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Eliot Sorel, MD
Founding Editor-in-Chief
Editorial Board
MansoorMalik,MDMBA
Senior Editor
GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020
ZONAL EDITORS:
AFRICA:
Prof. David M. Ndetei, Kenya
Prof Bonginkosi Chiliza, South Africa
Victoria Mutiso, PhD, Kenya
ASIA/PACIFIC:
Prof. Yueqin Huang, China
Prof. Roy Kallivayalil, India
THE AMERICAS:
Prof. Fernando Lolas, Chile
Prof. Vincenzo Di Nicola, Canada
EUROPE:
Prof. Gabriel Ivbijaro, United Kingdom
Dr. Mariana Pinto da Costa, Portugal
ASSOCIATE EDITORS:
Miguel Alampay, MD
John Chaves, MD
Kyle Gray, MD, MA
Madeline Teisberg, DO, MS
G M H P
REVIEW
Eliot Sorel, MD
Founding Editor-in-Chief
MansoorMalik,MDMBA
Senior Editor
GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020
Volume 1, No. 3
Autumn 2020
Eliot Sorel, MD, Founding Editor-in-Chief
ZONAL EDITORS:
AFRICA:
Prof. David M. Ndetei, Kenya
Prof Bonginkosi Chiliza, South Africa
Victoria Mutiso, PhD, Kenya
ASIA/PACIFIC:
Prof. Yueqin Huang, China
Prof. Roy Kallivayalil, India
THE AMERICAS:
Prof. Fernando Lolas, Chile
Prof. Vincenzo Di Nicola, Canada
EUROPE:
Prof. Gabriel Ivbijaro, United Kingdom
Dr. Mariana Pinto da Costa, Portugal
ASSOCIATE EDITORS:
Miguel Alampay, MD
John Chaves, MD
Kyle Gray, MD, MA
Madeline Teisberg, DO, MS
Dear Colleagues and Friends,
Welcome to the Autumn 2020 issue of Global Mental Health & Psychiatry Review…!
We are very pleased to welcome cordially to our Review’s Editorial Board two new Africa Zon-
al Editors, Professor Bonginkosi Chilliza of South Africa and Victoria Mutiso, PhD of Kenya,
enhancing the quality, depth, and diversity of our team. We are also delighted to start a Book
Review Section led by Professor Vincenzo Di Nicola, one of our Zonal Editors.
As CVD-19 erupted in Wuhan, China in the autumn of 2019 and quickly engulfed the world,
infecting more than 26 million people, nearly 19 million have recovered and causing nearly
900,000deathsasofSeptember4th,withnopandemicendinsight,wehavedecidedtodedicate
this consecutive GMHPR issue to a CVD-19 focus and its primary care, mental health, and
public health consequences: a populations’ TOTAL Health focus.
We commend Madame Ursula van der LEYEN, European Commission President, and Doctor
Victor DZAU, the President of the United Stated National Academy of Medicine, for their su-
perb leadership. A high-level Vaccine Development Funding meeting, led by Mme. LEYDEN
and Dr. DZAU in June of this year focused on a rapid CVD-19 vaccine development, received a
€ 16 B pledge from those attending.
As with any vaccine for populations’ health, public trust is essential for a successful vaccination
campaign launch and sustaining it to its effective completion. Public health depends on public
trust.
.
Toachievepublictrust,requiresaclear,concise,consistent,transparent,andreliablesetofcom-
munications among the public, the scientific community, and policy makers in anticipation,
prior and during the vaccination campaign, nationally and globally.
The successful implementation of a safe, effective, and reliable CVD-19 vaccine buttressed by
public trust, will have a catalytic impact; restoring populations’ health and stimulating a global
economic recovery.
Stay well, Be safe…!
Eliot SOREL MD
G M H P
REVIEW
COVID-19
TABLE OF CONTENTS
The Global Mental Health and
Psychiatry Review (GMHPR)
is a multidisciplinary
publication serving the Global
Mental Health Community. It
welcomes scholarly
contributions that focus on
research, health systems and
services, professional education
and training, health policy, and
advocacy. It is published three
times a year in January, May,
and September of each year.
GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW:
Introduction ..............................................................................................................1
Eliot Sorel, MD, Founding Editor-in-Chief
AFRICA ZONE:
COVID-19 and Mental Health
Consequences in Kenya ..........................................................................................3
Prof. David M. Ndetei, Dr. Frida Kamati, Dr. Victoria Mutiso and Christine Musyimi
COVID-19 and Mental Health
Consequences in South Africa ..............................................................................4
Prof. Bonginkosi Chiliza, MD, PhD
the AMERICAS ZONE:
Syndemics And Suffering:
The Goals Of Medicine Revisited ......................................................................................5
Prof. Fernando Lolas
Inauguration of a New Section: BOOK REVIEW
A Manifesto: Healing a Violent World.......................................................................6
Prof. Vincenzo Di Nicola
ASIA/PACIFIC ZONE:
COVID-19: A Review of
Psychological Crisis Intervention in China .........................................................8
Prof. Yueqin Huang, MD, MPH, PhD
Covid-19: Fight Against Drug Abuse and for Mental Health in
South Asia.....................................................................................................................9
Prof. Roy Abraham Kallivayalil, MD
EUROPE ZONE:
Pandemics – Have Any Lessons Been Learned? .............................................10
Prof. Gabriel Ivbijaro, MBE, JP
Eliot Sorel, MD, Founding Editor-in-Chief
GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020
G M H P
REVIEW
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20203
AFRICA
COVID-19and Mental Health
Consequencesin Kenya
Prof. David M. Ndetei, DSc1,2
Frida Kamati, PhD2
Victoria Mutiso, PhD2
Christine Musyimi, PhD2
1
University of Nairobi
2
Africa Mental Health Research and Training Foundation, Kenya
David M. Ndetei Victoria Mutiso
On March 2020, the World Health Organization (WHO)
declared the COVID-19 outbreak a global pandemic.
Coronavirus disease is a communicable respiratory disease
which is caused by a new strain of coronavirus that causes
illness in humans. While scientists are still learning about
COVID-19, they have determined that it is spread from
person to person through infected air droplets, direct
physical contact or contact with services that contain the
virus then touching the face with the contaminated hands[1].
The Coronavirus disease (COVID-19) has hit the globe
with unprecedented psychosocial needs and challenges that
touch on every aspect of life and life cycle which have led
to ramifications on mental health of the people affected[2].
While the focus has been on physical symptoms and primarily
respiratory with acute respiratory distress syndrome leading
to death in the most severe cases, there has been little focus on
how the pandemic has affected many people’s mental health.
Kenya has not been spared from the virus which began in
Wuhan city in China. The country has seen 13,353 infections,
5,122 recoveries and 234 COVID-19 related deaths as of July
19th, 2020. In terms of age, the youngest infected is a seven
old month infant and the oldest being an 86 year old [3]. The
Kenya ministry of health (MOH) at the beginning of July
reported that 186 health care workers had tested positive
for coronavirus and on the same month, the country lost its
first Kenyan doctor to COVID-19. Healthcare professionals
who have been at the forefront of the COVID-19 pandemic
are likely to suffer from poor mental health due to burnout,
increased anxiety and other mental health conditions especially
for those with preexisting conditions. COVID-19 associated
deaths among healthcare workers worldwide have been due
to inadequate protective equipment, diagnostic tests, drugs
and increased workload due to the rising COVID-19 cases[4].
Several studies have shown that most health care workers
have high levels of anxiety and depressions as majority are
afraid of getting infected and infecting their families. Kenya
has seen a new wave of COVID-19 stigma that is similar to the
AIDS associated stigma. Discharged patients have reported
being shunned by their own family members and neighbors.
Individuals who have tested positive and have been placed
under quarantine in their own homes due to inadequate
isolation facilities have also reported experiencing stigma.
It is clear that as the pandemic continues to ravage the
country and more people test positive from the coronavirus,
we are likely to see an increase in the mental health burden as
the government continues to implement physical distancing,
curfews, school closures which is affecting the economy.
