National Psychiatric Associations Research Articles

Organized professional response to a large-scale disaster: Earthquakes in Türkiye

AbstractIn February 2023, a series of earthquakes with high magnitudes affected 11 cities in Türkiye, a region with a population of over 13 million. With more than 50000 recorded deaths and more than 3 million survivors replaced, rescue and recovery efforts were challenging. The Psychiatric Association of Türkiye (PAT) immediately launched a “Disaster and Crisis Management,” which urgently formed and installed a program for psychosocial support and psychiatric care. The program included immediate, medium, and long-term actions. Hundreds of recruitments followed a call for volunteers for on-site and online support. An online “Earthquake and Mental Health” library was launched immediately, and a series of webinars on psychological first aid and disaster psychiatry were organized in the first two weeks. Furthermore, in three major cities, separate interactive meetings where question and answer sessions with trauma experts have been possible were held weekly with smaller groups. Almost a hundred volunteer PAT members served in the region in the first few months after the earthquake. All colleagues in the field, including those who survived the earthquakes, benefited from the resources of the PAT for their needs in housing, food, and mobilization. Starting from the first days, the PAT organized regional centers for coordination, which required financial resources and staff. The demand was high and could only be met with close collaboration with the Turkish Medical Association and the financial support obtained from international agencies, WPA, and other national psychiatric associations. The PAT started an online support system with technical support from a professional company, targeting healthcare professionals and first responders in the earthquake area. Volunteering psychiatrists provided appointment slots, rendering the system available 12 hours a day, seven days a week. With time, as the national healthcare delivery recovered, the PAT activities transformed into coordination, education, and supervision. Furthermore, the psychiatry residency training, which was interrupted due to the disaster, has been supported through a nationwide mentorship program launched by the PAT. The experience of the Psychiatric Association of Türkiye with disasters paved the way for an organized response, which was made possible through national and international solidarity.Disclosure of InterestNone Declared

The impact of natural disaster on mental health and how to deal with it?

AbstractNatural disasters are and will continue to represent a great challenge in addressing mental health issues globally. The most devastating recent (earthquakes on 6th February 2023 in Turkey and Syria) caused death of more than 55,000 people, injury of about 100,000 people and loss of property, overall affecting millions of people. Moreover, in the last several years in Europe, they came in a form of double disasters (for example coupled with the COVID-19 pandemic) and pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations.However, in going through these experiences, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. As a practical example of it - verbalized by the mental health professionals from Turkey through the Council of National Psychiatric Associations of the European Psychiatric Association, we organized a webinar delivered by experienced clincians, trauma experts and experts with lived experince in the earthquake zones. However, structural -implementation of mental health policies that focus on prevention and improving crisis response in care delivery are important to support populations affected by natural disasters to prevent the trauma sequel.Disclosure of InterestNone Declared

Ethical dilemmas in contemporary psychiatry: Findings from a survey of National Psychiatric Associations in Europe.

The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of National Psychiatric Associations (NPAs). The aim of this study to identify and investigate current contents of ethical codes and practices in the countries belonging to EPA. The study is an expert survey sent out to 44 representatives of 30 NPAs covering the following topics: the existence of national bodies dealing with ethical issues in psychiatry, the availability of documents relevant to ethical issues, the types of ethical issues addressed at the national level, and the current and envisaged ethical debates. Out of 44 experts invited to participate in the study, 31 NPAs from 30 countries responded (response rate 70.45%). In the majority of countries, the general mission statement serves as the main document covering ethical issues in psychiatry. Most frequently, internal documents were reported to address medical malpractice, workplace bullying, plagiarism, academic fraud, sexual abuse, and discrimination/racism. Furthermore, internal documents cover the ethical assessment of potentially controversial procedures, including psychosurgery, euthanasia, and pregnancy termination. The most important topics for debate at the level of NPAs/EPA were associated with violations of clinical practice standards and human rights. NPAs are active in the field of professional ethics, defining ethical standards related to interactions among professionals and services provided by mental health care professionals. Future collaboration of NPAs, under the umbrella of the EPA, could allow to develop a database of local ethical documents that would be translated into English and accessible to all EPA members.

