2017 has been a very fulfilling year in WAPR. The coming year 2018 is very close. This will be the year of the WAPR XIII World congress. This may be a timely opportunity to express some expectancies and wishes for the coming time in our field.
As many of us think, the attention to the mentally ill is experiencing a profound change, often characterised as a change of paradigm. There is an increasing awareness of the importance of mental health as potential contributor to disability in general population, and the importance of tackling in the more effective way severe mental health problems as a way to reduce the burden of suffering and disability. Many ideas and proposals have been laid on the table in recent years in areas like prevention, treatment and rehabilitation. But in this opportunity, I will only mention three, from a very subjective way.
Let us continue understanding the recovery process from mental illness. Beyond treatment as a way to overcome specific symptoms, for the people suffering from severe mental illnesses, recovery means gaining a significative life beyond the residual symptoms treatment cannot eliminate, disability and possible side effects form treatment. The more we learn from users’ experience in successful recovery processes, the best we can use that knowledge in helping new patients in their unique and personal process to recover. This need of new understanding also includes understanding the process to getting ill, understanding vulnerability, the role of adverse biographic events and other traumatic experiences as potential contributor factors to further development of illness. The best we understand the role all these factors, the better we will be able to help patients in tackling them. Understanding will lead to services that better contemplate the extraordinary complexity of getting sick and also in getting better.
Let us improve accessibility to mental health services. We are aware that many people in the world has a limited access to correct psychiatric treatment, even to a very basic and limited one. As WHO often states –see WHO Atlas database-, in many countries available services are mostly allocated in mental hospitals, that receive the biggest part of public budgets in detriment of community services, more accessible and usually friendlier to people. Improving accessibility entails that policy makers take the responsibility to create mental health plans –whereas they do not exist- and allocating the required budget, in order to ensure that the access to services for the mentally ill is made available in equity basis respect to people with other health problems, usually better funded that mental health. Community services, services allocated near the places where people lives, able to provide quality and continuous services as long as they may be necessary, are the right strategy to improve accessibility to recovery oriented services for the people affected by severe mental illnesses. Year 2017 has offered interesting examples of countries improving dramatically access to mental health services to their citizens –the case of Peru may be paradigmatic-. Let us expect that 2018 may increase awareness of the need to improve access to services and offer similar experiences in other countries.
Let us succeed in reducing coercive interventions. Coercion and psychiatry have been historically linked for complex reasons. We now know that mental illness is usually a lasting process that begins much sooner that when it is recognised. However, since early signs of mental distress are usually not very specific and are usually neglected, the onset of mental illness is often dramatic and linked to acute conflicts that may involve concerns about security of the patient and of third parties. If we add that madness is an extreme human experience that challenges understanding, and is usually perceived in a stigmatised way, we can understand that coercion is linked to psychiatric interventions, and that psychiatry has received two different tasks- and quite incompatible-: to offer treatment and to guaranty security. That is why along many years, in many psychiatric services all over the world, coercion is widely and uncritically accepted as a “normal” part of the practice. But this perception need readjustment. First, research shows that coercion can be widely and easily reduced by improving training and changing attitudes on staff. Second, although it is difficult to deny that security is sometimes a real concern in practice, it has been proved in different places that a well-trained and motivated team can tackle most emergencies without using coercive methods. And third, the perspective of Human Rights, specially that emerging from the U.N. Convention of Rights of People with Disabilities, obliges to reconsider the use of coercion in psychiatric interventions as a routine practice wherever it takes place. Reducing coercion to the minimum -...may it be close to zero?- may be a good challenge for the new year.
Let us expect the best for the coming year, and may these three wishes may find their way in it. The WAPR World Congress Madrid 2018 will gather some of the most interesting experiences in the world in these topics and will offer training workshops to make those experiences available to all delegates.