All these public health measures are integral in reducing
the spread of the infection and preventing loss of life due
to coronavirus but they are also likely to cause poor mental
health outcomes like joblessness, anxiety and depression due
to isolation. The pandemic will likely have short and long term
impact on mental health meaning the need for mental health
services will escalate.
REFERENCES
1. World Health Organisation ‘Rolling updates on Coronavirus
Disease (COVID-19) <https://www.who.int/emergencies/
diseases/novel-coronavirus-2019/events-as-they-happen>
(accessed 6 April 2020)
2. Fu L. Clinical characteristics of coronavirus disease 2019
(COVID-19) in China: a systematic review and meta-analy-
sis. J. Infect. 2020 doi: 10.1016/j.jinf.2020.03.041.
3. National Emergency Response Committee on Coronavi-
rus; Update of Coronavirus in the Country and Response
Measures, As At 19th July, 2020 Brief No. 121 assessed 19th
July,2020
4. Maunder R, J, Vincent L, et al. The immediate psychological
and occupational impact of the 2003 SARS outbreak in a
teaching hospital. CMAJ. 2003; 168(10): 1245-1251. Pub-
MedGoogleScholar
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 4
AFRICA
COVID-19and Mental Health
Consequencesin SouthAfrica
Prof. Bonginkosi Chiliza, MD, PhD
Nelson R Mandela School of Clinical Medicine
University of KwaZulu-Natal
Bonginkosi Chiliza
The first case of COVID-19 in South Africa was confirmed
at the beginning of March 2020. The government’s response
was to institute a nationwide “hard lockdown” before the end
of the month (Abdool Karim, 2020). South Africa instituted
severe restrictions in order to prepare the health system for the
expected onslaught of cases with COVID-19 infections. The
government has been lauded for their early robust response to the
pandemic; however, the severe restrictions could not be sustained
as the deleterious socio-economic consequences became
quickly evident. South Africa has one of the lowest COVID-19
mortality rates in the world due, perhaps, to our relatively young
population age and the response to the pandemic.
The mental health response has focused on planning and the
rapid generation of policy and protocols. We have comprehensive
guidance on mental health interventions that should be
implemented during the COVID-19 disaster. However, the effects
of the pandemic and the subsequent lockdown had significant
negative impact on many mental health care users. Many users
with severe mental illnesses became too afraid to utilise our
services. Some were impatient with the new regulations for
COVID-19 screening, resulting in a number of users defaulting
on treatments with subsequent increases in relapses in the last
few months. We have also seen some ethical challenges where
the triage policies for access to limited resources have excluded
people with severe mental illnesses.
The COVID-19 pandemic and the measures put in place have
led to increased rates of loneliness, fear, anxiety and depression.
Two rapid general population surveys that have been published
point to rising levels of distress and increased utilisation of
services. One of our philosophy, so-called UBUNTU, states
that, “I am, because we are.” Therefore, the very idea of being
human is being connected to other human beings. The necessary
social distancing in a country that has low levels of smart
phone technology penetration has led to calls to ramp up larger
psychosocial responses in order to prevent mental illnesses and
promote resilience and mental wellbeing. The pandemic has also
put a spotlight on the ‘humaneness’ of doctors and nurses on
the frontlines. The multitude of posts on social media prompted
the South African Society of Psychiatrists to come together
with other organisations to form a HealthCare Workers Care
Network. The network offers seminars and workshops to health
care leaders in an effort to improve the work place in order to
promote mental wellbeing of all front line workers. The network
also offers free psychological first aid, by volunteer psychiatrists
and psychologists, to any worker in the front lines.
Lastly the monthly webinars organised by the Africa Global
Mental Health Institute (AGMHI) have answered the call of
many psychiatrists in our country for urgent information on
how to deal with the mental health outcomes of the pandemic.
The AGMHI is currently fulfilling its vision of equipping mental
health professionals in Africa and the diaspora with the tools
and agency to effectively care for those suffering from mental
illness, by organising the most amazing dialogues. The webinars
have ranged from dealing with mental health issues in resource-
constrained settings to racism and mental health in the context of
the Black Lives Matter at the end of July 2020.
REFERENCES
1. Abdool Karim SS. The South African Response to the Pan-
demic. N Engl J Med. 2020 Jun 11;382(24):e95. doi: 10.1056/
NEJMc2014960
2. Grillo A, Ghebrehiwet S, Johnson K, Borba CPC, Fricchione
GL, Sorel E, Durham M, Chiliza B, Motlana M, Henderson
DC. The African Global Mental Health Institute: Increasing
capacity, inclusivity and translation of psychiatric research
and care. The Journal of Global Health, Oct 2019
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20205
the AMERICAS
Fernando Lolas
SYNDEMICS and SUFFERING:
THE GOALS OF MEDICINE
REVISITED
Many years ago, I was invited to participate in a
groundbreaking project headed by the eminent bioethicist
Daniel Callahan. The aim was to reflect upon the goals of
medicine (1).
Under the current situation, with a generalized challenge to
healthcare systems all over the world, the questions posed by
that initiative, and the answers provided by a group of scholars,
renew the notions then discussed.
We do not need to stress the fact the syndemics (the
complex network and contexts of distress triggered by
the viral pandemics) place a heavy burden on peoples and
institutions. Not only the consequences of infection and
its effects on personal wellbeing are devastating. Disrupted
social life and economic recession impacting on the wellbeing
of communities and individuals bring to light structural
inequalities and unfair conditions. The institution of medicine,
as a complex socio-technical system, is requested to provide
answers to the problems identified by experts. Successes
and failures are evaluated by the number of contagions, the
seriousness of clinical pictures, the number of deaths, and the
availability of therapies or vaccines.
From an ethical point of view, issues such as autonomy
and dignity of persons, access to proper care, just distribution
of resources, priority-setting under social demands,
confrontation with death, besides political leadership and
sound policymaking, have come to the foreground. Traditional
bioethical thinking ends up reminding practitioners of the
principles that make the practice acceptable, proposing
guidelines and written statements, and resorting to the ideal
of the informed, decent citizen endowed with the capacity to
understand directives, trust experts, and behave properly.
A neglected topic that the coronavirus emergency brings
to light is the limit of expertise. In addition to framing the
problem as a scientific challenge, and emphasizing the
enlightened response of the biomedical and epidemiological
establishments, the professions (and not only the medical one)
need to respond to human suffering. This is what I call the
“pathic” dimension: feeling a certain way or having a certain
condition that induces fear, despair, and helplessness. My
impression is that we all too often tend to convert the pathic
into the pathological. This is how the helping professions
reframe the enigma of not feeling at ease into a dis-ease.
It is no wonder that professionals, each in his/her area
of expertise, identify and label the “main problem” or the
dilemmas. Thus, for economists, the challenge is how to
maintain economic activity. For lawyers and human rights
activists, how to implement measures safeguarding human
rights. For ecologists, how to preserve biospheric balances. For
scientists, how to translate their findings into proper practice.
For politicians, how to acquire and maintain leadership in
times of turmoil. Last, but not least, for healthcare workers how
to respond to the needs of persons and communities.
In this multifarious scenario, human suffering, the pathic
dimension of human life, needs to be addressed. Questions like
“why me” or “us”? “why now”? “why in this way”?, the classical
triad of the anthropological medicine of the Heidelberg School
(von Weizsäcker, Christian) belong to classical philosophical
questions that ultimately reduce to the vague feeling that evil is
part, wish it or not, of the human existence. And human life is
valuable not only for having problems but for how persons and
cultures conceptualize suffering and respond to it.
Acknowledging the fact that these are not “technical”
matters requiring “non-technical solutions”, it is perhaps time
to consider that, despite this, someone has to tackle the issue.
Is, for instance, a duty of mental health professionals to address
discomfort, stress, fear, and suffering, as “real” problems before
our diagnostic systems have adequate labels to handle them?
What kind of public counseling, advice, or advocacy, do we
need to anticípate the next phase of the pandemic, which will
certainly not be a strictly medical challenge but a complex
mixture of social derangement, economic crisis, political
unrest?
It seems to me that the time-valued question on the goals
of medicine, that pioneer Hastings Center Project, needs
reconsideration. And – perhaps- the global stance taken by
this publication might be a seminal viewpoint to rethink goals,
perspectives, and language.
