MENTAL HEALTH
NEUROLOGY
Mental health in an era of global crisis and uncertainty
Climate change and artificial intelligence was a main topic of the recent World Congress of Psychiatry held in Mexico
January 28, 2025
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The perhaps obvious link between mental health and international peace and security, was described at the first plenary session of the World Psychiatric Association’s (WPA) 24th World Congress of Psychiatry, which took place in Mexico City in November. War doubles a person’s likelihood of mental health problems, Prof Juan Ramon de la Fuente, a former Minister for Health in Mexico, told the conference of over 3,600 representatives from 96 countries.
He also gave the Covid-19 pandemic as an example of a global mental health crisis that unfairly affected some countries more than others in terms of access to vaccines. He spoke of limits to what the United Nations can do on foot of five permanent Security Council member states each having the power of veto. While the UN may produce sound resolutions, unfortunately they are not always implemented.
This theme was elaborated upon at a State of the Art Session entitled, ‘The Challenges for Disaster Psychiatry in the Era of Climate Change, Artificial Intelligence and Armed Conflict’ presented by Prof Nikos Christodoulou, a Greek psychiatrist and chair of WPA Section of Disaster Psychiatry. He said 400-500 natural disasters occur each year globally, with a significant increase in the past two decades, making them three to four times more frequent than in the last century. Between 2005 and 2015, 1.5 billion people were affected by disasters. Some 20-50% of disaster survivors report acute distress, about one-third of whom progress to a clinical diagnosis over time. These include PTSD (higher for those directly impacted, experiencing loss or if the disaster is man-made), depressive symptoms (with 15% developing clinical depression within a year), and anxiety (in up to 30%, especially with prolonged displacement or high exposure levels).
Prof Christodoulou referred to the joint WHO/UN Advisory Committee on Response to Emergencies (ACRE) Action Plan 2023-2026, but emphasised that response alone is inadequate. Preparedness is essential and psychiatry worldwide has a role in public health advocacy. He spoke about the importance of cultivating resilience and how “normal people react normally in abnormal circumstances”. The best immediate support is usually material rather than psychological. Debriefing, despite its popularity among politicians, has been shown to be harmful. Beyond this, evidence based treatments include psychological first aid, cognitive behavioural therapy, exposure therapy, virtual reality interventions and medications such as SSRIs and SNRIs. Prof Christodoulou described the typical phases seen in society’s response to a disaster, from ‘pre-disaster’, to heroic, to ‘honeymoon/community-cohesion’, to ‘disillusionment’ phases, to ‘trigger events’ such as anniversaries and finally ‘reconstruction’. He stressed the importance of avoiding public leadership disagreements and delusions of invincibility. Societal systems (much like people) break down at their weakest point in times of crisis and this usually has an “acute on chronic” effect. Hence his emphasis on the need for prevention and resilience.
Prof Helen Herrman, emeritus professor at the University of Melbourne, echoed much of the above in her plenary session entitled ‘Evidence Based Methods to Mitigate the Mental Health Effects of Crisis, Wars and Terror Attacks’. She cited the need for action research into the effects of natural, human-made and complex-health disasters, with people experiencing war or conflict doubling their risk of a major mental disorder over two years. With disasters increasing globally, there is much work to be done.
The conference also covered several other prominent themes relevant to modern psychiatry, including women’s mental health and perinatal psychiatry, youth mental health and the risk factors for schizophrenia, physical health monitoring for severe and enduring mental illness, eating disorders, suicide prevention and telepsychiatry including artificial intelligence. Many of these are covered in a separate article