10 pluses and 2 minuses for the World Mental Health Congress, 18-21 October 2011, Cape Town

With e few hundred other delegated from all over the world, I attended this 3 days biennial Global Mental Health Congress(WMHC2011), organized by the South African Federation of Mental Health(SAFMH) and the World Federation for Mental Health(WFMH). Besides 5 keynote lectures each day, there were 20 symposia, 21 free paper sessions, 16 workshops, 4 video-presentations and dozens meet-the-author poster sessions. And off course there was a opening and closing ceremony and other ingredients like films, expositions of art made by South African service users and some music. And in addition to the 3 days congress the organization offered 7 half day tours to mental health facilities in Cape Town. I must say the congress was extremely well organized; comfort, accuracy, an impressive venue, a stones throw from the city center (the Cape Town International Convention Center(CTICC), and a cozy atmosphere. My compliments!

Because more then half of the program was in parallel sessions I could not attend all, and had to make choices beforehand. So, forgive me when you are not mentioned here although you had a standing ovation after your presentation. I was just not present.
Other exclusion criteria here are:
-Presentations with only facts, figures and conclusions. Better next time send me the text and I will stay at home.
-Presentations which are not adding new things, are not innovative or not heading for solutions or new developments. To prevent that we will talk about the same things each 2 years….
-Presentations with a lack of open access or sharing of knowledge, tools and other material. If you explain me a great new tool or field experience with no clear references or open access, something that can not be multiplied by others, then I’m not interested in your success story.

To start with the 2 minuses:
1. Where are the technical innovators in ‘the top’ of the global mental health field? There are inspired entrepreneurs, marketers and software developers who could add so much in this field. It was, at this congress, as if we were still in the nineties or even further back. Even the social media coverage by the organizers showed a kind of neglect which I must address here. There are no news updates, photo’s or reflections on the congress on the congress website, the WFMH or SAFMH websites yet (end of October). The last update on the WMHC2011 Facebook page was 4th of July and on their Twitter feed 11th May!. On the Facebook page of the WFMH the conference is not mentioned at all, although there are regular updates about other matters, and the same happens on their Twitter account. How come? Wake up, it’s 2011.
And in the oral presentations no apps, hardly any internet program, no SMS text or chat projects. An exception here is the The Global Mental Health Assessment Tool from Virmal Sharma a.o. which is free available online and ‘planned to be on an mobile and app in the future’, and Shekhar Saxena’s announcement that in December the WHO mhGAP Intervention Guide will have an interactive website. And I saw a few nice and successful information and user websites on the poster sessions, like the South African Depression and Anxiety Group website, with 600.000 hits each month!
The health field in 2011 is more then journals, books and meetings, and I think we must catch up with the new technologies and social media, otherwise we, global mental health, will get even more isolated then that we are right now.
2. Can the organization, a next time, please forbid Power Point Presentations. Or regulate it more with, for instance, max 5 slides per presentation, or only slides with pictures or maximum of 200 world on the whole PPP. I know we are not born stand up comedians and we do not need to be asked for the next TED talks, but we can do better then this. And I’m sure that skipping those PPP slides will help to talk ‘from the heart’ and convey the personal inspiring message that the presenter has in mind. You were not traveling across 2 oceans to read 25 slides as fast as you can, were you?

And now the 10 pluses (in chronicle order):
1. Keynote speaker Nomfundo Walaza, Desmond Tutu Peace Centre, Cape Town, South Africa. Title of the lecture was ‘Forgiveness and the maternal body; exploring an African ethic of interconnectedness’. About ‘I am because you are, and you are because I am’, about torturers and survivors, mothers and sons, about compassion, listening and kindness, engagement and the relationship between client and caregiver, amongst other things. A passionate personal account with no slides! I hope the text/video of this lecture will be published on internet somewhere.

2. Keynote speaker Vikram Patel, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, and Sangath, India. Title of keynote lecture was ‘Poverty and mental illness; breaking the vicious cycle’. About the Social Determinants of Health, poverty and the ‘dollar a day’ paradigm, more definitions, background information, references to research, examples and literature. A sound multi-angle record of the contemporary developments in poverty and health discussions. Talented speaker. The Lancet article about poverty and mental disorders from Vikram Patel a.o. can be downloaded for free (after registration).

3. Free paper presentation session about ‘Effects of violence and war’. Since I’m regularly a mental health trainer in the field for MSF Holland (Médecins Sans Frontières), I was very pleased with the first hand experiences from these 4 speakers. Athena Madan, University of Toronto, Canada, is working and doing research with refugees in Canada and she find out that ‘speaking about the trauma’ is not what refugees always want and gave other best practices and advices. Pierre Bastin, MSF Switzerland, told us what hurdles and successes he and his colleagues met in a large Palestine refugee camp in Beirut. Very clear presentation, with maps, figures and tools for monitoring like the DSM Global Assessment of Functioning scale (GAF) and the Self Regulation Questionaire SRQ20. Ernest Khalema, University of Calgary, explained us how ‘cultural brokers’ were facilitating the mental health care with young refugees. Cooperating with the mental health practitioners side by side. And the fourth speaker was Andrew Mohanraj, ngo CBM, Indonesia about the aftermath of the 2005 tsunami in Aceh, Indonesia. Examples of the creativity and flexibility one needs in the mental health and psychosocial support, after these kind of mass catastrophes, like building a ‘mourning house’ or outreach to traditional healers.

4. Keynote speaker Marianne Farkas, Centre for Psychiatric Rehabilitation, Boston University. Title of keynote lecture was ‘Recovery from mental illnesses; an imperative with or without resources’. From mental illness to mental health and social well being, about internal stigma, role of the family and friends, about peer support and the need of a ‘peer leadership academy’, amongst other things. About recovery not as a model, but as a mission; not changing the services, but the paradigm. A warm and convincing plea for change, which made a few service user take the microphone, proudly revealing their proof of recovery by participating at this conference.

