Hong Kong Seminar on Stress at Work

At the Hong Kong Seminar: Dr. E.K.Yeoh, J.P., Secretary for Health and Welfare, Hong Kong Special Administrative Region, at the podium; Barbara Murray, ILO (center);
and WFMH President Pirkko Lahti.

The International Labour Office (ILO), the World Federation for Mental Health (WFMH) and New Life Psychiatric Rehabilitation Association (NLPRA) jointly organized a seminar in Hong Kong on mental health in the workplace on 31 January-1 February 2002. This was the first time the two international organizations had worked with a local organizer to arrange a regional meeting of this kind. The aim was to raise the awareness of employers and employees about the challenges of job stress, and to provide a better understanding of the relationship of job stress to productivity. .

Dr. E.K. Yeoh, J.P., Secretary for Health and Welfare of the Hong Kong Special Administrative Region, gave a welcoming address signifying his support and highlighting the efforts made by the Hong Kong Government on mental health education. The program was introduced by Pekka Aro of the ILO’s Infocus Program on Skills, Knowledge and Employability and by Dr. Raymond Wu of NLPRA.

The seminar was divided into two parts. The first day targeted chief executives, directors and senior managers of organizations, and was attended by 163 people. On the second day 224 professionals from human resources and other divisions of management participated. The industries represented included construction, engineering, accounting, IT and electronics, banks, financial services, hospitals, transportation, retailing, government and public bodies, and non-governmental organizations.

Experts from Japan, England and Thailand spoke about the impact of job stress on productivity as well as strategies for improving well-being at work. As good practice models for employers, Nokia (HK) Limited and the Hong Kong Police Force provided information about their programs to improve employees’ mental health. Barbara Murray, ILO Coordinator for Equity Issues, spoke on stress in the workplace. WFMH President Pirkko Lahti drew attention to the stigma and myths associated with mental health issues. A discussion session allowed the participants to exchange views about ways of managing stress at work.

Deborah Wan, Chief Executive Officer of NLPRA and the local organizer of the meeting, presented results of a survey taken to provide a picture of the mental health of employees in Hong Kong. These results were also reported in a background paper prepared for the seminar by NLPRA, “Mental Health in the Workplace: Situation Analysis – Hong Kong.”

Pirkko Lahti prepared a report on a project supported by the ILO to draw together various WFMH activities on mental health and work. This publication included selected World Mental Health Day country reports and other material submitted by Regional Vice Presidents. Mental Health Europe contributed information, and the Regional Vice President for South America, Paulo Alterwain, provided a detailed report of activities over a two-year period. The Finnish Mental Health Association produced an item for inclusion and gave editorial support.

Ms. Lahti praised the arrangements made by Deborah Wan and NLPRA. She added: “The Hong Kong Seminar is an excellent example of cooperation between the International Labour Organization and WFMH. One important result is that we have a list of possible partners for other enterprises in the region.”

The presentation materials of all the speakers are available on the web-site of NLPRA at . In addition, the background paper, “Mental Health in the Workplace: Situation Analysis – Hong Kong,” has been published. Copies can be obtained by e-mailing to ho@nlpra.org.hk.

The Plight of Afghan Refugees

Uniaza Niaz, M.D., a Pakistani psychiatrist and WFMH Life Member, visited two relief centers for Afghan refugees in January, one at Chaman Quetta near Pakistan’s border with Afghanistan, and one across the border at Spin Buldak in Afghanistan. Both centers are run by the Pakistan Islamic Mission Association (PIMA). She was part of a four-member team that also included a clinical psychologist, a medical registrar and a medical journalist.

She reported that the group had intended to visit the camps to identify and document the psychological impact of the war on the civilian population – “but obviously this was impossible as the people were dying of hunger, starvation and exposure to the cold….Secondly, we wanted to educate and debrief the voluntary workers seeing this enormous human misery. But the actual visit to the camps shocked us even more as the Afghans were fighting for survival from hunger. The onslaught of the elements, particularly the dusty storms and freezing temperatures on the ground, were making survival impossible.”

Dr. Unaiza Niaz with two sick refugee children.

The refugees were affected by cumulative disasters - two decades of tribal conflict, a prolonged drought, and now modern warfare. She found that families had suffered losses (often of several members) and injuries from bombing raids and mine explosions. Malnutrition contributed to other deaths, particularly of children.

Although she thought that almost 90% of the refugees were affected by bereavement, PTSD or depression/anxiety, and that “the psychological trauma endured by the Afghans is undoubtedly tremendous and needs urgent recognition and help,” there were even more urgent requirements, so that “psychiatric help comes last on the list.” She named as priorities food and emergency medical care. “Medical facilities are appalling right now.”