Prof. Fernando Lolas, MD, IDFAPA 1
________________
1 Professor of Psychiatry and Director, Interdisciplinary
Center for Studies in Bioethics, University of Chile. Professor,
Central University of Chile. International Distinguished Fellow,
American Psychiatric Association.
REFERENCES
1. Lolas, F. On the goals of medicine: reflections and distinc-
tions. In Hanson,MJ & Callahan, D. (editors) The Goals of
Medicine.The forgotten issues in health care reform. George-
town University Press, Washington DC, 1999.
2. Green, R.M. & Palpan, N.J. (editors) Suffering and Bioethics.
Oxford University Press, Oxford-New York, 2014
A Manifesto: Healing a Violent World
G M H P
REVIEW
By Richard F. Mollica
Tunbridge Wells, UK: Solis Press, 2018
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 6
REVIEW
Psychology
CognitiveBehavioralTherapy
ManagingAnxiety
MentalConstructs
TreatmentforAnxiety
ResearchMethodsinPsychology
ManagingDepression
TheCriticalMind
Anxiety&Depression
ClinicalPsychopathology
PsychiatryMorningReport
NeuroscienceofPersonality
Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA*
Professor of Psychiatry,
University of Montreal &
The George Washington
University
President, Canadian Association
of Social Psychiatry
President-Elect, World
Association of Social Psychiatry
*Trained in the Harvard
Program in Refugee Trauma
(2008-09)
A Manifesto: Healing a Violent World
By Richard F. Mollica
Tunbridge Wells, UK: Solis Press, 2018, pp. 56
Contents:
“Preface” by Charles Figley
Texts by Richard F. Mollica:
· “Manifesto I: Healing a Violent World”
· “Manifesto II: Healing the Healer”
· “Manifesto III: Healing Power of Justice”
Each Manifesto is followed by a poem by Marjorie Agosin
(translated from the Spanish by Celeste Kostopu-
los-Cooperman)
“Moments of Revelation” by Richard F. Mollica
“Afterword” and “Pearls of Observation on our Violent
World” by Marjorie Agosin
Essays:
· “On Beauty and the Obligation to Care: Commentary”
by Nisha Sajnani
· “Relationships: The Lighthouses of Our Generation:
Reflections on the Manifestos” by Hanna Solomon and
Chris Mollica
RICHARD F. MOLLICA, MD, MAR is Director of the Harvard
Program in Refugee Trauma affiliated with the Massachusetts
General Hospital and Professor of Psychiatry at Harvard Medi-
cal School. He has been treating trauma in situ for more than 30
years, from the killing fields of Cambodia to the civil war in Sudan
and from the 9/11 destruction of the World Trade Center in New
York to the Kobe earthquake in Japan. He is the recipient of many
awards and honors, including the APA’s Human Rights Award
(1993) and Doctor of Humane Letters, Honoris Causa, conferred
by William James College (2011).
This beautifully crafted volume, published in 2018, announces
a manifesto for healing a violent world. It is in fact, not one but
three manifestos – “Healing a Violent World,” “Healing the Healer,”
and “Healing Power of Justice.” Each one is followed by a poem by
Marjorie Agosin, ably translated from the Spanish by
Celeste Kostopulos-Cooperman. The heart of the matter is
these three manifestos which create a humanistic tapestry,
compassionately stated, and deeply informed by the science and
art of psychiatric medicine, while the tapestry is embroidered with
original artwork by Nisha Sajnani and framed by the richly allusive
poetry of Marjorie Agosin with a lovely Afterword in which she
declares that:
“Throughout history, the poet has been able to illustrate the
indescribable and has been able to illuminate the malignancy
of our time, weaving metaphors and images with the enchant-
ment of lyricism.” (p. 44)
Mollica touches on the themes that have animated his career: the
trauma story and the wounded healer which were the core of his
previous volumes, Healing Invisible Wounds (2006) and Textbook of
Global Mental Health: Trauma and Recovery (2012). Each manifesto
is rich and nuanced and carries a core message. “Manifesto I” rec-
ognizes the trauma around us and the need to heal a violent world.
Key notions include the trauma story, the wounded healer, and the
need for personal healing or self-care. This Manifesto’s most stirring
phrase in my reading is: “Except in beauty, there is no healing. Beauty
is the salve and ointment that creates our healing space and healing
relationships.” (P.5). “Manifesto II” asserts hope to deal with the enor-
mity of the world’s crises. The key words here are hope and empathy,
along with gratitude to the wounded healer. It’s deepest affirmation
is this: “Empathy is a biological miracle uniting all living creatures
and the planet earth itself.” (P. 14). Manifesto III embraces the healing
power of justice. The key here is the foundation of justice in beauty:
“Justice is beautiful as it creates harmony and symmetry in the world
that resonates with all animals, plants, and people. Injustice is ugly
…” (P. 28). The accompanying essays enrich Mollica’s core message of
beauty and caring for others in the healing context of relationships.
This is a volume to read slowly, aloud if possible, inspired as it is
by poetry and sacred texts; a volume that instructs as it heals; a
volume to cherish. It sums up the masterful life and career of a
healer, synthesizing the compassionate mission of psychiatric med-
icine with a paean to justice and beauty. It should not surprise that
Mollica has a Master’s degree in Religious Arts from Yale. With its
humanistic message and call for healing, Mollica’s Manifesto joins
the corpus of devotional literature resonant with Teresa d’Ávila’s
The Interior Castle and Ignatius Loyola’s Spiritual Exercises.
REFERENCES
1. Mollica, Richard F. (2006). Healing Invisible Wounds: Paths to
Hope and Recovery in a Violent World, 1st Edition. Nashville,
TN: Vanderbilt University Press. Available in hardcover,
softcover and Kindle editions; translated into Italian
and Khmer.
2. Mollica, Richard F. (2012). Textbook of Global Mental Health:
Trauma and Recovery, A Companion Guide for Field and
Clinical Care of Traumatized People Worldwide. Cambridge,
MA: Harvard Program in Refugee Trauma.
BOOK REVIEW
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20207
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 8
ASIA/PACIFIC
The sudden pandemic began to spread in China and
the world at the beginning of the year. In the face of such
a new type of infectious disease, pathogens, sources of
infection, transmission routes, susceptible people are not
fully recognized, and the anxiety and psychological crisis
caused by the uncertainty of the disease to different people
are incalculable. Therefore, psychological crisis intervention
has become an indispensable content during the diagnosis,
treatment and prevention of COVID-19.
In order to reduce the psychological injury caused by the
COVID-19 pandemic, China initiated psychological crisis
intervention. On January 27, National Health Commission
issued the Guiding Principles of Emergency Psychological
Crisis Intervention for COVID-19, which requires that
psychological crisis intervention be integrated into the overall
deployment of pandemic prevention and control.
First of all, the guiding principle of psychological crisis
intervention for high-risk groups is to divide the COVID-19
pandemic population into four levels, and require that the
focus of intervention should start from the first level of
population, gradually expand.
Secondly, the guiding principles for the establishment
of psychological rescue medical teams and aid hotline teams
put forward that all units must ensure professionalism in the
formation of these two teams, and require the personnel of
psychological rescue medical teams to be mainly psychiatrists.
Clinical psychological staff and psychiatric nurses can
participate. Psychological assistance hotline team is mainly
mental health workers trained by psychological hotline and
volunteers with experience in psychological crisis intervention
in public emergencies.
Third, the guiding principles of providing the necessary
financial guarantee in various localities require that the
psychological crisis intervention work be led by the joint
prevention and control mechanism of the provinces,
autonomous regions and municipalities directly under the
Central Government in response to the COVID-19 situation,
and provide the necessary organizational and financial support.
Commendably, after a series of major disasters, such as
the Wenchuan earthquake, SARS, and so on, mature state
behavior during COVID-19 pandemic promoted psychological
crisis intervention to the national level of prevention and
control, integrated into clinical diagnosis and treatment,
community prevention, crowd intervention strategies. In
the face of disasters, psychological crisis intervention and all
disease prevention and control measures at the same time,
for the global prevention and control of COVID-19 to make a
Chinese example.
