Advances in Psychiatry at Crossroads of Asia and Europe:Contributions from Turkey

Berna Uluğ*, Peykan Gökalp**, Levent Küey***

* Psychiatric Association of Turkey** Turkish Neuropsychiatric Society*** WPA Zonal Representative for Southern Europe

At the crossroads there was Hospital Aesclepion in Pergamon

This was a round building in 6 sections. Patients were given exercises, honey cures, supervised diets, herbal medicines, mud baths, and could have their dreams analyzed for diagnostic purposes.

They drank from a 'sacred spring' and bathed in those waters, and used the theater and library resources there.

There was the tunnel....Underground tunnel that led

to healing center

262' long, with 12 windows above for sunlight, patients were given hashish, walked in silence through the tunnel while listening to soothing sound of water from the sacred spring flowing under the floor

...and there was the Bayezid Complex …

At a time when in Europe the mentally ill were believed to be under the influence of the devil, and frequently burnt at the stake, patients in Bayezid's hospital were treated with music therapy. The hospital staff included ten singers and musicians playing the ney, violin, santur and ud. Certain modes of Turkish music were found to be particularly beneficial, among them neva, rast, dügah, segah, çargah and buselik. As well as music, another form of therapy involved the scent of flowers...

On the fertile soil of past now has to be raised the power of National and International Associations and Alliances

Social and Political Challenges in Turkey High rate of population growth

Young population!

Migration (to urban centers and other countries) Progressive and rapid urbanization Economic inadequacy and inequalities Insufficient levels of public services Gender inequalities

Geographic localization of the country International relationships

Turkey....

This country Coming from full gallop from far east AsiaStretching to Mediterrenean ...

is ours...N. Hikmet

Who are we? Asians, Middle Easterns, Mediterreneans, Europeans (South or East).... May be all!

In the last decades advancement in….

Psychiatric Epidemiology Community psychiatry studies on

PTSD after earthquake 1999 and other community studies

Role and initiatives of Psychiatric Associations

Psychiatry training and state of art International collaborations

Advances in Psychiatric Epidemiology

Use of standard screening and diagnostic instruments (e.g. CIDI)

National Mental Health Survey (1998) Knowledge of prevalence of

psychiatric disorders across age groups, genders and geographical regions

Ability to compare with the figures in different cultures and nations

Some major findings of surveys…. International Consortium of Psychiatric Epidemiology

(ICPE) Surveys* North America (Canada and the U.S.) Latin America (Brasil, Chile, and Mexico) Europe (Czech Rep., Germany, the Netherlands and Turkey) Asia (Japan)

For Major Depressive Episode consistent socio-demographic correlate: being

FEMALEstrongly co-morbid with primary anxiety disorders

*Kessler et al., 1998

Prevalence of Psychiatric Disorders: High!

10,9 11,3

17,2

0

2

4

6

8

10

12

14

16

18

2-3 y.o. 4-18 y.o. over 18 y.o.

Mental Health Profile of Turkey, 1998

Use of Mental Health Services: Low!

10,9

0,0

11,3

0,2

5,0

0,3

17,2

4,7

0

5

10

15

20

2-3 y.o. 4-11 y.o. 12-18 y.o. adult

prevalence use of m.h. Services

Absence from work due to physical vs. mental illness: High disability due to mental illness!

15,9

20,9

7,5

11,8

0

5

10

15

20

25

1-7 days more than 7 days

Physical illness Mental illness

In the last decades advancement in….

Psychiatric Epidemiology Community psychiatry studies on

PTSD after earthquake 1999 and other community studies

Role and initiatives of Psychiatric Associations

Psychiatry training and state of art International collaborations

Epidemiological Studies for the Psychological Effects of 1999 Earthquake*

Prevalence of PTSD and Comorbid Depression (23 and 16% at the epicenter)

Psychometric testing for validity and reliability of screening instruments

Differential prediction for depressive and traumatic stress symptoms

Long-lasting morbidity

*Kılıç and Ulusoy, 2003

Mental Health Promotion and Antistigma Actions Public Awareness Training

Program:Interpersonal relations and psychosocial wellbeing awareness*

WPA Institutional Program on Anti stigma – collaboration from Turkey

Foundation of the Families’ and Patients’ Organizations Society of Friends for Schizophrenia Others

*Coskun and Coskun, 2004

In the last decades advancement in….

