Correspondence Address:
Dr. Andrew Molodynski
Oxford Health NHSFT, Warneford Hospital, Oxford University, Gypsy Lane, Headington, Oxford, OX37JX, UK. World Association of Social Psychiatry
UK

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In this commemorative issue, we discuss the Joint Congress of the World Association of Social Psychiatry and the Rehabilitation and Social Psychiatry Faculty of the Royal College of Psychiatrists (RCPsych) in January 2023. The relevance of social psychiatry has never been greater, with the world facing multiple challenges in ensuring mental health support for people who need it. The recent pandemic has shone a light on poorly served populations alongside the impact of social adversity and disadvantage.

This event was the first opportunity for many to come together after COVID travel restrictions to discuss and debate the key issues in mental health-care globally. Many of the papers and articles in this edition will describe in detail the important topics presented, ranging from the effects of financial and societal inequality, through climate change and the effects of war and natural disasters to the use of digital technology and avatars in the treatment of people with severe mental illnesses. There was a clear consensus that, wherever one was in the World, times have never been more challenging for people needing mental health care and support, and their families, as well as those tasked with providing services. People who require mental health care and support globally remain marginalized, disenfranchised, and are subject to lower living standards and life expectancy than the populations in which they live. The reasons for this are complex and multifactorial (obviously) and the solutions will be equally complex to deliver. Contributors to this congress helpfully outline the issues and provide potential ways forward in our ultimate goal-to maximize access to, effectiveness, and outcomes of mental health-care systems globally.

Professor sir Michael Marmot spoke eloquently about the impact of inequality on life expectancy, crime, and mental health[1] before laying before us in the starkest terms the evidence that health inequalities and outcomes (including for those with mental health problems) are increasing steadily in the UK and many countries. He outlined on a national level how things might be changed with political will. We also heard in another keynote address of the effects of big business and insecure employment contracts, poor working conditions, and exploitation damaging peoples' mental health. The challenges are clearly huge but a presentation by Oscar Jiménez-Solomon and Pablo Méndez-Busto showed that there was good evidence for small-scale local peer-led programs to assist with finance and debt management.[2]

The second enormous challenge is that of the climate and humankind's effects upon it. We have seen in recent years an increase in extreme weather, with devastating floods in Pakistan in the run up to the congress that took over 1000 lives and left 2.1 million homeless. Professor Olga Falceto addressed the Congress on the effects of climate change, what the future may hold and the psychological impacts of climate anxiety on younger people.[3] There is strong empirical evidence that natural disasters substantially increase the rate and severity of mental health problems in those affected and those in the region.[4] It is increasingly clear that existential concerns regarding the future of the world are affecting the ability of many young people to lead healthy, happy, and productive lives as well.[5] A number of speakers focused on the use and benefits of assistive technology both to improve access to treatment but also to reduce its carbon burden by reducing the need for travel or accommodation. The use of virtual Avatars in mental health care is now gaining ground with encouraging clinical trial results to back it.[6] Other presenters rightly described the promise of online applications and treatments for mental health problems and addiction.[7]

The third is the challenge of the exclusion of people with lived experience and their family/career supports from the design, development, and maintenance of services. This has been a substantial contributor to a situation where many mental health services are not considered to be a “good fit” for those who use them, with high levels of coercion and restriction and limited flexibility.[8] Powerful and moving sessions led by Giacco et al.[9],[10],[11] and Mooney et al.[12] included presenters with lived experience describing their contributions to the research and development process and, importantly, different perspectives and, at times, difficult to hear, testimony from careers of people detained using mental health legislation and how things could change for the better, respectively. These sessions both highlighted existing gaps and showed us the beginnings of a way forward in which different types of experts work collaboratively together to build a new, more sustainable future for mental health care and support services.

Another important theme running through the conference was the limited and variable provision of services for people experiencing very severe mental health difficulties. Such services in the UK and other high-income group countries are often referred to as rehabilitation teams or units. This group is especially vulnerable, with high levels of excess mortality from all causes and substantially reduced life expectancy.[13] There is often relatively little advocacy, but in a round table discussion facilitated by Killaspy and through other work at the congress, we hope that more consensus has been reached on what should be available for this group, how it may be adapted, and how we can advocate for it.[14] The importance of rehabilitation and recovery services was further described by Asha Praseedom, the vice chair of the rehabilitation Faulty of the RCPsych, using case studies of patient experience of poor access to services during the pandemic. Support and recovery-based treatments were harder to access for people with severe and enduring mental illnesses during the pandemic and this is very likely a worldwide phenomenon.

Several presentations emphasized the themes of inclusion, advocacy, and forming alliances. Fascinating presentations on projects to reach out to conventionally poorly served African American religious communities with mental health first aid training by Jordan and to followers of K-POP using an online community approach by Bernadette Carandang remind us that both traditional in person reaching out and new virtual approaches to geographically diverse but interest-associated communities can both be powerful and complement each other.[15],[16] Michael Marmot, Olga Falceto, and Dinesh Bhugra all stressed the importance of mental health policymakers and providers reaching out to politicians and big business in attempts to reduce inequality, improve the psychological health of the work environment, and ensure climate actionall these three things would bring substantial improvements in mental health at population levels.

There was a clear emphasis on the impact of inequity and inequality on the mental health of the population. Dr. Lade Smith (the incoming president of RCPsych) led a symposium that discussed the evidence on inequality and discrimination and explored how these could be addressed to provide a fairer system of care. It is evident that each geographical region has its own inequities and that solutions need to be tailored to specific needs with data and using a systematic approach. The importance of lived experience in shaping solutions cannot be overestimated.

A congress like this can never have just one message as there is so much richness, but the dominant themes of inequality, pressure from climate change and natural disasters, and the lack of collaboration in the development of services call upon us to reach out to allies among patient and family groups, the so-called “green movements,” and those who lobby big business and government to work to together to improve the life chances of those with mental health problems. Social psychiatrists have an important role to play in enabling appropriate and sustainable solutions to the challenges for mental health care. This conference and its commemorative issue serve as an essential call for action and share ideas on how to improve things in the short term and also in years and decades to come.

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