Compulsory Admissions of Patients with Mental Disorders in Europe: State of The Art on Ethical and Legislative Aspects

Globally, mental health legislation has been changing and evolving throughout time. Compulsory admission is when patients with mental disorders are admitted to a psychiatric unit against their own will to receive treatment. In Europe, as public attitudes and practices shifted, compulsory admission procedures were reformed to ensure patient rights and safety. Differences however exist for compulsory admission procedures between countries. In 2018, a survey was created and disseminated by the European Psychiatric Association Ethics Committee to National Psychiatric Associations within 40 European countries to learn more about the legislation, key actors involved, and reasons for admission. Results showed that approximately half of the responding countries required an independent medical expert, typically a psychiatrist, to be involved in the procedure. Most countries by law required the involvement of a court-appointed judge in making the decision about compulsory admission and to review the case after a certain period of time. All but one country have time limits on legal decisions for compulsory admission. Further, patients have the right to obtain legal counsel to assist them through the process of appeal or the decision in most countries. The primary reasons for admission were the patient being a danger to themselves or others. Despite continued efforts, stigma still surrounds mental health disorders. Public awareness and increased knowledge are needed to improve the perception of compulsory admissions. Moving forward, it is necessary to create educational courses, as well as written guidelines for key actors, to stimulate good practice and promote voluntary treatment (Wasserman et al. 2020; https://doi.org/10.1192/j.eurpsy.2020.79).DisclosureNo significant relationships.

The EPA-council of national associations in implementing digital mental health across Europe: Opportunities and challenges

Abstract BodyDigital solutions and interventions for mental health have increasingly been taking place in many societies in the last several decades. There are significant differences among countries due to economical and organizational situations. On the other hand, despite digital gap, there is a significant increase in the use of telepsychiatry and e-mental health applications with the Covid-19 pandemic throughout the world. Experiences of this pandemic times make many opportunities and challenges more apparent in this field. Safety and security, legislation, regulations, good practice standards, evidence based data, ethics and education are several of main areas of needs. EPA with the Council of National Psychiatric Associations (NPAs) is one of the crucial organizations in Europe which may play an important role to work on these challenges and opportunities. EPA-Council of NPAs consists of 44 associations represent psychiatrists (and other mental health workers in some) from 40 European countries. NPAs are crucial organisations in contact with local and national mental health stakeholders; competent in national, local, authentic and cultural issues and sensitivities; and could serve as crucial junctions for Europewide policies and their widespread implementations. Some reflections on challenges and opportunities from the Council of NPAs will be presented, based on a rapid survey and personal communications with presidents and official representatives of NPAs for future perspectives.DisclosureNo significant relationships.

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice.

The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

Survey of the European Psychiatric Association on the European status and perspectives in early detection and intervention in at-risk mental state and first-episode psychosis.

Early detection/early intervention (ED/EI) programmes have been inconsistently implemented throughout Europe. We evaluated the ED/EI service distribution in European Psychiatric Association (EPA) member countries, considering indicators of socio-economic development, human and financial resources allocated in mental health (MH) as well as presence of a national branch of the Early Intervention in MH (IEPA). Contextually, we evaluated the duration of untreated psychosis (DUP) in relation to ED/EI service implementation. EPA section "Prevention of Mental Disorders" conducted the cross-sectional survey administering the 16-item questionnaire to the representatives of its National Psychiatric Associations (NPAs). The survey addressed the Service status and profile, national guidelines, education and policy, DUP and IEPA national branch status. The data were analysed in relation to the indices of economic parameters and MH resources. Neither the national economic parameters, nor indices of MH financial resources were significantly associated with variables related to ED/EI implementation. However, more MH human resources per country were associated with shorter DUP. In comparison to countries without a national branch of IEPA, all of these with the branch had more MH human resources, ED/EI chapters in the national guidelines and services involving both adolescents and adults. An unequal development of ED/EI services and related academic activities appears throughout Europe. The current results, besides providing a useful starting point to set the agenda for harmonizing ED/EI services, reveal that their implementation was more likely to be influenced by the IEPA membership status, rather than by country-specific financial and human resources allocated to MH.

