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The European Psychiatric Association: Mission, Structure and Perspectives W. Gaebel1; P. Falkai2 1Klinik

und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich Heine Universität, Düsseldorf; 2Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität, München

Keywords

Summary

Mental health care, European psychiatry, early career psychiatrists, psychiatric associations, quality indicators, guidance

The European Psychiatric Association (EPA) is an association of individual members and national psychiatric societies with the aim to improve mental health care in Europe. In the last years, EPA has developed from an association of individuals into a representative stakeholder for European psychiatry and European psychiatrists. EPA is well connected with other stakeholders in the field of European psychiatry. To make good use of the potential of experts and experiences in the EPA in order to improve mental health care in Europe will be a challenge for the next years.

Schlüsselwörter

Zusammenfassung

Versorgung bei psychischen Störungen, europäische Psychiatrie, Psychiater in Weiterbildung, psychiatrische Fachgesellschaften, Qualitätsindikatoren, Empfehlungen

Die European Psychiatric Association (EPA) ist eine Gesellschaft von Individualmitgliedern und nationalen wissenschaftlichen Fachgesellschaften mit dem Ziel einer Verbesserung der Versorgung bei psychischen Störungen in Europa. In den letzten Jahren hat sich die EPA von einer Gesellschaft von Einzelmitgliedern zu einer repräsentativen gesamteuropäischen Interessenvertretung der Psychiatrie und ihrer Fachvertreter gewandelt. Sie ist mit anderen europäischen Initiativen und Interessenvertretern im Bereich der psychischen Gesundheit eng vernetzt. Das Potenzial der Vielzahl von Experten und deren Erfahrungen zu nutzen, um die Versorgung von Menschen mit psychischen Störungen in Europa zu verbessern, wird eine der Hauptherausforderungen für die EPA in den kommenden Jahren sein. Die European Psychiatric Association – Mission, Struktur und Perspektiven Die Psychiatrie 2014; 11: 5–9 Received: 19. December 2013 Accepted after Revision: 15. January 2014

EPA: An introduction The European Psychiatric Association (EPA) is an association of individual members and national psychiatric associations founded in 1983 in Strasbourg with the aim to improve psychiatry and mental health care in Europe. An essential goal of founding EPA in 1983 was a better inclusion of aspects of mental health care in European health politics. This was one of the reasons for choosing Strasbourg as the headquarter city, the city of the Council of Europe and the European Parliament. Although all twelve individual founding members had been either French or German, EPA activities moved beyond the borders of these two countries already at the first EPA congress in Stras-

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bourg in 1984. EPA became observer at the Council of Europe already in 1989. Since 2003, EPA has been a participant of the European Council. Following the end of the cold war, members from eastern European countries increasingly joined EPA and in 1990 attendance at the biannual EPA congresses exceeded 1000 participants. Today, approximately 3000–4000 participants from around 80 countries are taking part in EPA activities. To underline the pan-European approach of EPA the congress venue has changed with each congress since 1990. Following increasing participant numbers, the congress changed from a biannual to an annual conference in 2004. EPA decided to become a European association and not merely an association of European members. In 2008, the name was

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changed from „Association of European Psychiatrists“ to „European Psychiatric Association“. In 2012, EPA statutes were changed so that national psychiatric associations could become members. Currently, EPA has approximately 2,000 individual members and 33 institutional members, who represent about 77,000 associated individuals. For more details about the history of the EPA see http://www. europsy.net/wordpress/wp-content/uploads/2013/05/ epa30thbd_livret_web.pdf?rs_file_key= 207692845851836c9cd8cee712344503.

EPA: Mission The main aim of EPA is to improve the quality of mental healthcare in Europe. This includes the goals as detailed in the revised 2013 EPA statutes (http://www.europsy.net/ wordpress/wp-content/uploads/2013/10/epa-statutes_approved-on-7042013.pdf): a) enhancing the standard of psychiatric education and training b) creating sections to explore and solve problems in different specific areas of psychiatry c) promoting excellence in psychiatric research and clinical practice d) encouraging progress in psychiatric clinical practice e) supporting the development of public health policies relevant to mental health f) disseminating information about psychiatric research and practice g) contributing to initiatives improving ethical standards of psychiatric care h) encouraging professional interchange/exchange between European Psychiatrists i) representing European Psychiatry in the framework of the various European Institutions j) providing a unified organisation representing the different national psychiatric associations in European Psychiatry; along with individual psychiatrists To achieve these goals, EPA has decided to use the following means: a) Organizing European Congresses of Psychiatry, other meetings and courses b) Appointing special Committees, groups or individuals for purposes related to furthering the aims of the EPA. c) Publishing journals, including European Psychiatry, books, papers, online and other material. d) Disseminating information through journals and books. e) Publicizing its activities by all appropriate means. f) Collaborating with other organisations in so far as they have shared aims with the EPA. g) Refraining from party political or religious activities.

