
Upstate psychiatrist to head global psychiatric society
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.
Dr. Thomas Schulze is the president-elect of the World Psychiatric Association, which is a global group representing 147 psychiatric societies in 123 countries.
Dr. Schulze is a professor of psychiatry and behavioral sciences at Upstate, and he agreed to talk about the association and his upcoming role.
Welcome back to "The Informed Patient," Dr. Schulze.
Thomas Schulze, MD: Well, thanks very much. Thanks for having me. It's a pleasure and an honor.
Host Amber Smith: Please tell us about the World Psychiatric Association. When and why did it begin?
Thomas Schulze, MD: Well, the World Psychiatric Association has been around for over 60 years now. It is the global umbrella organization, as I may say, for national psychiatric associations.
So what does it mean in national psychiatric associations? In America, you have the American Psychiatric Association. So I'm here in America, and in Germany, we have the German Psychiatric Association, and so, many countries have their psychiatric association or several basically professional organizations representing the psychiatrists in that country, in that region.
And at one point, several of these associations thought, well, it would be a good idea to join forces and to have an international body representing our core values, our core ideas and our core mission. And that's how the World Psychiatric Association came into existence, and now, as you pointed out, there are 147 member societies and, like, 120 countries or something like this; the numbers always change because we get new members.
So it's the umbrella organization trying to advance psychiatry. That's the mission: Advance psychiatry all over the world, advance mental health all over the world, and help the local societies also fulfill their mission. So when you have a bigger group behind you, you have, of course, more power and more clout to maybe advance your goals or to convince policy makers, stakeholders in your respective country or region. And very often we actually do have these, we have requests from national societies to support them in their missions or in their dealings with government or other stakeholders that are important for mental health.
So then we will help our societies, we will support them, and by doing this, we can advance the mission that we have.
Speaker: So how do you communicate when you have members from so many different countries speaking different languages?
Thomas Schulze, MD: Well, first of all, we are all connected. We have various bodies, so we have the member societies, then we have regions, we have zonal representatives. So the world is divided up into regions, and these zonal representatives have close contact with representatives of these national societies. So if we want to get the word out, first of all, of course, there is email communication. But we will also go directly to these zonal representatives, who know many of these leaders of these individual national societies personally, for instance, so we can get out the word quickly. Also, we have 65 scientific sections. These are research leaders in their respective fields, and they are connected.
As president-elect, I am on the executive committee, and I've been on the executive committee for quite some while. I was the secretary for sections before. And if we, let's say, have one common topic that we want to address research-wise or policy-wise, we then send an email to the zonal representatives. We send an email to our sections, and actually within no time, we get response from all over the world.
And of course, the language that we use is English.
Host Amber Smith: I see. Now, the association's focus has broadened in recent years, from treating and rehabilitating psychiatric patients to include the prevention of mental health problems and promotion of good mental health. Where did that come from? Why did that evolve to that?
Thomas Schulze, MD: Well, I think psychiatry has always had, I would say, an agenda to not only treat mental illness, psychiatric disturbances, but also to prevent them. But I would agree that this part of our field, maybe for many years, was not that developed, or people wouldn't focus on that. That's why I think there are many, let's say, prejudices against psychiatry and misconceptions that we guys only give people pills and want to make them sleep, whatever. There's some misconceptions, and sometimes it's our own fault because we have not, or for many years maybe we didn't emphasize, this, but we now know there are biological causes, reasons, genetic factors and so forth, that are main drivers of mental illness.
But we also know that there are environmental factors that do play a role and that the awareness is important. So it is very critical that psychiatric disorders be dealt with early on. If you do not treat the disorder, then it gets worse, and bad things can happen. So that's why educating the general public, going into schools, going into the workplace, is so important, I think. And now, we also think of exercise. There's a lot of evidence showing that exercise, physical exercise, helps in the treatment of mental illness.
So I think it's a very important mission, and I cannot really tell you when it started. It should have always been there, but maybe we were not so good about it. But now, prevention, going out to the public and also maybe talking with you, what I'm doing right now, is a very important thing.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Thomas Schulze. He's a professor of psychiatry and behavioral sciences at Upstate, and he's the president-elect of the World Psychiatric Association, which he's been telling us about.
The World Health Organization says one of every eight people lives with a mental health disorder. What sorts of disorders does that include?
Thomas Schulze, MD: Very important point. I always tend to say, these are the most frequent disorders in the world. And we say one in eight. I would say even the lifetime prevalence, that means that the likelihood of having a psychiatric disorder in one's lifetime is around, like, even 30%.
What it entails? Well, we have the things that people have heard about: depression, major depression. We have bipolar disorder; that is mania and depression together, these ups and downs. We have the large field of anxiety disorders, panic disorders, social phobia and maybe phobia -- fear -- of height, and all these things.
Then, of course, these primary psychotic disorders, like schizophrenia, where you hear voices, where you feel persecuted, where you have these delusions.
Then, of course, the whole field of addiction is part of psychiatry. Very often it's not considered, or it's not named, as a psychiatric disorder addiction, but they do fall into our field, our discipline, so professionals who specialize in addiction are typically psychiatrists or psychologists.
So these are definitely these main disorders, and then you have definitely other disorders, like the big group of dementias, right? That's old-age psychiatry.
Then you personality disorders. You all have heard about borderline personality disorders and things like that. So it is a vast array of disorders. One may say that, well, they share symptoms, and that's true. They sometimes overlap, and there's not always a clear cut, and you can have several. When you have addiction problems, you may also have depression or any other way around.