Therefore, in the future, the psychological crisis
intervention followed will continue to play an irreplaceable
role in actively preventing, controlling and mitigating the
psychological and social effects of disasters, promoting the
reconstruction of post-disaster mental health, maintaining
social stability and ensuring the mental health of the public.
COVID-19: A Review of
Psychological Crisis
Intervention in China
REFERENCES
National Health Commission of PRC, the Guiding Principles
of Emergency Psychological Crisis Intervention for
COVID-19, 2020, January 27
HUANG Yueqin. Self-relieving for anxiety symptom during
the COVID-19 epidemic Chinse Mental Health Journal,
2020,(3): 275-277
Prof. Yueqin Huang, MD, MPH, PhD
Institute of Mental Health, Peking University
Beijing, China
Yueqin Huang
ASIA/PACIFIC
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20209
The UN International Day Against Drug Abuse and Illicit
Trafficking was observed at the Dept of Psychiatry, Pushpagiri,
Thiruvalla, India on 26 June 2020 in association with Indian
Medical Association and National Alliance for Mental Health. The
theme this year ,  “Better Knowledge for Better Care” emphasizes
the need to improve the understanding of the world drug problem
and how in turn, better knowledge will foster greater international
cooperation for countering its impact on health, governance and
security.
Dr Abraham Varghese, Kerala state president, IMA
inaugurated the meeting online. Dr Roy Abraham Kallivayalil,
Secretary General WPA delivered the keynote address and said
drug abuse is affecting even the adolescent and young population.
It can lead to organised crime corruption and mental and
emotional problems. Hence collaborative action by all stakeholders
is necessary for peace and sustainable well-being of society.
Effects of covid-19 on drug markets: The biggest immediate
impact on drug trafficking can be expected in countries where
large quantities are smuggled on commercial airliner flights. In
the longer run, the economic downturn and associated lockdowns
have the potential to disrupt drug markets. Rising unemployment
and lack of opportunities will make it more likely that poor and
disadvantaged people engage in harmful patterns of drug use,
suffer drug use disorders and turn to illicit activities linked to
drugs – either production or transport. Dr Felix Jones, Professor
of community medicine was honoured on the occasion. Large
number of delegates participated online.
COVID-19 taking its toll on mental health: The world at
large are faced with a major health crisis following the outbreak
of COVID-19. News of deaths, social alienation, fear,
and the resultant psychological trauma are indicative of mental
health problems such as post-traumatic stress disorder, depression,
and suicide, said Roy Abraham Kallivayalil, Secretary General
of World Psychiatric Association (WPA). Talking to The Hindu
(one of India’s most prestigious newspapers) Dr. Kallivayalil
said the most common emotion by all was fear that makes
people anxious, scared, and do things what society considers
abnormal and inappropriate. He says COVID-19 has serious
consequences on both physical and mental health of people. It is
evident that the pandemic, besides leading to severe morbidity
and mortality, has serious emotional, social and economic
consequences which could worsen further at a later stage.
Preventable: Depression, anxiety disorders, stress reactions,
suicides, adjustment disorders, alcohol and substance abuse, and
acute psychotic disorders
are various post-Covid
mental problems reported
from many affected
countries. However,
most of these mental
disorders are preventable.
The challenges posed
by the pandemic are severe
as it affects the physical
and mental health of
people, their finances and
social life. Worries about
an uncertain future and
loss of employment are
only some aspects that
impact the mental well-
being, ultimately leading to an unprecedented post-Covid suicide rate.
Evidence-based methods: Suicides can be prevented by using
evidence-based methods. People with mental disorders may be
at a higher risk for COVID-19 due to their social disadvantages
such as poor nutrition, overcrowding, stigma, poverty or their
inability to follow the public health protective advices like hand
hygiene, physical distancing, self-isolation etc. Though home
quarantine decreases viral transmission, it also increases the risks
of excessive alcohol use, family violence, and suicidality. Education
on the pandemic safety measures should be provided by authorities
and reinforced by psychiatrists.
Rights protection: Human rights of individuals with mental
disorders must be protected and appropriate and safe services
may be provided for their treatment. The negative impact
of the pandemic on government budgets should not be used as an
excuse to reduce essential services for people with mental illness
during or after the pandemic.
REFERENCES
1. World Drug Report 2020. UNODC. https://wdr.unodc.
org/wdr2020/en/exsum.html
2. COVID-19 taking its toll on mental health https://www.
thehindu.com/news/national/kerala/covid-19-taking-its-
toll-on-mental-health/article32154987.ece
3. Psychiatry and the COVID-19 Pandemic. WPA Position
Statement. May 2020.
Roy Abraham Kallivayalil
Roy Abraham Kallivayalil, M.D.
Professor and Head,Department of Psychiatry
Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala- 689101, India
Secretary General, World Psychiatric Association (2014-2020)
President, World Association of Social Psychiatry (2016-2019)
August 3, 2020.
Photo Caption: Prof Roy Abraham Kallivayalil (Secretary
General, WPA) delivers Keynote Address at the UN
International Day Against Drug Abuse and Illicit Trafficking
Webinar at Tiruvalla, India on 26 June 2020. Also seen in
the photo are Dr Soumya P Thomas, Prof Felix Johns and
Dr Liza Varghese.
Covid-19: FightAgainst Drug Abuse
and for Mental Health in
South Asia
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 10
EUROPE
PANDEMICS – HAVE ANY LESSONS
BEEN LEARNED?
The current COVID 19 pandemic has shaken the fabric of
society in medical and non medical fields. Despite the fear of
a possible second wave cautious optimism has emerged in a
number of countries.
A key lesson that is emerging is the need for academics,
policy makers, citizens and those who commission services to
collaborate effectively if we are to see the end of the current
pandemic cycle.1
One of my greatest concerns is that in a few years time we
will go back to square one and forget all the lessons learned.
Allowing this to happen will be a big mistake.
Although the risk of pandemics has increased successive
governments do not incorporate the learning going forward.
In 2016, at a high level conference on global health security,
President François Hollande of France highlighted the need for
collective solidarity in order to tackle crisis with the need for:
1. An improved global mechanism for surveillance, alert,
diagnostics and plans for crisis response.
2. The management of crises by reinforcing the role of
civil society, local experts, and affected populations
3. Supporting research in life, human, and social services
4. The application of International Health Regulations
with a strong and transparent global governance2
If we had applied these four principles globally would the
pandemic have been so deadly? Probably not.
During this meeting President François Hollande also
noted that eradicating poverty should be a global priority and
suggested setting a target for this to happen by 2030. Poverty
and health crises are major threats to peace and security
worldwide and we need to advocate for our governments to do
something about this.
The COVID 19 pandemic as increased poverty, resulted in
increased homelessness and global insecurity. It has shown that
no nation was adequately prepare despite previous warnings
from scientists and opinion leaders.
A pandemic respects no country and has no boundaries.3
We all need to work together, whether we are low, medium or
high income countries and global health professionals need
to do more to share their expertise and support each other in
transcontinental research. The training of health professional
needs to change to include the challenges resulting from global
health crises and food security. We need to promote good
governance and tackle corruption and misinformation at every
level and encourage our professional colleges to work together
supported by formal partnership arrangements that can enable
this to happen.
REFERENCES
1. Rutter H, Horton R, Marteau TM. The Lancet-Chatham
House Commission on improving population health post
COVID-19 (2020) .
2. Hollande F. (2016). Towards a global agenda on health securi-
ty. http://dx.doi.org/10.1016/S0140-6736916)30393-2
3. Morse SS (ed) 1993) Emerging Viruses. New York: Oxford
University Press
Prof. Gabriel Ivbijaro MBE, JP
MBBS, MMedSci, MA, PhD, FRCGP, FWACPsych, IDFAPA 
Medical Director The Wood Street Medical Centre, London, UK
Professor, NOVA University, Lisbon Portugal 
Honorary Visiting Fellow, Faculty of Management, Law and Social Sciences,
University of Bradford UK 
President, The World Dignity Project 
Gabriel Ivbijaro
© GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 202011
Stay well and
Be Safe
Stay well and
Be Safe
SAVE THE DATE!
