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

1. 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

2. 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.

3. 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

4. ...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...

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

6. 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

7. Turkey.... This country Coming from full gallop from far east Asia Stretching to Mediterrenean ... is ours... N. Hikmet Who are we? Asians, Middle Easterns, Mediterreneans, Europeans (South or East).... May be all!

8. 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

9. 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

10. 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 FEMALE strongly co-morbid with primary anxiety disorders *Kessler et al., 1998

11. Prevalence of Psychiatric Disorders: High!

12. Use of Mental Health Services: Low!

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Scientific Sections of the PAT 52 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

22. 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

23. 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”

24. 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

25. Mental Health Policy and National Mental Health Program According to WHO Atlas we seem to have those Do not believe that!

26. 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.

27. Ethical Codesfor 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

28. 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

29. 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

30. 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.

31. 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

32. 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

33. 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…..

34. What to be done? • The implementation of a national mental health programme is a priority • Active participation for the planning and implementation

35. What to be done? More… • Adjustment to the WHO Mental Health Action Plan • Facing the challenges • Building the solutions • Promoting Young People’s Health!

36. The bridge between Asia and Europe... To face the challenges and build the solutions we need to use the cultural heritage of both continents!