ROYAL COLLEGE OF PSYCHIATRISTS
TRANSCULTURAL PSYCHIATRY
SPECIAL INTEREST GROUP SYMPOSIUM
ONE DAY CONFERENCE
Friday 21st June 2013
10am to 5pm
Council Room
Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG
PROFESSOR SIR ROBIN MURRAY - The Royal College of Psychiatrists - has kindly
agreed to Chair our symposium.
The Transcultural Psychiatry are delighted and honoured that Prof. Sir Robin Murray
has agreed to Chair our symposium and also agreed to give a brief talk on:
The importance of advanced transcultural psychiatric issues in practising psychiatry
in the U.K.
Professor Sir Robin M MURRAY MD
DSc FRCP FRCPsych FMedSci FRS
Professor of Psychiatric Research,
Institute of Psychiatry
Honorary Consultant, South London and
Maudsley NHS Foundation Trust
Robin Murray decided on a career in
psychiatry at high school and in pursuit of
this, trained in medicine at the University
of Glasgow. After this he started in
psychiatry at the Maudsley Hospital, and
has remained there ever since apart from
one year at the National Institute of
Mental Health in the USA; fortunately this
latter did not do him much harm! He has
been Dean of the Institute of Psychiatry,
and Professor of Psychiatry there, but
now focusses on research into
schizophrenia. In 1987 he and Shon
Lewis were among the first to suggest
that schizophrenia might in part be a
neurodevelopmental disorder. He, and
the many very able colleagues with whom
he has been privileged to work,
demonstrated the important role of
environmental factors in the aetiology of
schizophrenia including obstetric events
and other early childhood hazards. Later
they showed the contribution of social
adversity to the high rates of
schizophrenia in African-Caribbean
people living in the UK. Most recently they
have demonstrated that prolonged heavy
abuse of cannabis can contribute to the
onset of psychosis and are researching
why some people are especially
vulnerable to this commonly used drug.
He has written numerous papers and
books and he has been President of the
European Association of Psychiatrists.
He has a Research Unit named after him
in the University of Sao Paulo, and was
elected a Fellow of the Royal Society in
2010.
SPEAKERS:
Zar as a traditional healing ceremony of psychiatric
disorders in Egypt.
1.
Dr. Salah Abou Alfadl
Salah Abou Alfadl graduated in the medical school of Cairo university 1975.
He obtained his Membership of the Royal College of Psychiatrists, in June 83.
He did his higher psychiatric training in Nottingham and Derby Rotation where he
continued his training and took interest in forensic psychiatry.
He worked for a few years as a consultant psychiatrist/ Assistant professor in King
Saud University, Riyadh, Saudi Arabia and later in King Khalid National Guard
Hospital in Jeddah between. Dr Salah Abou Alfadl has been working as NHS
consultant psychiatrist in Essex, UK since April 1990. He took his first NHS
consultant post in the Clacton-on- Sea area with North Essex Mental Health Trust
where he worked for five years. He then moved to St Margaret’s Hospital in Epping
where he worked as consultant psychiatrist for 9 years; during that period he also
served as Clinical Director/ Associate Medical Director for seven years. In June 2004
he moved to a consultant post in Goodmayes Hospital with North East London
Mental health Trust, and became the Chair of the Senior Medical Staffing
Committee. He contributed to developing a team for Early Intervention in Psychosis;
and later took a leading role in Liaison Psychiatry and Audit Lead. In July 2009 he
became a member of the Council of Governors of North East London Foundation
Trust. He is an examiner on the Royal College of Psychiatrists membership exam,
and an assessor for approval of foreign qualified psychiatrists to obtain specialist
registration in the UK.
Dr Abou Alfadl has been a medical member of the Mental Health Review Tribunal
since June 2004. He was also a regular visiting psychiatrist to Chelmsford and
Bulwood Hall prisons between 1992 and 2004.
Torn in Customs – My psychiatric experience is divided
between Bahrain and the UK.
2.
Dr Ahmed Shooka
“Dynamic, Motivated, Team Player and keen to learn “
Consultant Psychiatrist & Lead Clinician, North Essex Partnership University
NHS Foundation Trust
Specialist Associate Member of the Royal College of Psychiatrists, UK
Honorary Lecturer, School of Health & Human Sciences, Essex University,
UK
Member of the International Society of Early Psychosis Intervention
Member of British Association of Psychopharmacology (BAP)
Member of the Royal College of Psychiatrists Psychopharmacology Special
Committee
Member of the British Arab Psychiatric Association (BAPA)
Research and keen interest:
*OCD, Depot medications, Physical Health of patients with SMI
*Psychopharmacology
* Depression, Anxiety and Pain; the conundrum!