Mark your calendars for these upcoming events:
WED. - SAT.
SEP. 16, 2020
Washington Psychiatric Society (WPS)
STRUCTURAL RACISM AND THE PRACTICING
PSYCHIATRIST: WHAT TO RECOGNIZE,
WHAT TO CHANGE
SEP. 16, 2020 Location: via ZOOM, 7 pm - 8:15 pm
WED. - SAT.
DEC. 11 - 13, 2020
World Psychiatric Association (WPA)
PSYCHOLOGICAL TRAUMA: GLOBAL BURDEN
ON MENTAL AND PHYSICAL HEALTH
DEC. 11 - 13, 2020 Location: Athens, Greece
WED. - SAT.
MAR. 10 - 13, 2021
World Psychiatric Association (WPA)
CONGRESS OF PSYCHIATRY
MAR. 10 - 13, 2021 Location: Bangkok, Thailand

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COVID-19 Focus of Global Mental Health & Psychiatry Review

  • 1. Eliot Sorel, MD Founding Editor-in-Chief Editorial Board MansoorMalik,MDMBA Senior Editor GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020 ZONAL EDITORS: AFRICA: Prof. David M. Ndetei, Kenya Prof Bonginkosi Chiliza, South Africa Victoria Mutiso, PhD, Kenya ASIA/PACIFIC: Prof. Yueqin Huang, China Prof. Roy Kallivayalil, India THE AMERICAS: Prof. Fernando Lolas, Chile Prof. Vincenzo Di Nicola, Canada EUROPE: Prof. Gabriel Ivbijaro, United Kingdom Dr. Mariana Pinto da Costa, Portugal ASSOCIATE EDITORS: Miguel Alampay, MD John Chaves, MD Kyle Gray, MD, MA Madeline Teisberg, DO, MS G M H P REVIEW
  • 2. Eliot Sorel, MD Founding Editor-in-Chief MansoorMalik,MDMBA Senior Editor GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020 Volume 1, No. 3 Autumn 2020 Eliot Sorel, MD, Founding Editor-in-Chief ZONAL EDITORS: AFRICA: Prof. David M. Ndetei, Kenya Prof Bonginkosi Chiliza, South Africa Victoria Mutiso, PhD, Kenya ASIA/PACIFIC: Prof. Yueqin Huang, China Prof. Roy Kallivayalil, India THE AMERICAS: Prof. Fernando Lolas, Chile Prof. Vincenzo Di Nicola, Canada EUROPE: Prof. Gabriel Ivbijaro, United Kingdom Dr. Mariana Pinto da Costa, Portugal ASSOCIATE EDITORS: Miguel Alampay, MD John Chaves, MD Kyle Gray, MD, MA Madeline Teisberg, DO, MS Dear Colleagues and Friends, Welcome to the Autumn 2020 issue of Global Mental Health & Psychiatry Review…! We are very pleased to welcome cordially to our Review’s Editorial Board two new Africa Zon- al Editors, Professor Bonginkosi Chilliza of South Africa and Victoria Mutiso, PhD of Kenya, enhancing the quality, depth, and diversity of our team. We are also delighted to start a Book Review Section led by Professor Vincenzo Di Nicola, one of our Zonal Editors. As CVD-19 erupted in Wuhan, China in the autumn of 2019 and quickly engulfed the world, infecting more than 26 million people, nearly 19 million have recovered and causing nearly 900,000deathsasofSeptember4th,withnopandemicendinsight,wehavedecidedtodedicate this consecutive GMHPR issue to a CVD-19 focus and its primary care, mental health, and public health consequences: a populations’ TOTAL Health focus. We commend Madame Ursula van der LEYEN, European Commission President, and Doctor Victor DZAU, the President of the United Stated National Academy of Medicine, for their su- perb leadership. A high-level Vaccine Development Funding meeting, led by Mme. LEYDEN and Dr. DZAU in June of this year focused on a rapid CVD-19 vaccine development, received a € 16 B pledge from those attending. As with any vaccine for populations’ health, public trust is essential for a successful vaccination campaign launch and sustaining it to its effective completion. Public health depends on public trust. . Toachievepublictrust,requiresaclear,concise,consistent,transparent,andreliablesetofcom- munications among the public, the scientific community, and policy makers in anticipation, prior and during the vaccination campaign, nationally and globally. The successful implementation of a safe, effective, and reliable CVD-19 vaccine buttressed by public trust, will have a catalytic impact; restoring populations’ health and stimulating a global economic recovery. Stay well, Be safe…! Eliot SOREL MD G M H P REVIEW COVID-19
  • 3. TABLE OF CONTENTS The Global Mental Health and Psychiatry Review (GMHPR) is a multidisciplinary publication serving the Global Mental Health Community. It welcomes scholarly contributions that focus on research, health systems and services, professional education and training, health policy, and advocacy. It is published three times a year in January, May, and September of each year. GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW: Introduction ..............................................................................................................1 Eliot Sorel, MD, Founding Editor-in-Chief AFRICA ZONE: COVID-19 and Mental Health Consequences in Kenya ..........................................................................................3 Prof. David M. Ndetei, Dr. Frida Kamati, Dr. Victoria Mutiso and Christine Musyimi COVID-19 and Mental Health Consequences in South Africa ..............................................................................4 Prof. Bonginkosi Chiliza, MD, PhD the AMERICAS ZONE: Syndemics And Suffering: The Goals Of Medicine Revisited ......................................................................................5 Prof. Fernando Lolas Inauguration of a New Section: BOOK REVIEW A Manifesto: Healing a Violent World.......................................................................6 Prof. Vincenzo Di Nicola ASIA/PACIFIC ZONE: COVID-19: A Review of Psychological Crisis Intervention in China .........................................................8 Prof. Yueqin Huang, MD, MPH, PhD Covid-19: Fight Against Drug Abuse and for Mental Health in South Asia.....................................................................................................................9 Prof. Roy Abraham Kallivayalil, MD EUROPE ZONE: Pandemics – Have Any Lessons Been Learned? .............................................10 Prof. Gabriel Ivbijaro, MBE, JP Eliot Sorel, MD, Founding Editor-in-Chief GlobalMentalHealth&PsychiatryReview,Vol.1No.3,Autumn2020 G M H P REVIEW
  • 4. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20203 AFRICA COVID-19and Mental Health Consequencesin Kenya Prof. David M. Ndetei, DSc1,2 Frida Kamati, PhD2 Victoria Mutiso, PhD2 Christine Musyimi, PhD2 1 University of Nairobi 2 Africa Mental Health Research and Training Foundation, Kenya David M. Ndetei Victoria Mutiso On March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. Coronavirus disease is a communicable respiratory disease which is caused by a new strain of coronavirus that causes illness in humans. While scientists are still learning about COVID-19, they have determined that it is spread from person to person through infected air droplets, direct physical contact or contact with services that contain the virus then touching the face with the contaminated hands[1]. The Coronavirus disease (COVID-19) has hit the globe with unprecedented psychosocial needs and challenges that touch on every aspect of life and life cycle which have led to ramifications on mental health of the people affected[2]. While the focus has been on physical symptoms and primarily respiratory with acute respiratory distress syndrome leading to death in the most severe cases, there has been little focus on how the pandemic has affected many people’s mental health. Kenya has not been spared from the virus which began in Wuhan city in China. The country has seen 13,353 infections, 5,122 recoveries and 234 COVID-19 related deaths as of July 19th, 2020. In terms of age, the youngest infected is a seven old month infant and the oldest being an 86 year old [3]. The Kenya ministry of health (MOH) at the beginning of July reported that 186 health care workers had tested positive for coronavirus and on the same month, the country lost its first Kenyan doctor to COVID-19. Healthcare professionals who have been at the forefront of the COVID-19 pandemic are likely to suffer from poor mental health due to burnout, increased anxiety and other mental health conditions especially for those with preexisting conditions. COVID-19 associated deaths among healthcare workers worldwide have been due to inadequate protective equipment, diagnostic tests, drugs and increased workload due to the rising COVID-19 cases[4]. Several studies have shown that most health care workers have high levels of anxiety and depressions as majority are afraid of getting infected and infecting their families. Kenya has seen a new wave of COVID-19 stigma that is similar to the AIDS associated stigma. Discharged patients have reported being shunned by their own family members and neighbors. Individuals who have tested positive and have been placed under quarantine in their own homes due to inadequate isolation facilities have also reported experiencing stigma. It is clear that as the pandemic continues to ravage the country and more people test positive from the coronavirus, we are likely to see an increase in the mental health burden as the government continues to implement physical distancing, curfews, school closures which is affecting the economy. All these public health measures are integral in reducing the spread of the infection and preventing loss of life due to coronavirus but they are also likely to cause poor mental health outcomes like joblessness, anxiety and depression due to isolation. The pandemic will likely have short and long term impact on mental health meaning the need for mental health services will escalate. REFERENCES 1. World Health Organisation ‘Rolling updates on Coronavirus Disease (COVID-19) <https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/events-as-they-happen> (accessed 6 April 2020) 2. Fu L. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analy- sis. J. Infect. 2020 doi: 10.1016/j.jinf.2020.03.041. 3. National Emergency Response Committee on Coronavi- rus; Update of Coronavirus in the Country and Response Measures, As At 19th July, 2020 Brief No. 121 assessed 19th July,2020 4. Maunder R, J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003; 168(10): 1245-1251. Pub- MedGoogleScholar