Psychiatric Epidemiology Community psychiatry studies on

PTSD after earthquake 1999 and other community studies

Role and initiatives of Psychiatric Associations

Psychiatry training and state of art International collaborations

What are the Associations doing?

Relate with Ministry of Health and Turkish Medical Association in the service for promotion of mental health and psychiatry training

PAT Institutional Programs and Awards: Promotes the advancement of scientific information through awards to the research projects as well as financial and scientific support to the trainees

What are the Associations doing? strengthen and continue international

relationships of Turkish psychiatric community with international professional organizations and psychiatric community

strengthen and continue relationships among national professional organizations in mental health field

take ethical standards within the professional field

What are the Associations doing?

enhance awareness on mental health in the society, in physicians and all members of the mental health team

support the integration of young colleagues in the field so that they maintain strong ties with international body and gain leadership qualities

Scientific Sections of the PAT52 Scientific Sections: operate to build the scientific activities of

PAT and conduct educational as well as research oriented projects

produce and publish the Guidelines for Treatment of Psychiatric Disorders

organize scientific meetings in the National Congresses and Spring Symposia

initiate collaborative research and scientific projects across national centers and with related international organizations

Ministerial Actions-1 Ministerial attitude is “to command of

health system”, in a pattern of ordering the affairs without giving information to and receiving messages from communities or associations of mental health professionals

PAT succeeded to join the national delegation for the WHO Ministerial Meeting 2005 in Helsinki

Approval for the Action Plan for Europe

Ministerial Actions-2

PAT and TNS were invited to join to “Advisory Council for Mental Health” established in 2004

PAT mobilized the Ministery and encouraged mental health professionals’ participation for the “Improvement of Mental Health Services Project”

Ministerial Actions-3 PAT reported to Ministery of Health

about many problem areas in mental health issues and proposed for solutions Curriculum and rules for residency training High Security Psychiatric Clinics or Hospitals Minimum standarts for physical condition,

equipment and staff of psychiatric clinics Psychopharmacologic treatment in Primary-

care

Mental Health Policy and National Mental Health Program

According to WHO Atlas we seem to have those

Do not believe that!

Mental Health Legislation The history of the Mental Health

Legislation in Turkey dates back to 1876

A draft legislation on “the protection of the rights of psychiatric patients” is prepared and proposed by the Psychiatric Association of Turkey to the Ministry of Health.

Ethical Codes for Psychiatrists Ethical Code of Medicine

(Turkish Medical Association) Ethical Code of Psychiatry

(accepted in General Assembly of PAT in 2002)

Prepared by the Scientific Section for Human Rights and P sychiatric Ethics

Committees: Ethical Committee of TNS Ethical Committee and Discipline

Committee of PAT

In the last decades advancement in….

Psychiatric Epidemiology Community psychiatry studies on

PTSD after earthquake 1999 and other community studies

Role and initiatives of Psychiatric Associations

Psychiatry training and state of art International collaborations

Psychiatry Training Implementation of standards in

residency training and the core curriculum

Studies for core curriculum of psychiatry in medical schools

PAT Scientific Section of Residents and Residents’ Committee

CME activities Training at primary health care level, of

GPs and other service providers

Board Committee and Exam

Psychiatry Board is an autonomous Council of the PAT, responsible for establishing and auditing

the application of the core curriculum adjusted to international and national/cultural standards and necessities,

organize and implement the Psychiatry Board Examinations.

Scientific Advancement

The last decade witnessed remarkable increase in National and international publications Research activities Collaborative research projects across

national centers Collaborative international multi-center

research projects

In the last decades advancement in….

Psychiatric Epidemiology Community psychiatry studies on

PTSD after earthquake 1999 and other community studies

Role and initiatives of Psychiatric Associations

Psychiatry training and state of art International collaborations

Turkish Psychiatric Community and International Collaboration WHO WFMH WPA

WPA-YPC WPA Institutional

Program for Eastern Europe and Balcans

UEMS EFPT AEP EACLP And many others…..

What to be done?

The implementation of a national mental health programme is a priority

Active participation for the planning and implementation

What to be done? More…

Adjustment to the WHO Mental Health Action Plan Facing the challenges Building the solutions

Promoting Young People’s Health!

The bridge between Asia and Europe...

To face the challenges and build the solutions we need to use the cultural heritage of both continents!