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EPA: Structure EPA is guided by an Executive Committee (EC) with five members and a board consisting of 19 members. Both are chaired by the President of the EPA, who is elected for a period of two years (President of the EPA: D. Wassermann, Sweden, in office 2013–2014). The annual general assembly elects the president of the EPA and the board members, the latter for a period of four years. EPA has headquarters in Strasbourg with five administrators. Currently, EPA is considering establishing an office in Brussels. Besides the EC, EPA has the following committees (Table 1). To advance scientific excellence, EPA annually awards prizes. The best five scientific publications of young psychiatrists are awarded 2500 € each. In addition, five stipends for young psychiatrists to attend the EPA congress are awarded. To disseminate knowledge about psychiatry and mental health care, EPA installed an EPA Academy for Excellence in European Psychiatry, which evaluates and certifies proposals for CME courses and implements the EPA Summer School and EPA Faculty Workshops. EPA Summer School will take place at the end of June 2014 for the fourth time in Strasbourg. Main topic will be the comorbidity of mental and somatic disorders. Another means of disseminating scientific information is the journal „European Psychiatry“, which focuses on original work and has been published by the EPA since 1986. “European Psychiatry” covers all aspects of the field of psychiatry. Among the manifold EPA activities, we will focus here on two fields which document EPA´s commitment to scientific excellence and its role as a European association: the EPA Guidance project and the EPA Council of National Psychiatric Associations.

EPA: Guidance At the 16th EPA annual congress 2008 in Nice, the „EPA 2nd Platform of European Psychiatrists“ took place and the EPA Guidance project was launched (Table 2). Table 1

List of EPA Committees

Committee • Executive on Education • Committee Career Psychiatrists Committee • Early on Ethical Issues • Committee Committee • Guidance Committee • Ambassador • Section Committee

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EPA Guidance provides evidence based documents about the quality of mental health care and the prevention of mental disorders in areas where such guidance has not yet been covered (4). While medical guidelines focus on diagnostic and therapeutic processes, EPA guidances deal with topics of importance for European psychiatry, for which guidance has so far been lacking either because of a lack of evidence or because guideline developers had not been interested. By providing written material, EPA Guidance strives to improve mental health care in Europe based on the best available scientific evidence and expert consensus (4). EPA Guidance takes a decidedly European point of view given that Europe is growing in size and that demands to harmonize health care politics are present, yet allowing EPA Guidance documents and recommendations to be adapted to national or regional specifics if this is demanded in the course of implementation (4). In 2009, a survey among 35 European national psychiatric associations led to a list of potential topics and a list of priority EPA Guidance topics was developed (4). Given the experiences of this first series on selected topics (Table 3), standardized methodological approaches were developed for the second and any further EPA Guidance. Work on this second series started in 2013. Evidence should be obtained from systematic literature searches and a structured consensus dialogue should follow when deriving recommendations from the retrieved evidence. However, given the broad range of topics, each EPA Guidance may adapt special methods for these steps if necessary. The results of the second EPA Guidance series will be

Table 3

Table 2 Members of the EPA Guidance Committee. *National Psychiatric Associations EPA Guidance Committee

• Danuta Wassermann (President of the EPA) • Dinesh Bhugra (former Guidance Steering Group) • Peter Falkai (Council of NPAs*) • Andrea Fiorillo (Early Career Psychiatrists) • Wolfgang Gaebel (Chair) • Reinhard Heun (European Psychiatry) • Hans-Juergen Möller (Co-Chair) • Michael Musalek (Representative of EPA Sections) presented in the next EPA annual congress in Munich in 2014. EPA Guidance documents are published in special issues of European Psychiatry. In the future, EPA Guidance documents shall be developed in closer collaboration with other European organizations (see chapter below). This function may be a task for the EPA Council of National Psychiatric Associations.

The Development from AEP to EPA In 1983 the foundation of the Association of European Psychiatrists (AEP), today called EPA, was driven by a

Topics and leading authors of the first and second series of EPA Guidances

First Series (European Psychiatry, 2012, Vol. 27)

Second Series (European Psychiatry, 2014, in press)

European Guidance – a project of the European Psychiatric Association (Gaebel W & Möller H-J)

EPA Guidance on mental health care of migrants (Bhugra D, Gupta S, Schuler-Ocak M et al.)

European Psychiatric Association guidance on prevention of mental disorders (Campion J, Bhui K, Bhugra D.)

EPA Guidance on post-graduate training in psychiatry (Mayer S, van der Gaag R, Dom G, Falkai P et al.)

Mental health promotion: Guidance and strategies (Kalra G, Christodoulou G, Jenkins R et al.)