  • 5. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 4 AFRICA COVID-19and Mental Health Consequencesin SouthAfrica Prof. Bonginkosi Chiliza, MD, PhD Nelson R Mandela School of Clinical Medicine University of KwaZulu-Natal Bonginkosi Chiliza The first case of COVID-19 in South Africa was confirmed at the beginning of March 2020. The government’s response was to institute a nationwide “hard lockdown” before the end of the month (Abdool Karim, 2020). South Africa instituted severe restrictions in order to prepare the health system for the expected onslaught of cases with COVID-19 infections. The government has been lauded for their early robust response to the pandemic; however, the severe restrictions could not be sustained as the deleterious socio-economic consequences became quickly evident. South Africa has one of the lowest COVID-19 mortality rates in the world due, perhaps, to our relatively young population age and the response to the pandemic. The mental health response has focused on planning and the rapid generation of policy and protocols. We have comprehensive guidance on mental health interventions that should be implemented during the COVID-19 disaster. However, the effects of the pandemic and the subsequent lockdown had significant negative impact on many mental health care users. Many users with severe mental illnesses became too afraid to utilise our services. Some were impatient with the new regulations for COVID-19 screening, resulting in a number of users defaulting on treatments with subsequent increases in relapses in the last few months. We have also seen some ethical challenges where the triage policies for access to limited resources have excluded people with severe mental illnesses. The COVID-19 pandemic and the measures put in place have led to increased rates of loneliness, fear, anxiety and depression. Two rapid general population surveys that have been published point to rising levels of distress and increased utilisation of services. One of our philosophy, so-called UBUNTU, states that, “I am, because we are.” Therefore, the very idea of being human is being connected to other human beings. The necessary social distancing in a country that has low levels of smart phone technology penetration has led to calls to ramp up larger psychosocial responses in order to prevent mental illnesses and promote resilience and mental wellbeing. The pandemic has also put a spotlight on the ‘humaneness’ of doctors and nurses on the frontlines. The multitude of posts on social media prompted the South African Society of Psychiatrists to come together with other organisations to form a HealthCare Workers Care Network. The network offers seminars and workshops to health care leaders in an effort to improve the work place in order to promote mental wellbeing of all front line workers. The network also offers free psychological first aid, by volunteer psychiatrists and psychologists, to any worker in the front lines. Lastly the monthly webinars organised by the Africa Global Mental Health Institute (AGMHI) have answered the call of many psychiatrists in our country for urgent information on how to deal with the mental health outcomes of the pandemic. The AGMHI is currently fulfilling its vision of equipping mental health professionals in Africa and the diaspora with the tools and agency to effectively care for those suffering from mental illness, by organising the most amazing dialogues. The webinars have ranged from dealing with mental health issues in resource- constrained settings to racism and mental health in the context of the Black Lives Matter at the end of July 2020. REFERENCES 1. Abdool Karim SS. The South African Response to the Pan- demic. N Engl J Med. 2020 Jun 11;382(24):e95. doi: 10.1056/ NEJMc2014960 2. Grillo A, Ghebrehiwet S, Johnson K, Borba CPC, Fricchione GL, Sorel E, Durham M, Chiliza B, Motlana M, Henderson DC. The African Global Mental Health Institute: Increasing capacity, inclusivity and translation of psychiatric research and care. The Journal of Global Health, Oct 2019
  • 6. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20205 the AMERICAS Fernando Lolas SYNDEMICS and SUFFERING: THE GOALS OF MEDICINE REVISITED Many years ago, I was invited to participate in a groundbreaking project headed by the eminent bioethicist Daniel Callahan. The aim was to reflect upon the goals of medicine (1). Under the current situation, with a generalized challenge to healthcare systems all over the world, the questions posed by that initiative, and the answers provided by a group of scholars, renew the notions then discussed. We do not need to stress the fact the syndemics (the complex network and contexts of distress triggered by the viral pandemics) place a heavy burden on peoples and institutions. Not only the consequences of infection and its effects on personal wellbeing are devastating. Disrupted social life and economic recession impacting on the wellbeing of communities and individuals bring to light structural inequalities and unfair conditions. The institution of medicine, as a complex socio-technical system, is requested to provide answers to the problems identified by experts. Successes and failures are evaluated by the number of contagions, the seriousness of clinical pictures, the number of deaths, and the availability of therapies or vaccines. From an ethical point of view, issues such as autonomy and dignity of persons, access to proper care, just distribution of resources, priority-setting under social demands, confrontation with death, besides political leadership and sound policymaking, have come to the foreground. Traditional bioethical thinking ends up reminding practitioners of the principles that make the practice acceptable, proposing guidelines and written statements, and resorting to the ideal of the informed, decent citizen endowed with the capacity to understand directives, trust experts, and behave properly. A neglected topic that the coronavirus emergency brings to light is the limit of expertise. In addition to framing the problem as a scientific challenge, and emphasizing the enlightened response of the biomedical and epidemiological establishments, the professions (and not only the medical one) need to respond to human suffering. This is what I call the “pathic” dimension: feeling a certain way or having a certain condition that induces fear, despair, and helplessness. My impression is that we all too often tend to convert the pathic into the pathological. This is how the helping professions reframe the enigma of not feeling at ease into a dis-ease. It is no wonder that professionals, each in his/her area of expertise, identify and label the “main problem” or the dilemmas. Thus, for economists, the challenge is how to maintain economic activity. For lawyers and human rights activists, how to implement measures safeguarding human rights. For ecologists, how to preserve biospheric balances. For scientists, how to translate their findings into proper practice. For politicians, how to acquire and maintain leadership in times of turmoil. Last, but not least, for healthcare workers how to respond to the needs of persons and communities. In this multifarious scenario, human suffering, the pathic dimension of human life, needs to be addressed. Questions like “why me” or “us”? “why now”? “why in this way”?, the classical triad of the anthropological medicine of the Heidelberg School (von Weizsäcker, Christian) belong to classical philosophical questions that ultimately reduce to the vague feeling that evil is part, wish it or not, of the human existence. And human life is valuable not only for having problems but for how persons and cultures conceptualize suffering and respond to it. Acknowledging the fact that these are not “technical” matters requiring “non-technical solutions”, it is perhaps time to consider that, despite this, someone has to tackle the issue. Is, for instance, a duty of mental health professionals to address discomfort, stress, fear, and suffering, as “real” problems before our diagnostic systems have adequate labels to handle them? What kind of public counseling, advice, or advocacy, do we need to anticípate the next phase of the pandemic, which will certainly not be a strictly medical challenge but a complex mixture of social derangement, economic crisis, political unrest? It seems to me that the time-valued question on the goals of medicine, that pioneer Hastings Center Project, needs reconsideration. And – perhaps- the global stance taken by this publication might be a seminal viewpoint to rethink goals, perspectives, and language. Prof. Fernando Lolas, MD, IDFAPA 1 ________________ 1 Professor of Psychiatry and Director, Interdisciplinary Center for Studies in Bioethics, University of Chile. Professor, Central University of Chile. International Distinguished Fellow, American Psychiatric Association. REFERENCES 1. Lolas, F. On the goals of medicine: reflections and distinc- tions. In Hanson,MJ & Callahan, D. (editors) The Goals of Medicine.The forgotten issues in health care reform. George- town University Press, Washington DC, 1999. 2. Green, R.M. & Palpan, N.J. (editors) Suffering and Bioethics. Oxford University Press, Oxford-New York, 2014