Building national associations for psychiatry trainees: The MENTA recipe for success

European Federation of Psychiatric Trainees (EFPT) is an umbrella organization for national psychiatric trainee associations in Europe, aiming to develop collaboration between psychiatric trainees. EFPT states that organised trainee interest is crucial in promoting high quality psychiatric training, therefore it promotes that both general adult psychiatry and child and adolescent psychiatry trainees are represented by national trainee association in each European country. The Maintaining and Establishing a National Trainee Association Working Group (MENTA WG), a permanent EFPT working group, has been created to assist trainees in building a local trainee organization. MENTA WG supports organising meetings, helps manage the problems of functioning of an association, sends letters of support to national decision makers, helps prepare the organization's bylaws and facilitates the process of application for full EFPT membership. The group also helps reactivate the inactive associations and assists them in expansion and developing new initiatives. MENTA WG maintains close collaboration with the European Psychiatric Association Early Career Psychiatrists Committee (EPA ECPC) Task Force on Meetings and Associations and other organizations dedicated to early career psychiatrists, such as the Young Psychiatrists’ Network. In the last few years, due to the work done within MENTA WG, the EFPT family has grown and welcomed new official members, such as: Poland, Spain and Slovakia. Currently, we are planning on supporting trainees in Moldova, Bulgaria and Kosovo to establish new official organizations in these countries. We also expand our activities beyond Europe and offer counselling for psychiatric trainees from such countries as Australia or South Africa.Disclosure of interestThe author has not supplied his declaration of competing interest.

Psychiatry's and psychiatrists’ contract with society

IntroductionThe World Psychiatric Association (WPA) is a world-wide association of national psychiatric associations, aiming to increase knowledge and skills necessary for work in the field of mental health and care of the mentally ill. It was suggested that Psychiatry's relationship with society should be seen as a contract [1]. This implicit understanding usually specifies the scope, principles, quality and outcome of this agreement. It also implies a series of reciprocal rights and duties, privileges and obligations, as well as expectations from both sides.AimTo investigate the extent of existing social contracting of WPA Member Associations (MAs) and WPA structures regarding:– communities they serve;– general public;– medical institutions;– other practitioner groups in the multidisciplinary team;– administrations, managers and funders.ObjectivesInclude to describe the current scope of psychiatric practice across WPA regions and the content of existing social contracts.MethodsA mixed–methods, explorative, descriptive, theory generating inquiry, with different phases, including a systematic review of literature and WPA documentation, electronic questionnaires to MAs and focus group discussions with WPA ZS chairs/representatives.ResultsMA profiles and progress indicators were identified and summarised. A transcription of group discussions was made, while pertaining documents, questionnaires and in depth/focus group interview content was analysed.ConclusionsThis presentation will report on progress with this study to date.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Experiences from newly created trainee associations in Spain And Macedonia

Until July 2016, Spain was not member of European Forum of Psychiatric Trainees. Why? Because Spain did never have Association of Psychiatric trainees. In July 2015, 2 Spanish trainees were invited to attend EFPT meeting in Porto. There, they connect with other European trainees and with the help of MENTA group they starting the foundation of Spanish Psychiatric Trainees Society, now known as SERP. In just 1 year, SERP has increased in number of members and have successfully developed numerous initiatives such as the establishment of our founding documents, the constitution of a democratic board through an Elective General Assembly, the design and update of a website and profiles in the social networks and the organization of the 1st Meeting for National Psychiatric Trainees, which was held in Vitoria-Gasteiz on March 2015 and had as topic Research on psychiatric training period. Last July, Spain was accepted for first time in history as full member of EFPT and we are actively participating in several working groups, even chairing the Child and Adolescent Psychiatry one. This year, Spain is also participating in international exchanges, offering two destination for European trainees. We must acknowledge that during the foundation process, the support of the Spanish National Psychiatric Associations (SEP and SEPB) and EFPT (specially its ENTA group since the first meeting of some of our now board members in the Annual Forum in Porto in 2015), has been crucial.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ethical Dilemmas, Needs and Unmet Needs in European Psychiatry – A Survey Made by the European Psychiatric Association (EPA)