She singled out the medical needs of women and children as deserving special attention. At the refugee camp in Spin Buldak there were few female doctors and no gynecologists. Women were unwilling or unable to breast-feed babies. She saw an urgent need for educating mothers about basic hygiene and infant nutrition.

Dr. Niaz commented on the patience and endurance of the refugees, and the strength of their religious faith. “Strangely, we found no overt expression of anger, or signs of frustration. Perhaps they are numbed by the twenty years of war.”

Tents in an Afghan refugee camp.

Although the relief efforts in the camps she visited were generally inadequate, she commented favorably on facilities provided by the Red Cross with support from the United Arab Emirates, and praised the work of PIMA and Islamic missions from Malaysia and South Africa in Spin Buldak.

A Collaborating Center reports on human trafficking

Prof. Syed Arshad Husain, who heads the International Center for Psychosocial Trauma at the University of Missouri, USA (a WFMH Collaborating Center), has been involved in trauma counseling in Pakistan for many years and has been working recently at a camp for Afghan refugees near Peshawar. His team established a counseling center there and raised funds to support it.

He reports that while working in camps in Pakistan, his group has become aware of a common practice among Afghan refugee families of selling women and children who have lost their husbands and fathers to other Afghan men. The extreme poverty of these families contributes to the situation. The Center’s training courses for professionals in countries affected by conflict include education about human trafficking as part of the general curriculum in trauma psychology. Prof. Husain views it as “a major complication of war.”

The work of the Commission on Women spanned the period from 4 to 15 March. NGOs pursued advocacy activities related to the two themes of this year’s session, the impact of poverty, and environmental management and the mitigation of natural disasters. Participants from WFMH included Main Representative Nancy Wallace, UN representatives Ricki Kantrowitz and Pamela Collins, Board Member-at-Large Chueh Chang, and a group of Federation members from Asia.

Nancy Wallace and Chueh Chang chaired a panel discussion on the impact of poverty and natural disasters on Asian women’s mental health on 6 March. Ricki Kantrowitz organized a panel on 7 March featuring presentations about poverty in Europe, the response after Hurricane Mitch in Honduras, and poverty and economic change in Taiwan. The speaker from Taiwan, an aboriginal woman called Melevlev (many people in her tribe use only one name), gave an account of the stress endured by the island’s aboriginal peoples because of their marginal economic situation and exclusion from mainstream society.

The WFMH group took a lead role in a successful lobbying effort by the NGO Committee on Mental Health to have appropriate language about women’s mental health inserted in the Agreed Conclusions of the CSW Session. With invaluable help from government representatives from Thailand and Turkey, who brought the language to the floor, the following paragraphs were inserted in the official documents:

On Natural Disasters:

• Improve and develop physical and mental health programs, services and social support networks for women who suffer from psychological effects in natural disasters.

On Poverty:

• Improve and develop physical and mental health programs, services and social support networks, and preventative care for women who suffer from poverty.

Nancy Wallace said that she was particularly pleased that the mention of prevention was accepted, as some of the government representatives were unfamiliar with the work that has been done in this area.

At the March session of the UN Commission on the Status of Women (left to right):
Chueh Chang, WFMH Board Member-at-Large; A-bu, President,
Kaohsiung County Indigenous Women’s Growth Association, Taiwan;
Nancy Wallace, WFMH’s Main Representative at UN NY; and
Melevlev (Huei-Chuan Sung), Director, Aboriginal Women’s Affairs, Awakening Foundation.

Support for Women in Afghanistan
International Women’s Day was observed at United Nations headquarters on 8 March 2002 during the annual session of the Commission on the Status of Women (CSW). This year the event was focused on the status of women in Afghanistan (where the first public observance of the Day was held in eleven years). The theme was the right of girls and women in that country to education.

To underscore the importance that the United Nations attaches to improving the situation of women in Afghanistan, high-profile speakers addressed the assembled government representatives and NGO observers. These included Secretary General Kofi Annan, Mrs. Laura Bush, Queen Noor, the presidents of the UN General Assembly and Security Council, and representatives from UN agencies.

In a series of presentations about the multiple problems faced by women in Afghanistan, mental health was not mentioned. But the magnitude of the problems described left no doubt that over time, this will need to be addressed after the most urgent requirements are met. One of the most compelling accounts came from Sima Wali, an Afghan woman who heads Refugee Women in Development (and one of the three women delegates at the Bonn talks on the future of Afghanistan in late 2001). She described the feminization of poverty and a systematic isolation of women, creating “non-citizens in our own country.” The illiteracy rate for women is 80% or more.