  • 7. A Manifesto: Healing a Violent World G M H P REVIEW By Richard F. Mollica Tunbridge Wells, UK: Solis Press, 2018 © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 6 REVIEW Psychology CognitiveBehavioralTherapy ManagingAnxiety MentalConstructs TreatmentforAnxiety ResearchMethodsinPsychology ManagingDepression TheCriticalMind Anxiety&Depression ClinicalPsychopathology PsychiatryMorningReport NeuroscienceofPersonality
  • 8. Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA* Professor of Psychiatry, University of Montreal & The George Washington University President, Canadian Association of Social Psychiatry President-Elect, World Association of Social Psychiatry *Trained in the Harvard Program in Refugee Trauma (2008-09) A Manifesto: Healing a Violent World By Richard F. Mollica Tunbridge Wells, UK: Solis Press, 2018, pp. 56 Contents: “Preface” by Charles Figley Texts by Richard F. Mollica: · “Manifesto I: Healing a Violent World” · “Manifesto II: Healing the Healer” · “Manifesto III: Healing Power of Justice” Each Manifesto is followed by a poem by Marjorie Agosin (translated from the Spanish by Celeste Kostopu- los-Cooperman) “Moments of Revelation” by Richard F. Mollica “Afterword” and “Pearls of Observation on our Violent World” by Marjorie Agosin Essays: · “On Beauty and the Obligation to Care: Commentary” by Nisha Sajnani · “Relationships: The Lighthouses of Our Generation: Reflections on the Manifestos” by Hanna Solomon and Chris Mollica RICHARD F. MOLLICA, MD, MAR is Director of the Harvard Program in Refugee Trauma affiliated with the Massachusetts General Hospital and Professor of Psychiatry at Harvard Medi- cal School. He has been treating trauma in situ for more than 30 years, from the killing fields of Cambodia to the civil war in Sudan and from the 9/11 destruction of the World Trade Center in New York to the Kobe earthquake in Japan. He is the recipient of many awards and honors, including the APA’s Human Rights Award (1993) and Doctor of Humane Letters, Honoris Causa, conferred by William James College (2011). This beautifully crafted volume, published in 2018, announces a manifesto for healing a violent world. It is in fact, not one but three manifestos – “Healing a Violent World,” “Healing the Healer,” and “Healing Power of Justice.” Each one is followed by a poem by Marjorie Agosin, ably translated from the Spanish by Celeste Kostopulos-Cooperman. The heart of the matter is these three manifestos which create a humanistic tapestry, compassionately stated, and deeply informed by the science and art of psychiatric medicine, while the tapestry is embroidered with original artwork by Nisha Sajnani and framed by the richly allusive poetry of Marjorie Agosin with a lovely Afterword in which she declares that: “Throughout history, the poet has been able to illustrate the indescribable and has been able to illuminate the malignancy of our time, weaving metaphors and images with the enchant- ment of lyricism.” (p. 44) Mollica touches on the themes that have animated his career: the trauma story and the wounded healer which were the core of his previous volumes, Healing Invisible Wounds (2006) and Textbook of Global Mental Health: Trauma and Recovery (2012). Each manifesto is rich and nuanced and carries a core message. “Manifesto I” rec- ognizes the trauma around us and the need to heal a violent world. Key notions include the trauma story, the wounded healer, and the need for personal healing or self-care. This Manifesto’s most stirring phrase in my reading is: “Except in beauty, there is no healing. Beauty is the salve and ointment that creates our healing space and healing relationships.” (P.5). “Manifesto II” asserts hope to deal with the enor- mity of the world’s crises. The key words here are hope and empathy, along with gratitude to the wounded healer. It’s deepest affirmation is this: “Empathy is a biological miracle uniting all living creatures and the planet earth itself.” (P. 14). Manifesto III embraces the healing power of justice. The key here is the foundation of justice in beauty: “Justice is beautiful as it creates harmony and symmetry in the world that resonates with all animals, plants, and people. Injustice is ugly …” (P. 28). The accompanying essays enrich Mollica’s core message of beauty and caring for others in the healing context of relationships. This is a volume to read slowly, aloud if possible, inspired as it is by poetry and sacred texts; a volume that instructs as it heals; a volume to cherish. It sums up the masterful life and career of a healer, synthesizing the compassionate mission of psychiatric med- icine with a paean to justice and beauty. It should not surprise that Mollica has a Master’s degree in Religious Arts from Yale. With its humanistic message and call for healing, Mollica’s Manifesto joins the corpus of devotional literature resonant with Teresa d’Ávila’s The Interior Castle and Ignatius Loyola’s Spiritual Exercises. REFERENCES 1. Mollica, Richard F. (2006). Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World, 1st Edition. Nashville, TN: Vanderbilt University Press. Available in hardcover, softcover and Kindle editions; translated into Italian and Khmer. 2. Mollica, Richard F. (2012). Textbook of Global Mental Health: Trauma and Recovery, A Companion Guide for Field and Clinical Care of Traumatized People Worldwide. Cambridge, MA: Harvard Program in Refugee Trauma. BOOK REVIEW © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20207
  • 9. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 8 ASIA/PACIFIC The sudden pandemic began to spread in China and the world at the beginning of the year. In the face of such a new type of infectious disease, pathogens, sources of infection, transmission routes, susceptible people are not fully recognized, and the anxiety and psychological crisis caused by the uncertainty of the disease to different people are incalculable. Therefore, psychological crisis intervention has become an indispensable content during the diagnosis, treatment and prevention of COVID-19. In order to reduce the psychological injury caused by the COVID-19 pandemic, China initiated psychological crisis intervention. On January 27, National Health Commission issued the Guiding Principles of Emergency Psychological Crisis Intervention for COVID-19, which requires that psychological crisis intervention be integrated into the overall deployment of pandemic prevention and control. First of all, the guiding principle of psychological crisis intervention for high-risk groups is to divide the COVID-19 pandemic population into four levels, and require that the focus of intervention should start from the first level of population, gradually expand. Secondly, the guiding principles for the establishment of psychological rescue medical teams and aid hotline teams put forward that all units must ensure professionalism in the formation of these two teams, and require the personnel of psychological rescue medical teams to be mainly psychiatrists. Clinical psychological staff and psychiatric nurses can participate. Psychological assistance hotline team is mainly mental health workers trained by psychological hotline and volunteers with experience in psychological crisis intervention in public emergencies. Third, the guiding principles of providing the necessary financial guarantee in various localities require that the psychological crisis intervention work be led by the joint prevention and control mechanism of the provinces, autonomous regions and municipalities directly under the Central Government in response to the COVID-19 situation, and provide the necessary organizational and financial support. Commendably, after a series of major disasters, such as the Wenchuan earthquake, SARS, and so on, mature state behavior during COVID-19 pandemic promoted psychological crisis intervention to the national level of prevention and control, integrated into clinical diagnosis and treatment, community prevention, crowd intervention strategies. In the face of disasters, psychological crisis intervention and all disease prevention and control measures at the same time, for the global prevention and control of COVID-19 to make a Chinese example. Therefore, in the future, the psychological crisis intervention followed will continue to play an irreplaceable role in actively preventing, controlling and mitigating the psychological and social effects of disasters, promoting the reconstruction of post-disaster mental health, maintaining social stability and ensuring the mental health of the public. COVID-19: A Review of Psychological Crisis Intervention in China REFERENCES National Health Commission of PRC, the Guiding Principles of Emergency Psychological Crisis Intervention for COVID-19, 2020, January 27 HUANG Yueqin. Self-relieving for anxiety symptom during the COVID-19 epidemic Chinse Mental Health Journal, 2020,(3): 275-277 Prof. Yueqin Huang, MD, MPH, PhD Institute of Mental Health, Peking University Beijing, China Yueqin Huang