During the present decade matters of ethics have been increasingly the focus of European National Psychiatric Associations and on the agenda of the European Psychiatric Association (EPA). Discussions in the association’s ethical committee have scrutinized the problems and elucidated the range of ethical dilemmas. A questionnaire sent by the Committee in 2011 to the National European Psychiatric Associations has given a panorama of the ethical problems in European Psychiatry and shown their diversity and even communalities. This overview has been presented at different meetings of the EPA and has recently been reviewed, updated and additionally commented by all committed European national associations. Hereby, new problems in European psychiatry have emerged or became again underlined e.g. the demand on psychiatry’s ethical involvement in end of life issues as well as the consequences of financing routines in times of resource limitations and changed prioritizations within medical care and mental health support systems implied by an ever more predominant market economy. Other re-emerged problems are questions and problems in contact with private sectors of users’ organizations, care providers or pharmaceutical industries and the need and strategies for multidisciplinary involvement in psychiatric education and research support. In this article these newly emerged ethical challenges will be elucidated and some positions of national psychiatric associations and their recently updated priorities regarding ethical challenges will be reviewed. Activities and structures regarding a continuous ethical sensitization as well as needs of a sustainable ethical agenda in European psychiatry are addressed.

The impact of racism and discrimination on mental health of refugees and asylum seekers

With the strong focus on terrorism in recent years, there is an increasing concern that the fundamental rights of refugees and asylum seekers may be violated in the interest to combat acts of terrorism. It may also lead to increasing racism and discrimination towards these populations.Racism and discrimination encompass the negative stereotypes and prejudicial beliefs that people may hold, as well as inequitable practices that may result hereof.Knowledge about the mental health consequences of racism and discrimination is of clear clinical relevance for psychiatrists worldwide, as a significant proportion of psychiatric patients will have a background as refugees and asylum seekers. Many of them have experiences of war, strife, persecution and torture that further ads to their mental distress.The paper will outline the psychiatric symptomatology related to racism as well as ethical dilemmas and educational needs for the psychiatric profession.Further the role of national psychiatric associations in combating racism and discrimination by e.g. defining best practices and revising medical training curricula will be outlined.http://www.mariannekastrup.dk/Disclosure of interestThe authors have not supplied their declaration of competing interest.

Training in psychiatry throughout Europe.

Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Européenne des Médecins Spécialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an additional European Framework for Competencies in Psychiatry in 2009. Yet these have not been implemented throughout Europe. In this paper, the diversity in training throughout Europe is approached from different angles: the cultural differences between countries with regards to how mental health care is considered and founded on, the cultural differences between people throughout Europe in all states. The position of psychotherapy is emphasised. What once was the cornerstone of psychiatry as medical specialty seems to have become a neglected area. Seeing the patient with mental health problems within his cultural context is important, but considering him within his family context. The purpose of any training is enabling the trainee to gain the knowledge and acquire the competencies necessary to become a well-equipped professional is the subject of the last paragraph in which trainees consider their position and early career psychiatrists look back to see whether what they were trained in matches with what they need in the working situation. Common standard for training and certification are a necessity within Europe, for the benefit of the profession of psychiatrist but also for patient safety. UEMS is advised to join forces with the Council of National Psychiatric Associations (NPAs) within the EPA and trainings and early career psychiatrist, to discuss with the users what standards should be implemented in all European countries and how a European board examination could ensure professional quality of psychiatrists throughout the continent.