Thoraya Ahmed Obaid, Executive Director of the UN Population Fund (UNFPA), gave a powerful speech describing the situation of women - early marriage, high birth rates, absence of health care, malnutrition – leading to early death. A woman on average has eight children and lives to 44 years.

The 109th Executive Board meeting was held in Geneva on 14-21 January. WFMH was represented by its President, Pirkko Lahti, its representative in Geneva, Stanislas Flache, and Board members Agustin Ozamiz and Chueh Chang. Strengthening mental health was an agenda item, and a resolution (EB109.R8) called on member states to invest more in mental health, adopt appropriate policies and carry forward the recommendations of TheWorld Health Report 2001.

Representatives from selected medical schools and hospitals consulted with WHO staff on “Caring for Children and Adolescents with Mental Disorders: Setting WHO Directions” in Geneva on 31 January-1 February 2002. The objective was to provide input for WHO about broad issues to be addressed in a new initiative on care for young people. As WHO had already noted on the first page of the first chapter in the 2001 World Health Report: “Over 90% of countries have no mental health policy that includes children and adolescents.”

WFMH President Elect Patt Franciosi attended the meeting which discussed the general lack of attention to services for children, and the need to develop government mental health policies which include them. One of the main recommendations from the consultants was that WHO should produce a policy report and atlas of statistical information similar to those produced last year on mental health, but focused entirely on children and adolescents.

Dr. Franciosi commented that it was significant that WHO is giving special attention to the mental health needs of this neglected group. “It is appalling that so little has been done by governments in this area, and that so few countries include children and young people in their mental health planning. In fact, only 34 countries have been identified as having such policies at this time, and only 14 countries meet the highest criteria for a clearly articulated policy covering children and adolescents. There is a role for WFMH in this area to work in cooperation with WHO.”

Dr. Franciosi has a special interest in the subject as the Chair of World Mental Health Day, which has as its theme for 2002 the effects of trauma and violence on children.” The goal of this campaign is to draw attention to extreme circumstances which affect children in many parts of the world, and the need to develop programs to provide mental health care. A recent WHO document noted: “Children and adolescents live in a world that is increasingly complex….New data are revealing that mental health problems and violence are more prevalent than previously thought. For example, WHO estimates that 10% to 20% of all children have one or more mental or behavioral problems. Children’s health is also directly and indirectly affected by conflicts, wars and migration.” [WHO Executive Board, Provisional agenda item 3.7, (EB109/10) 12 December 2001.]

The World Mental Health Day planning kit currently in preparation by WFMH will include an overview of the topic, more detailed discussion of selected issues (war and refugees; domestic and community violence; violence in the media), and a section on the pervasiveness of violence in society. A number of successful interventions and programs will also be described.

Patt Franciosi encourages those who would like to support the expansion of the WMHDay program to contact the Secretariat. The planning kit will be mailed to WMHDay event organizers in mid-May, and will be available on the WFMH web site at www.wfmh.org.  Material will be available in English, French, Spanish and Arabic.

At the WHO meeting in Geneva on mental health care for children and
adolescents (left to right): Helmut Remschmidt, President,
International Association for Child and Adolescent Psychiatry and
Allied Professions (IACAPAP); Patt Franciosi, President Elect, WFMH;
Jose Manoel Bertolote and Myron Belfer, Department of Mental Health
and Substance Dependence, WHO.

Africa

African Regional Council for Mental Health (ARCMH)

The African Regional Council for Mental Health held an executive meeting on Lusaka, Zambia, on 28 February. The meeting was convened by ARCMH President Isaac Mwendapole. Elizabeth Matare, WFMH Regional Vice President and Honorary Secretary of the ARCMH attended, together with Shona Sturgeon, WFMH Board Member at Large, and Petronella Mayeya, manager of the Canadian-sponsored Project MHASISA (Mental Health Action Strategies in Southern Africa). One of the major purposes of the meeting was to review the project’s workplan and the progress report to be submitted to the Canadian International Development Agency and the Canadian Mental Health Association. Fundraising to sustain the project was also discussed.

The meeting examined difficulties in creating new links throughout the African region. To improve contacts in French-speaking countries the next ARCMH newsletter will be printed in French as well as English.

- Shona Sturgeon, WFMH Board Member-at-Large

South Africa The Executive Director of the South African Federation for Mental Health for the past 22 years, Lage Vitus, retired at the end of February. He served a total of 33 years with the organization. The Federation held a dinner on 12 March in Johannesburg to honor him.