  • 10. ASIA/PACIFIC © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 20209 The UN International Day Against Drug Abuse and Illicit Trafficking was observed at the Dept of Psychiatry, Pushpagiri, Thiruvalla, India on 26 June 2020 in association with Indian Medical Association and National Alliance for Mental Health. The theme this year ,  “Better Knowledge for Better Care” emphasizes the need to improve the understanding of the world drug problem and how in turn, better knowledge will foster greater international cooperation for countering its impact on health, governance and security. Dr Abraham Varghese, Kerala state president, IMA inaugurated the meeting online. Dr Roy Abraham Kallivayalil, Secretary General WPA delivered the keynote address and said drug abuse is affecting even the adolescent and young population. It can lead to organised crime corruption and mental and emotional problems. Hence collaborative action by all stakeholders is necessary for peace and sustainable well-being of society. Effects of covid-19 on drug markets: The biggest immediate impact on drug trafficking can be expected in countries where large quantities are smuggled on commercial airliner flights. In the longer run, the economic downturn and associated lockdowns have the potential to disrupt drug markets. Rising unemployment and lack of opportunities will make it more likely that poor and disadvantaged people engage in harmful patterns of drug use, suffer drug use disorders and turn to illicit activities linked to drugs – either production or transport. Dr Felix Jones, Professor of community medicine was honoured on the occasion. Large number of delegates participated online. COVID-19 taking its toll on mental health: The world at large are faced with a major health crisis following the outbreak of COVID-19. News of deaths, social alienation, fear, and the resultant psychological trauma are indicative of mental health problems such as post-traumatic stress disorder, depression, and suicide, said Roy Abraham Kallivayalil, Secretary General of World Psychiatric Association (WPA). Talking to The Hindu (one of India’s most prestigious newspapers) Dr. Kallivayalil said the most common emotion by all was fear that makes people anxious, scared, and do things what society considers abnormal and inappropriate. He says COVID-19 has serious consequences on both physical and mental health of people. It is evident that the pandemic, besides leading to severe morbidity and mortality, has serious emotional, social and economic consequences which could worsen further at a later stage. Preventable: Depression, anxiety disorders, stress reactions, suicides, adjustment disorders, alcohol and substance abuse, and acute psychotic disorders are various post-Covid mental problems reported from many affected countries. However, most of these mental disorders are preventable. The challenges posed by the pandemic are severe as it affects the physical and mental health of people, their finances and social life. Worries about an uncertain future and loss of employment are only some aspects that impact the mental well- being, ultimately leading to an unprecedented post-Covid suicide rate. Evidence-based methods: Suicides can be prevented by using evidence-based methods. People with mental disorders may be at a higher risk for COVID-19 due to their social disadvantages such as poor nutrition, overcrowding, stigma, poverty or their inability to follow the public health protective advices like hand hygiene, physical distancing, self-isolation etc. Though home quarantine decreases viral transmission, it also increases the risks of excessive alcohol use, family violence, and suicidality. Education on the pandemic safety measures should be provided by authorities and reinforced by psychiatrists. Rights protection: Human rights of individuals with mental disorders must be protected and appropriate and safe services may be provided for their treatment. The negative impact of the pandemic on government budgets should not be used as an excuse to reduce essential services for people with mental illness during or after the pandemic. REFERENCES 1. World Drug Report 2020. UNODC. https://wdr.unodc. org/wdr2020/en/exsum.html 2. COVID-19 taking its toll on mental health https://www. thehindu.com/news/national/kerala/covid-19-taking-its- toll-on-mental-health/article32154987.ece 3. Psychiatry and the COVID-19 Pandemic. WPA Position Statement. May 2020. Roy Abraham Kallivayalil Roy Abraham Kallivayalil, M.D. Professor and Head,Department of Psychiatry Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala- 689101, India Secretary General, World Psychiatric Association (2014-2020) President, World Association of Social Psychiatry (2016-2019) August 3, 2020. Photo Caption: Prof Roy Abraham Kallivayalil (Secretary General, WPA) delivers Keynote Address at the UN International Day Against Drug Abuse and Illicit Trafficking Webinar at Tiruvalla, India on 26 June 2020. Also seen in the photo are Dr Soumya P Thomas, Prof Felix Johns and Dr Liza Varghese. Covid-19: FightAgainst Drug Abuse and for Mental Health in South Asia
  • 11. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 2020 10 EUROPE PANDEMICS – HAVE ANY LESSONS BEEN LEARNED? The current COVID 19 pandemic has shaken the fabric of society in medical and non medical fields. Despite the fear of a possible second wave cautious optimism has emerged in a number of countries. A key lesson that is emerging is the need for academics, policy makers, citizens and those who commission services to collaborate effectively if we are to see the end of the current pandemic cycle.1 One of my greatest concerns is that in a few years time we will go back to square one and forget all the lessons learned. Allowing this to happen will be a big mistake. Although the risk of pandemics has increased successive governments do not incorporate the learning going forward. In 2016, at a high level conference on global health security, President François Hollande of France highlighted the need for collective solidarity in order to tackle crisis with the need for: 1. An improved global mechanism for surveillance, alert, diagnostics and plans for crisis response. 2. The management of crises by reinforcing the role of civil society, local experts, and affected populations 3. Supporting research in life, human, and social services 4. The application of International Health Regulations with a strong and transparent global governance2 If we had applied these four principles globally would the pandemic have been so deadly? Probably not. During this meeting President François Hollande also noted that eradicating poverty should be a global priority and suggested setting a target for this to happen by 2030. Poverty and health crises are major threats to peace and security worldwide and we need to advocate for our governments to do something about this. The COVID 19 pandemic as increased poverty, resulted in increased homelessness and global insecurity. It has shown that no nation was adequately prepare despite previous warnings from scientists and opinion leaders. A pandemic respects no country and has no boundaries.3 We all need to work together, whether we are low, medium or high income countries and global health professionals need to do more to share their expertise and support each other in transcontinental research. The training of health professional needs to change to include the challenges resulting from global health crises and food security. We need to promote good governance and tackle corruption and misinformation at every level and encourage our professional colleges to work together supported by formal partnership arrangements that can enable this to happen. REFERENCES 1. Rutter H, Horton R, Marteau TM. The Lancet-Chatham House Commission on improving population health post COVID-19 (2020) . 2. Hollande F. (2016). Towards a global agenda on health securi- ty. http://dx.doi.org/10.1016/S0140-6736916)30393-2 3. Morse SS (ed) 1993) Emerging Viruses. New York: Oxford University Press Prof. Gabriel Ivbijaro MBE, JP MBBS, MMedSci, MA, PhD, FRCGP, FWACPsych, IDFAPA  Medical Director The Wood Street Medical Centre, London, UK Professor, NOVA University, Lisbon Portugal  Honorary Visiting Fellow, Faculty of Management, Law and Social Sciences, University of Bradford UK  President, The World Dignity Project  Gabriel Ivbijaro
  • 12. © GLOBAL MENTAL HEALTH & PSYCHIATRY REVIEW, Vol. 1 No. 3, Autumn 202011 Stay well and Be Safe Stay well and Be Safe SAVE THE DATE! Mark your calendars for these upcoming events: WED. - SAT. SEP. 16, 2020 Washington Psychiatric Society (WPS) STRUCTURAL RACISM AND THE PRACTICING PSYCHIATRIST: WHAT TO RECOGNIZE, WHAT TO CHANGE SEP. 16, 2020 Location: via ZOOM, 7 pm - 8:15 pm WED. - SAT. DEC. 11 - 13, 2020 World Psychiatric Association (WPA) PSYCHOLOGICAL TRAUMA: GLOBAL BURDEN ON MENTAL AND PHYSICAL HEALTH DEC. 11 - 13, 2020 Location: Athens, Greece WED. - SAT. MAR. 10 - 13, 2021 World Psychiatric Association (WPA) CONGRESS OF PSYCHIATRY MAR. 10 - 13, 2021 Location: Bangkok, Thailand