Mental Health Matters: February 2020

Prof Christopher Dowrick, Chair of the WONCA Working Party on Mental Health writes

Many of us are living through difficult times, including the corona virus in China and bush fires across Australia; while in the UK we are waking up today to our (less life threatening but still problematic) separation from the European Union. So we must continue to look after our own mental health as well as that of our patients. Fortunately, there is much for our Working Party to celebrate; including (as you will see at the end of this bulletin) the joy of making music together.
International activity.

Our WONCA book Global Primary Mental Health Care: Practical Guidance for Family Doctors is now published.

As you may recall, this book brings our existing guidance documents on core competencies, first depression consultation, non-drug interventions, physical health care for severe mental illness, and medically unexplained symptoms; together with new ones on mental health od young people, migrant mental health, multimorbidity, and dementia.

We are proud of our collective achievement in bringing this book together. Now is the time to let as many people as possible know about it, including those involved in training the next generation of family doctors.

So please will you draw it to the attention of your national family medicine colleges, and to people you know who are organising your country’s family medicine residency programmes: our book needs to be included in their reading lists.

Our Advocacy Programme for young family doctors is bursting into life, with the goal of enabling genuine practice-based transformation in the integration of mental/behavioural health and primary care.

o Our Faculty includes myself, Cindy Lam and Amada Howe from WWPMH, Ana Nunes Barata from WONCA Young Doctors Movement, and Larry Green and colleagues from Farley Health Policy Centre in Colorado USA.
o We received 25 response to our call for applications, from across all regions.
o We have selected 12 excellent young doctors to form our set of learners: 7 women and 5 men; three from Africa, two each from Asia-Pacific, Caribbean and South Asia, and one each from Eastern Mediterranean, Europe and Ibero-America.
o The training programme will run from March to August this year, and we will present our evaluation at conferences including World WONCA Congress in Abu Dhabi.

Regional Activity

• Asia Pacific

o Asia-Pacific Economic Project (APEC) workstream on mental health and primary care. Cindy Lam is leading for WONCA on this, with CEO Garth Manning and me in support. A letter of intent for collaboration was signed at a meeting in Singapore in November. We are now drafting a white paper setting out the preliminary framework, with emphasis on digital interventions to promote mental health; this will be submitted for publication and presented at the WONCA Asia-Pacific conference in Auckland. The next step is to agree a pilot programme in 3-5 countries in AP region.

o Also at the Auckland conference, there will be a presentation on our successful APAC family doctor train the trainer programme on anxiety and depression; this is expected to be led by Pramendra Prasad (Nepal), Darien Cipta (Indonesia) and Loretta Chan (Hong Kong).

o Translation work of our guidance documents into Chinese continues. As well as the MUS guidance translation reported in my last bulletin, work is now in progress on translating the guidance on non-drug interventions for common mental health problems.

• Eastern Mediterranean

o Abdullah al Khatami and colleagues continue to empower primary mental health care across the region. At a major WHO meeting in Lebanon in December, PMHC leaders from 10 countries produced key recommendations for action including
-work to exchange experiences in PMHC field.
-recognition that the innovative patients' interview (5-Steps) approach is a culturally suitable introduction to mhGAP implementation.
-request to establish a unit in the WHO-EMRO office concerning PMHC activities all over the EMRO region.

o In Saudi Arabia 49% of all 2015 PHC centres now include PMHC services: more than 1150 doctors have been trained; 60,000 PMHC files opened; and 120,000 visits provided.

o In January, Abdullah conducted a workshop in Cairo on integrating MH in PHC through applying the 5-Steps of patients' interview approach.

• Europe

o Preparations are in progress for WWPMH input to the WONCA Europe conference in Berlin
-Christos Lionis proposes round table discussion at WONCA Europe conference in Berlin, including WWPMH members and leads of other WPs and SIGs, to encourage cooperation on mental health and multi-morbidity
-Christos, Juan Mendive, Henk Parmentier and I intend to lead a workshop on Primary Mental Health Care in Europe: Opportunities and Challenges

• Ibero-Americana

o Sandra Fortes and WWPMH colleagues from Brazil have been involved with major training programme for primary care staff in the north of the country, based on mhGAP for humanitarian emergencies, to support the many thousands of refugees arriving across the border from Venezuela.

o Alfredo Oliveira Neto (Brazil) is involved with an amazing music group. The band Harmonia Enlouquece (Harmony gets Crazy) is formed by patients, employees and volunteers from the Psychiatric Center of Rio de Janeiro (CPRJ). The group started in 2001 and emerged from a music therapy workshop. They have played in many cities and produced four albums. A documentary about the band appears today on Brazilian TV. Here is a link to one of their songs Sufoco da Vida (Breathless Life) :

I think this is wonderful. Let us create bands like this across the world, in every WONCA regions!