His successor as Executive Director is Solomon Paul Mokgata, who had previously been the Assistant National Director of the South African National Epilepsy League. He has experience in business and the media, in social work, and as an industrial relations officer.

Europe

Mental Health Europe (MHE)

At its General Assembly in Brussels in March, Mental Health Europe elected Leo de Graaf, M.D., as its new President. .Dr. de Graaf has been Director of a diversified psychiatric and psychosocial service provider called “De Gelderse Roos” since 1990. Previously he worked from 1980 as a child psychiatrist in a community mental health center which merged into De Gelderse Roos. At an earlier stage in his career he practiced tropical medicine in Malawi. In addition to his medical work, he was a Representative in the Provincial Parliament of Gelderland from 1982 to 1995. He has been a Board member of MHE since 1999, and Treasurer from 2000. -Mental Health Europe, info@mhe-sme.org

Belgium’s Year of Mental Health
Five organizations in Belgium sponsored the “Year of Mental Health” in 2001 as a special effort dedicated to the destigmatization of mental illness and psychiatric patients. This initiative was arranged by the Flemish, Walloon and Brussels Leagues for Mental Health, joined by the Julie Renson Foundation and the Queen Fabiola Foundation for Mental Health. Many events were held throughout 2001 to reach the general public, the media, politicians, academics and professionals.

Financing such a campaign was difficult, and the organizers had little initial success. Eventually they got support from two international pharmaceutical companies, Eli Lilly and Sanofi-Synthelabo, and two Belgian companies, Electrabel (an electricity distributor) and BIAC (the manager of the national airport). They also obtained a great many smaller contributions of money, volunteer help, and donations of in-kind services. Getting such a large number of supporters involved was a very positive result of the campaign, showing that attention to mental health made sense for people in the field, even if not high-level decision-makers were more cautious about the issue.

One important conclusion of the year’s effort was the great need for mental health professionals to become more involved with other areas of society such as businesses, schools, the social services and the justice system – and with the places where people live, where psychiatric problems may occur, and where they have to be accepted. Destigmatization begins there, much more than in mental health services. During the year 2001 the doors were open as often as possible, and many positive results are now being seen.

- Martine Baudin
Julie Renson Foundation
info@julierenson.be

Western Pacific

Western Pacific Regional Meeting
Hong Kong

A WFMH Western Pacific Regional Meeting was held in Hong Kong on 2 February 2002. It was attended by the Federation’s President, Pirkko Lahti; Board Member at Large Chueh Chang (Mental Health Association of Taiwan); Morgan Ng (Richmond Fellowship of Hong Kong); Deborah Wan (New Life Psychiatric Rehabilitation Association); T.N. Foo and Marcus Chiu (Mental Health Association of Hong Kong); and Dr. Suchada Sakorusatian (Department of Mental Health, Thailand). The meeting was chaired by the Regional Vice President, Dr. Kazuyoshi Yamamoto (Japan). Pirkko Lahti reviewed recent Federation activities, including collaboration with the World Health Organization. Chueh Chang gave an update on regional affairs, and the group made preliminary plans for Western Pacific participation in the program of the Melbourne World Congress in 2003. Information was presented about a study on ageing in Japan, which was proposed at a WFMH regional meeting last November by Drs. Tsung-yi Lin, Kunihiko Asai and KazuyoshiYamamoto. There was also a review of ways to encourage broader local and regional participation in meetings such as the ILO-WFMH-NLPRA Seminar which had just taken place in Hong Kong. Dr. Suchada Sakorusatian reported on Thailand’s plans to hold a conference on mental health in the workplace in Bangkok in the near future. Guidelines for good practices have been prepared, and five corporations will join a pilot program.

- Kazuyoshi Yamamoto, WFMH Regional Vice President

At the WFMH Western Pacific Regional Meeting in Hong Kong (left to right):
Chueh Chang (Taiwan), Kazuyoshi Yamamoto (Japan), Pirkko Lahti (Finland),
and Suchada Sakorusation (Thailand) with Marcus Chiu, T.N.Foo and Deborah Wan (all of Hong Kong).

In recent correspondence with the Federation’s Secretariat WFMH Collaborating Centers described current issues in their work:

Prof. Donna E. Stewart, Lillian Love Chair in Women’s Health at the University of Toronto, Canada, linked good mental health for women with good physical health and social justice. She included among important international issues in women’s health the lack of education for girl children in many developing countries; poverty – 70% of the world’s poor are women with young children; violence against women; and the need for equity in opportunity, in representation in governance, and in pay and job promotion.