EPA Guidance on building trust in mental health services (Gaebel W, Muijen M., Baumann A et al.)

EPA Guidance on the quality of mental health services (Gaebel W, Becker T, Janssen B et al.)

EPA Guidance on tobacco dependence and strategies for smoking cessation in people with mental illness (Rüther T, Bobes J, de Hert M et al.)

Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression (Möller HJ, Bitter I, Bobes J et al.) The European Psychiatric Association (EPA) guidance on suicide treatment and prevention (Wasserman D, Rihmer Z, Rujescu D et al.) European Psychiatric Association guidance on the conflicts of interest (Höschl C & Fialova L)

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number of ambitious psychiatrists from Europe aiming to find a platform where European Psychiatry could combine and demonstrate its strengths. The next step forward was to install a platform where preferably all European Societies could find a suitable representation. In order to provide this new EPA with an administrative framework, the Council of the National Psychiatric Societies/Associations (NPA) was founded and installed in 2012. Constituents of 29 national psychiatric societies are coordinated by a small executive committee of the chair (Peter Falkai, Germany), the secretary (Rutger Van der Gaag, Netherlands) and vice chair (Manuel M. Carrasco, Spain). Representatives of the NPAs meet at least once a year usually during large congresses as, e.g., at the DGPPN congress in Berlin. Monthly telephone conferences are held in order to discuss current issues and further proceedings. At the 2013 DGPPN congress, working groups had been installed to discuss the following topics: “Parity issues” by Sue Bailey “Mental health and economic crises” by Manuel M. Carrasco “Migration and Mental Health” by Peter Falkai “Brain drain & work migration within Europe” by Dinesh Bhugra “Guidance papers” by Wolfgang Gaebel “Quality of training” by Marc Hermans “Recruitment” by Peter Falkai “Public image of psychiatrists (and Psychiatry)” by Pierre Vallon

• • • • • • • •

It is each working group’s task to build up a programme around its respective topic focussing on one or two important issues and then to present the results at the upcoming EPA congress in Munich in 2014. The subsequent step would be for each successful working group to prepare guidance papers on its respective key topic and thus present it to the EC of the EPA at the end of 2014. Additionally, the council is encouraged to select one or two topics which should be promoted to the EU administration in Brussels. In conclusion, the Council of NPAs has been successfully established in the past 12 months and was able to form a platform for the national societies in Europe.

EPA: Perspectives EPA has built a network with other organisations, e.g., the World Psychiatric Association (WPA), the WHO Regional Office for Europe in Copenhagen, the European Brain Council, the European Federation of Psychiatric Trainees, the European College of Neuropsychopharmacology, and with the Union of European Medical Specialists (UEMS).

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The collaboration with the national psychiatric associations is another hallmark of EPA networking. The main task for the EPA now is to improve mental health care in Europe. A strategic plan will be developed to use these connections synergistically and to position EPA clearly. New initiatives may become necessary, for example in counseling the European Community when legislation is pending or when European research programs are being developed. In these areas, new ways of improving mental health care may be feasible and should be implemented. The vision is to sharpen EPA´s profile as a psychiatric expert association which provides esteemed and valuable contributions when questions of mental health and illness are concerned. Given the continuing expansion of the European Union (EU) towards Eastern Europe and the ensuing increasing migration of parts of the European population, new challenges for EPA are lying ahead. One issue here may be the lack of comparative studies about standards of mental health care in the different EU countries. Also, issues of specialty training standards and of young psychiatrists’ support arise, e.g., to consider psychiatry as an interesting area of a medical professional career. Such efforts need to begin during medical school, which offers many opportunities to raise interest in psychiatry (11). One focus of EPA activities is with young psychiatrists. While this is a rewarding area of activities, it is still unclear why – or why not – psychiatry is chosen as a medical career. Longitudinal long-term studies from Great Britain indicate that 4–7% of medical students and young medical doctors are interested in psychiatry as a profession, and this rate has remained remarkably constant (8). Some studies show that psychiatry is a medical specialty which is chosen rather late in the professional course and not necessarily immediately after medical school (7). Therefore, it may be advisable to extend EPA initiatives to young medical doctors in other medical professions. Another aspect is retaining young psychiatrists in psychiatry. Questions of work-life balance, promotions and long-term professional commitments will become central issues here (8). However, one of the major challenges for European psychiatry is how to optimize mental health care in Europe (1). While increasing treatment rates is one aspect, another important aspect is to achieve the highest possible quality of care, which may be assessed using quality indicators. The EPA guidance – in its first series – had provided quality indicators for mental health care institutions (5), which will need to be implemented and assessed in different European countries now. EPA as a proponent of quality in mental health care could find a new field of activities herein. Another international trend is the continuing restructuring of mental health care in Europe – the

