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January 2014
Schizophrenia and Quality Assurance in Psychiatry

Joint WPA Workshop of the Schizophrenia Section and the Section on Quality Assurance in Psychiatry at the “4th European Conference on Schizophrenia Research (ECSR) – Together for better treatment and care”, 26-28 September 2013, Berlin, Germany

The ECSR, a WPA co-sponsored meeting that is jointly organized by the European Scientific Association on Schizophrenia and other Psychoses (ESAS) and the Competence Network on Schizophrenia, again was a great success. This biennial thematic conference that addresses recent developments in schizophrenia research as well as challenges in clinical settings attracted about 500 delegates from more than 50 countries. Tarek Okasha joined the congress in order to give a welcome address on behalf of the WPA.

According to the motto “Together for better treatment and care” the WPA as co-sponsor namely the WPA Secretary of Sections, Afzal Javed, and Wolfgang Gaebel, the chair of the Sections on Schizophrenia and Quality Assurance in Psychiatry organized a workshop on “International perspectives of quality of care and integration of persons with schizophrenia”. 

Norman Sartorius presented data on the long term outcome of schizophrenia in developing and developed countries. The results of long term follow-up studies of course and outcome of schizophrenia confirm that the course and outcome of the disorder is more clement in the developing countries. Hr concluded that anyhowcomparative, cross-cultural and long term follow-up studies are useful and should be promoted.

Antonio Lora gave a report on a WHO survey published in 2012 which had evaluated the service availability and utilization and treatment gap in 50 low- and middle-income countries. The respective findings are that about two thirds of the people with schizophrenic disorders in low- and middle-income countries do not have access to specialized mental health care. The level of available human resources in mental health facilities appears to positively predict treatment prevalence and rate of outpatient care and negatively predicts the overall treatment gap. He concluded that these results confirm the need to scale up the workforce in low- and middle-income countries.

Afzal Javed stated that in low income countries undertreatment occurs as a norm rather than exception which is due to a poorly organised healthcare sector, limited access to psychiatrists and longer duration of untreated psychosis.He also shared with the attendees his experience with a model project in Pakistan, the Fountain House, a Centre for Rehabilitation Psychiatry which consists of a Residential House and Day Services for more than 300 male and 50 female patients most of them suffering from schizophrenia. This program combines approaches for providing treatment in the community and providing support for small businesses through successful microfinance scheme organized by one of the largest microfinance providers in order to further enhance recovery by engaging patients in meaningful occupational activities.

The co-chair of the Section on Schizophrenia, Veronica Larach from Chile, presented a unique model to manage first-episode schizophrenia patients based on a strategy which is supported by state law guarantees that was established in 2005 as “Garantías Explícitas en Salud” (GES). GES is based on a network approach, and means explicit guarantees for accessibility, opportunity within specified time frames. It is financed by the Government regardless of income and social condition for the explicit actions and procedures that the program offers and implies. Quality of compliance with the program is centrally registered and audited.

In his presentation Wolfgang Gaebel, congress president and chair of the organizing Sections, referred to lessons learned from developing European Guidance on the Quality of Mental Health Services. He emphasized that quality is a multidimensional construct that can be defined according to various components and dimensions (categories - structures, processes, outcomes - and levels of observation), and that the availability and quality of mental health services varies within and between developed and developing countries. Thus EPA Guidance recommendations rather provide an overview of the current state of art. For generally valid, supranational recommendations and quality measures high-quality, multinational research on most effective components of mental healthcare service structures and processes would provide a more solid evidence base, said the section chair.

This workshop hopefully encourages further discussion on how to improve quality in developed and developing countries.

Wolfgang Gaebel

Chair, WPA Section on Schizophrenia

Chair, WPA Section on Quality Assurance in Psychiatry

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