in2mentalhealth

Last Friday, May 31th, I attended this one day conference, which was organized to mark the farewell of Joop de Jong as Professor at the VU University in Amsterdam, the Netherlands, Europe.
I hope the VU will publish the full text of the lecture of prof de Jong (‘Soul searching, a journey into global mental health’) online, but I can’t find it yet. So, here below are a few points he made in this farewell lecture.
Abstracts and bio’s of the other keynote speakers (Stevan Hobfoll, Devon Hinton and Vikram Patel), few forum speakers and chair (Daniel Botha, Mark van Ommeren), and the 21 symposium presenters are available online (26 pages pdf), together with the bio of prof de Jong. In the symposia a lot of qualitative/quantitative research and reports from all over the world.

Joop de Jong in the start of his career

Joop de Jong more recently

Few of Joop de Jong’s messages/conclusions from his farewell lecture:

-Locally trained paraprofessionals in Low Income Countries (LMIC) show similar (outcome) effect sizes as highly trained therapists in Western countries.
-Traditional healers have been described as the ‘ideal’ primary care workers. In LMIC they are ubiquitous: about 1:200 to 700 inhabitants is a healer in LMIC. In High income countries (HIC) like the Netherlands and USA, about 50% of the outpatients use complementary and alternative medicine as well.
-In LMIC with minimal financial and human resources, we need to focus more on population-wide interventions; removing the underlying cause of diseases.
-Our over-emphasis on clinical interventions is also surprising since there is much agreement on what could be done on a population level.
-In many African and Asian contexts, core values are the family, avoiding shame, conformity to social expectations, respect for the elders and ancestors, placing others need ahead of one’s own, reciprocity, interdependence and modesty. From a Western point of view, what may impress as maladaptive (e.g. passivity, avoidance, silence) may be appropriate in another context.
-Unlike colleagues who try to promote the HIC countries’ models as appropriate for developing countries, in my view (prof de Jong), LMIC should do the opposite and develop their own models. Build on community resources including healers, teachers, community leaders, extended families and persons affiliated with organized religion.
-We need more cooperation and fine tuning between health professionals and community resources to define what is at stake an who is able to do what.
-The five intervention principles: promotion of sense of safety, sense of self- and community-efficacy, connectedness, calming and hope.
-Regarding the psychiatric classification system, prof de Jong advocates for a prism approach: ‘the phenomenology of a patient’s affliction falls on a prism refracting biology, culture and history, and results in a spectrum disorders that vary across time, age, gender and culture’. This model contrasts strongly with the DSM5 normal/abnormal dichotomy.
And prof de Jong is searching for ways to prevent wars.
-The three most important social predictors of war and ill health are a lack of democracy, socio-economic inequalities, and group marginalization. Although the world knows a great deal about the roots of political violence and genocide, it has hesitantly started to act.
-One step forward for the health care would be to develop more concerted and multi-sectoral action by the local government in times of peace, and by the UN and NGOs in times of humanitarian emergencies.

Most of the presenters at this conference were (ex-)PhDs or otherwise affiliated with Joop de Jong’s work. The same ideas and premises were heart all over the place. It must be fantastic to hear your ideas expressed by so many colleagues when you say goodbye. A nice harvest.
The conference was a great encounter of global mental health advocates, with old and new food for thought. And with a great timing just a week after the WHO Draft Comprehensive Mental Health Action Plan 2013–2020 has been endorsed, and discussions about the recently released DSM5 are still fierce.