Prof. Brian Robertson of the Department of Psychiatry and Mental Health at the University of Cape Town, South Africa, wrote about a new Research Center for the Study of Violence and Mental Health which he established last year. He commented on the lack of funding for projects in Southern Africa, and felt that collaboration with researchers from the Northern Hemisphere would be helpful. He is also concerned about the lack of African representation at international meetings, not just because of cost and exchange rate difficulties, but because of inattention by conference organizers.

James Lavelle from the Harvard Program in Refugee Trauma, Cambridge, Massachusetts, USA, headed by Prof. Richard Mollica, described work to support the Center for Torture Survivors at Bellevue Hospital in New York. The Program is also involved with the collection of data for a National Institutes of Health study on the exposure to violence of political detainees who entered the US during the 1990s. A project called “IPC+” takes lessons learned at the HPRT Indochinese Psychiatry Clinic to four communities in Massachusetts which have large refugee populations. An innovative project with a statewide lawyers’ consortium is providing help to asylum seekers and their families. HPRT is also in the third year of a training project for physicians in Bosnia-Herzegovina, funded by the World Bank.

Jorge Arroche, Executive Director of STARTTS (Service for the Treatment and Rehabilitation of Torture and Trauma Survivors), works on issues involving refugee health care in Australia. He forwarded an editorial he wrote for the magazine Refugee Transitions discussing the current polarization of the refugee debate in Australian politics; action on developing national standards for torture and trauma services; and a successful fundraising appeal for new work with children and adolescents.

Prof. Lorraine Dennerstein, of the Office for Gender and Health at the University of Melbourne, Australia, wrote to describe her research on the study of women’s reproductive ageing, including research funded by the Alzheimer’s Foundation of the USA on early cognitive changes associated with ageing.

Prof. John Copeland of the Institute for Human Ageing at the University of Liverpool, UK, mentioned multiple issues in mental health and ageing. The fate of older people in conflict areas is a serious problem. The question of standards in nursing homes is deservedly attracting attention. In Western countries the provision of adequate pensions for future retirees is a matter of growing concern and will have an impact on their quality of life. In Sweden, a 15-year study of a cohort of older people appears to show that the prevalence of treatable depression rises with age but is largely unrecognized and not treated. “This problem is widespread and is part of the problem of stigma in ageing. The mentally ill old are being doubly stigmatized.”

Dear Friends:

The Organising Committee for the 2003 Biennial Congress in Melbourne, Australia, cordially invites you to a wonderfully full programme of science, mental health and social activity.

The dates of the Congress have had to be brought back two days to avoid major increases in hotel prices in Melbourne – the following week Melbourne hosts the International Grand Prix. Our Congress dates are now Friday 21 – Wednesday February 26 2003. We hope that this will fit your plans to attend the Congress.

The several committees necessary to organise an event of this magnitude are currently very active. They include the Local Organising, National Advisory, International Scientific Programme and Social Committees, comprising about 60 members. The Local Organising Committee is in regular contact with the WFMH Secretariat and the WFMH Congress Liaison Committee. Our focus currently is on invitations to keynote speakers, and on preparation of the registration brochure and call for abstracts. The brochure will be distributed by late April. The closing date for individual abstracts is July 8th.

We will also highlight those special meetings which are integral to and so important in ensuring a truly successful Congress. These include the George Albee, the Margaret Mead, and the Mary Hemingway Rees Lectures; and the WFMH General Assembly and Mental Health Associations Day.

We are delighted with the level of support within Australia and internationally by political leaders. In our First Announcement the Prime Minister of Australia, the Honourable John Howard, issued the invitation to you and the world mental health sector to participate in this Congress – only the second to be held in Australia. The first was in 1973, to mark the 25th anniversary of the World Federation for Mental Health.

We are also working already to make our social events something for you to remember. A highlight of the social programme will be our Golden Opportunity Ball – a “Black Tie” event with a difference!

We look forward to seeing you in Melbourne in February 2003. Put the Congress in your diary now!

Megan McQueenie
Executive Director,
Mental Health Foundation of Australia

The WFMH Newsletter is published by the Secretary General of the World Federation for Mental Health for its members four times a year.
Editor: Elena L. Berger, D. Phil.
Consultant: Prof. Eugene B. Brody, M.D.
Editorial Office: Sheppard and Enoch Pratt Hospital
P.O. Box 6815
Baltimore, Maryland 21285-6815
Telephone 410-938-3180
FAX: 410-938-3183
Email:wfmh@wfmh.com
Website: www.wfmh.org