound where we had the conversation was surrounded by
multiple layers of high fencing topped and grounded by razor wire. All
visitors had to pass through strict security checkpoints and I felt we
(the visitors) were treated as cattle. Nevertheless my colleague was
allowed to bring a manuscript to discuss with his co-author, Dr. Sultan.
The detained people around us sat with visitors, but with boredom,
aimlessness and apathy in their eyes. Birds were the only ones with
freedom, flying in and out of the compound.

I heard from Dr Sultan that most of the asylum seekers detained at
Villawood came from developing countries ruled by oppressive regimes
with poor human rights records. Many have been victims of
state-organized violence, including torture and other forms of inhuman
or degrading treatment and/or have family members who are suffering from
such abuses. These people are at high risk of the different kinds of
post-traumatic psychological reactions we know about from the
literature. Children living in Villawood are at special risk of being
influenced by a secondary effect mediated via their parents, whose
ability to provide a normal caring and nurturing environment is more or
less non-existent. These children are vulnerable to neglect and physical

The World Federation for Mental Health has had a longstanding commitment
to advocating for the mental health and psychosocial well-being of
refugees and other displaced persons, including those exposed to mass
conflict and organized violence. Its International Committee on Refugees
and Other Migrants consists of a multidisciplinary group of
professionals dedicated to advancing that mission. Evidence-based
research suggests that the most important intervention to reduce the
high rates of mental distress amongst asylum seekers is the
implementation of strategies to prevent unnecessary stress. At the
present time, when eagerness to combat terrorism may result in a climate
of discrimination, hostility and racism, we recommend the following:

  • That access to the same social and health services that are
    available to permanent residents be provided for asylum seekers
    until the final determination of their refugee applications, in
    order to minimize the hardships they face.
  • A policy to assess the psychological needs of asylum seekers is
    highly recommended. The literature shows that preventive
    psychosocial interventions for asylum seekers in a safe, supportive
    and predictable environment helps the recovery of those suffering
    from high levels of exposure to pre-migration trauma.
  • A national forum for dialogue among politicians, policy makers,
    researchers, clinicians and NGOs would be valuable, to monitor
    carefully the impact of detention practices on asylum seekers, and
    to examine the effect of any policy changes on their mental health
    and well-being after they are released into the community.

In the international arena, the United Nations meeting on children in
New York in May could provide an opportunity to raise urgent issues
about the impact of asylum detention centers on children’s mental health
and well-being, under the provisions of the Convention on the Rights of
the Child.

Solvig Ekblad
National Institute for Psychosocial Factors and Health
Box 230, S-171 77
Stockholm, Sweden
Fax: 46 8 33 06 52
Email: [email protected]

Silove, D., Steel, Z., Mollica, R. (2001).
Detention of asylum seekers: assault on health, human rights, and social
The Lancet 2001, volume 357, May 5, 1436-1437.

Steel, Z., Silove, D.M. (2001).
The mental health implications of detaining asylum seekers.
Medical Journal Australia 3, volume175, 596-599.

Sultan, A., O’Sullivan, K. (2001).
Psychological disturbances in asylum seekers held in long term
detention: a participant-observer account.
Medical Journal Australia 3, volume175, 593-596.

United Nations High Commissioner for Refugees (UNCHR)(2000).
The state of the world’s refugees: fifty years of humanitarian
New York, NY: Oxford University Press.

top Books

Partnership or Pretence

Janet Meagher

At the start of 2002 a new edition of “Partnership or Pretence” has
appeared in Australia, with several new chapters reflecting developments
in the consumer scene there. This book by WFMH Board member Janet
Meagher, AM, a leading consumers’ representative in Australia, was first
published in 1995. She says it “is not a heavy intellectual tome but is
a useful brief handbook for those who need to regain their place in the
world.” To judge by the reception of earlier editions, it provides a
viewpoint that is widely appreciated. The first edition sold out, and a
second edition was produced in 1996. [That year, Ms. Meagher was awarded
an Australian honor, the AM, for service as an advocate for people with
mental illness and psychiatric disability.] The book was later
translated into Japanese, sold out in that language within a year, and
may be reprinted in Japan the near future. A translation into Spanish is
almost complete, and one into Chinese is now under consideration.

The book’s thoughtful observations were the result of research
undertaken by Ms. Meagher when she held a Churchill Fellowship in 1994
to investigate consumer empowerment and self-advocacy programs in Great
Britain, the USA and Canada. At that time there was a need in Australia
for an informative handbook which could assist consumers setting out on
a path to empowerment, and would also be helpful to policy makers and
health workers interested in providing assistance. The book did not
underestimate the pitfalls and difficulties likely to be encountered
along the way.

To obtain a copy of “Partnership or Pretence” send a check or bank
draft in Australian currency, for $25 (Australian) to:
Psychiatric Rehabilitation Association
153-167 George Street
Redfern NSW 2016

Postage is included in the cost. The book is printed, bound and
published by consumers at Buckprint Graphics.

Women’s Mental Health in Pakistan

Unaiza Niaz

Unaiza Niaz, M.D. has produced a monograph , “Women’s Mental Health,”
for the Pakistan Psychiatric Society which integrates a standard
clinical overview of women’s mental health with insights about the
situation of women in Pakistan. The monograph is intended for
psychiatrists, obstetricians, other physicians, medical students and
other mental health professionals. The medical survey is supplemented
with sections by guest writers on additional topics. A chapter on
“Threats and Challenges to Pakistani Women” finds that observance of
purdah is less of a threat to women’s advancement than lack of
education. The author argues that placing blame on religious practices
has distracted attention from the government’s failure to include women
in education planning and to consider the needs of women’s health care
in both urban and rural areas. For information about this book, contact:
Dr. Unaiza Niaz
5A/11 West Avenue Phase-1
Defence Housing Authority
Karachi 75500
[email protected]


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