Friday April 13, 2018

Crossing the Channel

Last week I wrote about our Global Mental Health delegation meetings in Scotland. As our mission continued across the English Channel to Berlin and Geneva, we had much to learn and share about mental health, which culminated in an afternoon at the World Health Organization.

IAB Geneva resized

I think we have reached something of a tipping point. From classification and diagnosis of health conditions, to Syrian refugees in Europe, to multigenerational transmission of trauma, to the Sustainable Development Goals, people are talking about mental health priorities and recognizing that “no health without mental health” is not just a pithy saying but really a fundamental truth.

1.

Germany’s leadership & the ICD. You know all those codes on your medical forms?  They are WHO International Classification of Diseases codes used by all 194 WHO member countries around the world to diagnose health conditions and compile national public health data. These codes are essential to defining what is covered during your appointment, what providers get paid, and serve as the basis for statistics like “One in four individuals will have a mental health condition during their lifetime.” Although the US has just adopted ICD-10, the rest of the world did so about 25 years ago and is getting ready to adopt the ICD-11. Our GMHP has been working with WHO to update and improve the guidelines for mental health and behavioural disorders, and our meeting with key leadership in Germany provided tremendous guidance in terms of steps to advance the dissemination of the WHO ICD-11.  We anticipate Germany’s leadership will serve as a model for countries around the world.

2.

Multi-generational transmission of trauma. Being in Berlin, reminders of WWII and a post-war divided Berlin are everywhere, including Checkpoint Charlie, the Topography of Terror, Babelplatz, and the Holocaust Memorial.  The city is also buzzing with artists, craft restaurants and technology startups. What does it mean for today’s German youth to inherit the legacy of Nazism and the Holocaust? Is it truly history? Professor Markus Krah, from the School of Jewish Theology at University of Potsdam, shared his thought leadership and his personal reflections on how the trauma of the war and the holocaust continues to be transmitted to Germany’s youth even though they are generations removed. A reminder that we are all born into other people’s stories, and the clarion that failing to know our place in history portends great peril.

3.

Syrian refugees in Europe. No longer making headlines, the reality is that the Syrian refugee crisis is far from over. Over the past seven years, more than 13 million Syrians have been displaced and about 1 million have found their way to Europe as asylum seekers. We met with the International Rescue Committee (IRC) in Berlin, which serves as the headquarters for Europe as well as Germany. The challenge of resettlement is multifaceted. Existing policies make it extremely difficult for refugees to work or attend school. The mental health consequences are profound.

4.

World Health Organization. Dr. Shekhar Saxena, Director of the WHO Department of Mental Health and Substance Abuse hosted our GMHP International Advisory Board (see photo above) for an afternoon visit. He and his colleagues shared with us WHO mental health priorities focused on children and youth, aging and dementia, substance use and abuse, depression and suicide and maternal mental health.  As the sole UN agency tasked with setting and addressing global health priorities, WHO has its work cut out for it. Fortunately, its leadership is up for the challenge, and during Dr. Saxena’s tenure, WHO is effectively raising awareness of the essential role of mental health across all health priorities.

5.

Thanks to our GMHP International Advisory Board. WHO often speaks about the need to engage “civil society” to advance its aims. Also referred to as the “third sector,” civil society is the collective of non-governmental organizations and institutions that represent the interests and will of the people. It was eminently clear during all our meetings that mental health professionals need the partnership of civil society every step of the way to improve and advance mental health. I am enormously grateful to the members of our Global Mental Health Program’s International Advisory Board – a small group of individuals from civil society – for their passion, dedication, and commitment to this mission.

After ten days on the road, I am glad to be home. I am also energized by the meetings and conversations in Edinburgh, Berlin, and Geneva. On this trip, we crossed the English Channel. As a field, we have crossed the Rubicon for the good of advancing mental health understanding and care around the world. Let’s keep marching forward.