5. Workshop with speaker Nataly Woolett, Wits Reproductive Health and HIV Institute, South Africa, and title ‘Lay counselors training in trauma and traumatic bereavement: interventions that promote psychosocial change’. About attachment and trauma, about counseling and the own trauma’s of counselors. About Trauma Focused Cognitive Behavioural Therapy (TF-CBT), with examples, links (e.g. the proqol-scale), tips, photo’s, personal experiences and at the end of the workshop a funny exercise for the attendees as well. She loves her work, that’s clear, 90 minutes was too short. Looking forward for the manual and DVD which will be issued in December about this method.

6. Video presentation by Cedric Hall, City University London and East London NHS Foundation Trust, and Joseph Atukunda, Heartsounds, Uganda. Presentation with the title ‘Heartsounds, international health linking between public health services as a force for user empowerment’. In the video we saw UK service users travel to Butabika Psychiatric Hospital in Uganda and sharing experiences with their colleague users in the hospital with meetings, workshops and a soccer match. Impressive was the transformation seen in a lot of Butabika hospital patients; from shy listening in the beginning, to leadership and presentations in the workshops at the end. Now Heartsounds has a community website, a internet café, run by users, a micro-loan system, plans for poultry project and more ‘crazy ideas’. Excellent example of recovery and empowerment.

7. Keynote speaker Tsuyoshi Akiyama, NTT Medical Centre, Tokyo. Keynote lecture with the title ‘The east Japan disaster 3.11.2011’. The speaker first extensively unveiled, with maps and figures, all facts about this ‘triple disaster’: the earthquake, the tsunami and the fear for radiation. Then he took us from the very first crisis meetings to the whole process of implementation of the WHO IASC guidelines, and the close collaboration with the WHO in Geneva. He talked about ‘watchful waiting’ in stead of ‘debriefing’ and about the psychiatric first aid, etc. Although not a very lively presentation, it was great to hear his experiences at first hand and a such short notice; only 7 months after the quake.

8. Symposium with Joel Cocoran and Jack Yatsko, International Centre for Clubhouse Development(ICCD), René Minnies, Cape Mental Health Society, and a service user of the Fountain house, Grant Mpofu. The title was ‘The life changing impact that the clubhouse has had on their life’. The Clubhouses are ‘community centres that give people with mental illness hope and opportunities to reach their full potential’. Users are called members and the centres offer e.g. vocational rehabilitation, help by finding accommodation, advocacy and a ‘family feeling’; being part of a group and ownership. There are currently 340 clubhouses around the world with 3 in Africa, including the Fountain House Cape Town. The ICCD facilitates and assures the quality of training, consultation, certification and research. I like the global approach and the solid fundaments and support which are there for every group who wants to start a clubhouse in their area. All 4 talked with their heart; very inspiring.

9. The Mental Health Facilities tour option number 6: Focus on Psychiatric Disability. I don’t know if it’s common during or after conferences to plan tours like this, but I think it’s an excellent idea. With a touring car full of delegates and the enthusiastic tour guide René Minnies we visited 4 facilities. With such a large group and 45 minutes per service we got only an impression of each project, but still it’s so valuable; a taste of what’s happening in the local field of mental health. What words cannot say…
We first enjoyed the hospitality of The Valkenberg tertiary State Psychiatric Hospital with 370 beds, 165 for acute psychiatric patients and 145 for forensic psychiatry. We could not see the wards, but all our questions were patiently answered (and we had a lot!) and we roamed a bit through the beautiful colonial buildings and over the hospital terrain.
The second facility was the William Slater House (no website) a community based 3-6 months residential rehabilitation program for 40 men and women. It acts like ‘a cushion between in-patient hospital care and living in the general community’. We could see the whole venue and small groups of residents performed their ‘We in Slater House have talent’ acts. The final will be next Saturday. Other ingredients of the program were group sessions, brainstorming sessions, study groups, crafts, conflict reduction training, psycho-education, etc.
Third place the Fountain House SA. See point 8. A Clubhouse model day care centre in 2 houses in a common residential street. Their work-ordered day program offers on-the-job training in a variety of skills like administration, paper-making, catering, etc. We got explanations and clarifications from the members themselves. The house was preparing itself for the annual Kite Festival of the CMHS in Muizenberg, the next day.
The last facility we visited was one of the 8 Comcare Trust houses in the Western Cape. Each Comcare house accommodates around 9 people with chronic severe psychiatric disabilities. The residents are free to come or go, and can stay as long as they wish. During office hours support workers are present, and in the other hours available by phone. Aim is to let the residents live a life as normal as possible integrated in their local community. We were shown around by a few of the residents, and here as well in the other facilities, there was something to eat and drink.
I had a fabulous day, nearly as nice as my school trips long ago.

10. Ability to talk with colleagues and service users from overseas and especially from South Africa. Just to stand at a lunch table and share stories, wishes and plans with a totally stranger. People whose work and ideas are not published in journals or spread via the internet. Dedicated mental health workers, or users involved in activism and advocacy. Now and then I’m debating the pro and cons of conferences like this. Cons: costs/waste of funds, and waste of time. But this is certainly a pro. I can read about the Great Push Forward, the Global Challenges, the mhGAP, PRIME project, the Empower project, the Lancet series, DSM-V, etc. on the internet. But if I would have stayed at home I would have missed the compassion and all the wise words from the workers en users in the field here in South Africa and from representatives from other far away countries.

So, 10 pluses and 2 minuses make an 8. That is ‘very well done’ in the Netherlands.

Roos Korste, psychologist, blogger and trainer.

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