Host Amber Smith: So do mental health concerns differ much country to country?
Thomas Schulze, MD: Well, not really. The main disorders that I've just mentioned do not really differ. There has always been a discussion whether some disorders are more prevalent in certain countries, certain regions, certain cultural backgrounds.
But the disorders I've just mentioned are basically present at the same rate across populations. There may be, of course, disorders where environment actually has a strong impact. And that may be eating disorders, for instance, disorders where the public perception, public concepts, of fashion, of the ideal body, may play a role. And that, of course, may be influenced by culture-specific factors. And there you may see differences between countries, like, let's say, Western and Asian societies.
But overall, I would say that, especially in a very globalized world, also problems become very globalized, and we are not so isolated anymore. Even if you are on a far-flung island somewhere in the Pacific, you have your smartphone, and you are confronted with the same problems and challenges. So I would say, on average, these disorders are present at the same frequency all across the world.
Host Amber Smith: Is there a country or countries that are doing a particularly good job treating mental health disorders?
Thomas Schulze, MD: Well, that's a good one now, and actually that's a very political one. I'm German, and I'm an American and live in both countries. I love them both, and I work in both countries. I go back and forth. And I see great things in Germany and great things in America and bad things in Germany, bad things in America. And I would love to actually weed out the bad things in either country, but we know it's not possible. I think it comes down to this big issue of mental health parity. That means: Do we treat mental disorders with the same energy, with the same persistence, with the same will to succeed as somatic (physical or bodily) disorders -- so cardiac disorders or cancer? And do insurance companies pay for that?
So for instance, in Germany, I must say, it's quite good. If you have depression, and you need three, four months of treatment, well, you get three, four months of treatment, the same way you would get your heart surgery.
Now, in the U.S., It depends on your health insurance, whether you'll stay in the hospital for the time you need or whether you get the treatment you need.
So here, especially the U.S., not everywhere have we achieved mental health parity, and I think there's a lot to be done. I get calls from many people that cannot find doctors, even if they wanted to pay out of pocket. There's a shortage, so we need to do more in having skilled psychiatrists, psychologists, mental health experts, and then we need to work with insurance companies or health care providers because the mental health of the population is, I think, very important for the well-being of society and success of a society as a whole as well.
Host Amber Smith: Do you have members from countries that are at war? I'm wondering if war impacts psychiatric care?
Thomas Schulze, MD: Of course. We have, of course, the Russian Psychiatric Association, and we have the Ukrainians. We have two Ukrainian member societies. And at the beginning of the war, there was of course a lot of upheaval in a sense that some of the Ukrainian colleagues wanted us to kick out the Russians, to be blunt.
And there was a lot of discussion because our statutes don't allow for that, because only if you commit crimes against psychiatry, basically, or if you act against psychiatry, against the patients and so forth, then we would be able to take action. However, now with the situation in Russia, we know under which political and totalitarian pressure they are, we are in contact with them, but we don't have any more meetings there. And of course we support Ukraine in their fight to survive.
And also we have come up with special programs, training young psychiatrists. I was at a training session in Krakow, Poland, for young psychiatrists from Ukraine. We have specialized programs, we have online programs, how to deal with the situation. And I know there's a lot about veteran mental health now being done, where we try to bundle our expertise.
The WPA, we are headquartered in Geneva. We are a few people, the executive committee. We are not paid for that, right? We are kind of volunteers, but we are in touch with colleagues, and the idea is that we bring together the best people for a specific cause in a specific moment of time, like a war zone, we'll do that. Yes.
Host Amber Smith: What do you plan to prioritize during your presidency?
Thomas Schulze, MD: Actually the mental health parity is a very important aspect, and I outlined that in a small paper. So mental health parity to assess, first of all, the state of the art. How is mental health treated compared to somatic health in the world?
And then we have the WPA collaborating centers, expert centers all over the world. I want to strengthen their work. And currently I'm working with a small group of people to lay out plans how we can, with not much money actually, with limited resources in certain countries of the global South, how can we increase the quality of psychiatric education, of young psychiatrists, because that's really what's urgently needed when we think of a country like Ethiopia, with a 100,000,000-plus inhabitants, we have maybe 50 psychiatrists, and they're all clustered in the capital, Addis Ababa.
So we need to do something about training new psychiatrists and have online programs and what have you, so this is something where I'm working on a plan and also maybe hopefully getting funding from philanthropic organizations that would support that.
And another factor is human rights. We just saw things that happened in Iran, where now, ladies who do not wear the hijab are sent to special clinics because they're now considered psychiatric patients because they don't want to wear hijab.
So we, in the letter, protested against that, and even the psychiatric organization of Iran, they protested against that. Or the situation, the mental health situation, of the Uyghurs in China. And there are many other persecuted ethnicities in the world where mental health is severely impaired because of persecution that is going on. That is a very personal issue, very dear to my heart, and I would like to focus on that as well.
So mental health parity, training of young psychiatrists in the global South and human rights, in connection with mental health. These are the three topics that I would like to focus on in my three years, which will start in two years.
Host Amber Smith: Well, Dr. Schulze, thank you so much for making time to tell us about this. I appreciate it.
Thomas Schulze, MD: Well, thank you for having me. It was a pleasure, and I'm always happy to do similar things again.
Host Amber Smith: My guest has been Dr. Thomas Schulze. He's a professor of psychiatry and behavioral sciences at Upstate, and he's the president-elect of the World Psychiatric Association.
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