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process of „deinstitutionalisation“ seems to have been followed by „reinstitutionalisation“ to some degree (9). But even in Germany, which has a highly developed and diversified mental health care system, non-psychiatrist doctors (mainly general practitioners) care for the majority of patients with mental illnesses (6). Given the frequently life span limiting or life quality diminishing somatic comorbidity of those with mental disorders, EPA may need to look beyond psychiatry as a specialty to improve the quality of mental health care (3). New integrated, multidisciplinary ways of care are necessary, which will not be possible without integrating general practitioners and other somatic specialists. Vice versa, psychiatrists need to recognize the immense importance of somatic disorders in their patients, so that mutual benefits could be gained from closer cooperation (2). Another important task for the future is to advance the implementation of EPA Guidance recommendations. New educational tools may be necessary and much of this may be provided via the internet. Furthermore, guidance recommendations must be updated regularly in order to increase their acceptance and validity. Developing and implementing monitoring programs may become one of the future EPA tasks. Future guidances may need to address the issue of patient involvement more than previous guidances. Even though EPA is a scientific organisation, personal experiences of those with mental disorders and their relatives may become valuable contributions in the EPA Guidance development process as well. Another field of increased activity of EPA in the future may be informing the general public regarding mental disorders, symptoms and treatment opportunities. This will help to increase trust and reduce the stigma of psychiatrists and mental health care institutions. This could improve mental health care, increase utilisation rates and increase the fraction of adequate use of mental health care. Ignorance and stigmatization are still major obstacles for mental health care. Effective interventions are available but need to be implemented (10). To convey the impression of a modern, open, innovative, multifaceted, caring and scientifically based European psychiatry must be one of EPA´s goals. During the last years, EPA´s organisation and membership structure have undergone many changes. EPA is part of a network of European organizations and has the chance to take the next step and increase its role in European legislation and research planning. Furthermore, EPA may gain an important role in providing European guidance for mental healthcare and thus improve mental health care in Europe. These opportunities also pose challenges which should be mastered for the best of those with mental illnesses.

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References 1. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; (420): 47–54. 2. De Hert M, van Winkel R, Silic A, Van Eyck D, Peuskens J. Physical health management in psychiatric settings. Eur Psychiatry. 2010;25 Suppl 2: S22–28. 3. De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Möller HJ, Gautam S, Detraux J, Correll CU. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011; 10: 138–151. 4. Gaebel W, Möller HJ. European guidance – a project of the European Psychiatric Association. European Psychiatry 2012; 27: 65–67. 5. Gaebel W, Becker T, Janssen B, Munk-Jorgensen P, Musalek M, Rössler W, Sommerlad K, Tansella M, Thornicroft G, Zielasek J. EPA guidance on the quality of mental health services. Eur Psychiatry 2012; 27: 87–113. 6. Gaebel W, Kowitz S, Fritze J, Zielasek J. Inanspruchnahme des Versorgungssystems bei psychischen Erkrankungen. Sekundärdaten von drei gesetzlichen Krankenkassen und der Deutschen Rentenversicherung Bund. [Use of health care services by people with mental illness – secondary data from three statutory health insurers and the German statutory pension insurance scheme.] Dt Ärzteblatt 2013; 110: 799–808. 7. Goldacre MJ, Laxton L, Lambert TW. Medical graduates’ early career choices of specialty and their eventual specialty destinations: UK prospective cohort studies. BMJ 2010; 341: c3199. 8. Goldacre MJ, Fazel S, Smith F, Lambert T. Choice and rejection of psychiatry as a career: surveys of UK medical graduates from 1974 to 2009. Br J Psychiatry 2013; 202: 228–234. 9. Priebe S, Frottier P, Gaddini A, Kilian R, Lauber C, Martínez-Leal R, Munk-Jørgensen P, Walsh D, Wiersma D, Wright D. Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv 2008; 59: 570–573. 10. Sartorius N, Gaebel W, Cleveland HR, Stuart H, Akiyama T, Arboleda-Flórez J, Baumann AE, Gureje O, Jorge MR, Kastrup M, Suzuki Y, Tasman A. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2010; 9: 131–144. 11. Voderholzer U, Wündrich M, Zielasek J. Bedeutung der studentischen Lehre für die Attraktivität des Faches Psychiatrie und Psychotherapie: Was müssen wir ändern, damit wir mehr Nachwuchs bekommen? Die Psychiatrie 2012; 9: 31–39.

Correspondence to Univ.-Prof. Dr. med. W. Gaebel President Elect, EPA LVR-Klinikum Düsseldorf Bergische Landstr. 2 40629 Düsseldorf Tel. 0211–922–2019 Fax 0211–922–2020 E-Mail: [email protected]

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