EPA guidance on mental health and economic crises in Europe

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

WPA Position Statement on Spirituality and Religion in Psychiatry

WPA Position Statement on Spirituality and Religion in Psychiatry

Challenges, Needs and Unmet Needs – an EPa Overview of European Codes of Ethics

Since 3 years matters of ethics are in an increasing way on the agenda of the European Psychiatric Association. Intensive discussions in the associations ethical committee have scrutinized the problems and elucidated the range of ethical dilemmas. A questionnaire sent by the Committee to European Psychiatric Associations has given a panorama of the ethical problems in European Psychiatry and shown their diversity and even communalities. This overview has been presented at different meetings of the EPA and has recently been reviewed, updated and additionally commented by all committed European national associations. Hereby, new problems in European psychiatry have emerged or became intensified, e.g. the demand on psychiatry’s involvement in end of life issues as well consequences of the limitation of resources, specificities of financing routines in times of resource limitations and ways of prioritizations within medical care and mental health support implied by an all more predominant market economical system. Other re-emerged problems are questions and problems in contact with private sectors of users organizations, care providers or pharmaceutical industries and the need and strategies for multisectorial involvement in psychiatric education and research support. Here, again a need of ethical guidelines in psychiatrists contact has become actualized, especially regarding the needs of young psychiatrists and is one of the focuses in this symposium. In this contribution, these newly emerged ethical challenges will be elucidated, the positions of national psychiatric associations and their recently updated priorities regarding ethical challenges will be reviewed and the activities and structures of EPAs further activities on ethics will be presented for discussion.

From Psychiatry in Europe to European Psychiatry: the EPa Council of NPas Role

The EPA has undergone substantial structural changes in the last few years. It currently consists of 2 councils, the council of the individual members as well as the Council of the representatives of the National Psychiatric Associations. The aims of this presentation are to highlight ongoing projects of the Council of the NPAs on one side and raise important questions for the future as to how the EPA can develop and what role the NPAs will play in European Psychiatry in general. The Council consists of 34 Society/Association members from 30 European countries, representing 77,000 psychiatrists. The mission of the Council of NPAs is to support the general mission of the EPA and promote the highest possible quality of professionals, training and services for psychiatric patient care throughout Europe. Its aim is to initiate programs for working groups, prepare guidance papers on different relevant subjects to psychiatry and psychiatrists and furthermore, to support scientific symposia. The aim of this symposium is to initiate a fruitful discussion on timely topics central as well as to EPA as to European psychiatry in general.

This is why there is hope for psychiatry

This is why there is hope for psychiatry

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

BackgroundClinical practice guidelines (CPGs) aim to improve professionalism in health care. However, current CPG development manuals fail to address how to include ethical issues in a systematic and transparent manner. The objective of this study was to assess the representation of ethical issues in general CPGs on dementia care.Methods and FindingsTo identify national CPGs on dementia care, five databases of guidelines were searched and national psychiatric associations were contacted in August 2011 and in June 2013. A framework for the assessment of the identified CPGs' ethical content was developed on the basis of a prior systematic review of ethical issues in dementia care. Thematic text analysis and a 4-point rating score were employed to assess how ethical issues were addressed in the identified CPGs. Twelve national CPGs were included. Thirty-one ethical issues in dementia care were identified by the prior systematic review. The proportion of these 31 ethical issues that were explicitly addressed by each CPG ranged from 22% to 77%, with a median of 49.5%. National guidelines differed substantially with respect to (a) which ethical issues were represented, (b) whether ethical recommendations were included, (c) whether justifications or citations were provided to support recommendations, and (d) to what extent the ethical issues were explained.ConclusionsEthical issues were inconsistently addressed in national dementia guidelines, with some guidelines including most and some including few ethical issues. Guidelines should address ethical issues and how to deal with them to help the medical profession understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines. There is a need for further research to specify how detailed ethical issues and their respective recommendations can and should be addressed in dementia guidelines. Please see later in the article for the Editors' Summary

2981 – Stigmatisation of mental health patients an extra vulnerability in times of economical crisis

Cuts on health care are necessary for different reasons. First the economical burden of health care should be proportional to the possibilities of the population. Yet in times when the population grows older and possibilities augment, containment is necessary. Governements and health insurance authorities will look closely into possibilites of reducing costs by a great efficacy, by shared descision making, by choices that are to be made. An other alternative is found by asking patients for an own contribution to their health expenses. In that regard it was appauling to witness the fact that in the Netherlands this own contribution was raised soley in patients with psychiatric disorders where individuals with so called somatic diseases were exempted. With, among others a strong support from the national psychiatric associations, the own-contribution for psychiatric patients was banned. Yet the new governement threatens to repeat this non-sense by stating that only psychosis are real disorders and all other mental disorders a matter of pulling yourself together. Stigma on Mental disorders is a very actual theme! Let us face it!