*Compliance, Concordance and Adherence
*Has publications on Phenomenology of OCD, Depot antipsychotic
medications, adherence to medication
* Communication skills, Negotiation strategies and Persuasion techniques
* Medico-Legal expertise. The interface between Medical ethics and the Law
* Specialist in diagnosis and treatment of Adult ADHD
Torn in Customs - My psychiatric experience is divided between Bahrain and
the UK.
The Arab world is taken to mean the 22 countries of the Arab League, accounting for
280 million people. The region has the largest proportion of young people in the
world: 38% of Arabs are under 14.
The mental health expenditure as a percentage of total health expenditure is not
available in most Arab countries and not reported by officials. Only three Arab
countries have provided an estimate: Qatar (1%), Egypt (less than 1%) and
Palestine (2.5%). The highest number of psychiatrists is found in Qatar, Bahrain and
Kuwait, while seven countries including Iraq and Syria have less than 0.5
psychiatrists per 100.000 populations. Psychiatric nurses per 100.000 population
range from 23 in Bahrain to 0.09 in Yemen.
Recent years have seen significant changes in the field of mental health in the Arab
world. Large mental hospitals are now gradually being replaced by psychiatric units
with both inpatient and outpatient facilities in general hospitals. Training programmes
in mental health for GPs, non-physicians and health personnel working at primary
care level started in a large number of countries as a part of in-service skills
enhancement programmes.
Bahrain has a quite well established psychiatric service with sub-specialities and
community psychiatric facilities. Before the year 1932, there were no hospitals or a
place to keep the mentally ill; they were looked after by their families. In 1932,
Charles Belgrave asked the municipality to provide a home for these people. A small
house was rented in Manama. In 1974, Dr Emad Fareed was appointed as a director
of the psychiatric hospital. He was the first qualified psychiatrist on the Island. At
present, the main psychiatric hospital in Bahrain provides secondary and tertiary
healthcare services to the residents of the Kingdom. There are four large private
hospitals which provide outpatient psychiatric consultations beside the many private
clinics scattered all over the island. There is no formal Mental Health Act, but a newly
approved WHO-AIMS (2010) Mental Health System is in place.
The following areas will be highlighted during the presentation:
1- The utilisation of religious scholars as therapeutic alliance to ensure compliance
and to reduce stigma
2- Medically Unexplained Symptoms (MUPS). Parson's sick role!
3- Research; from pharmacology to phenomenology
4- First Gulf RCP conference 1998
5- Frist BAPA meeting outside the UK 2007
6- Medical schools and education; AGU and RCSI
Currently, most of the Arab countries are exposed to conflicts, wars, terrorism and
fundamentalism, which may be the seeds for many behavioural and mental,
disorders i.e. PTSD, anxiety and depression. Cultural beliefs of possessions and the
impact of sorcery or the evil eye affect the interpretation of mental symptoms. In this
context, the first resort for the families of mentally ill patients is not even the GP, but
the traditional healers, who acquire a special importance because of their claim of
dealing with the “mystical" and the "unknown". In the majority of the Arab countries
there is no interaction between the medical profession and the traditional healers. In
Jordan, there is some kind of a relationship, which remains informal and
unorganised. In Saudi Arabia, however, they constitute part of the staff, using
religious text and recitation in management.
Transcultural perspective of elderly psychiatry in the
Middle East.
3.
Dr. Saad Al-Khalaf
Dr. Saad Al-Khalaf is a senior consultant who worked for more than thirty years in
the NHS in the United Kingdom.
He is currently working in the independent sector.
He has been as a chairman of the consultant committee in Surrey and Hampshire
borders for a few years.
He is an Examiner for part I and Part II of the Royal college Membership
Examination.
He has delivered many lectures in local regional and international conferences.
He is a Fellow of the Royal College of Psychiatrists.
Elderly Mental Health-its cultural impact in the Middle East abstract
Cultural, ethnic and demographic changes in the Middle East are new realities in
unprecedented growth of the elderly population with the emergence of new chronic,
physical and mental health problems.
The diversity and cultural variable way of life, rituals and beliefs interacts, colouring
presentation to some extent but by and large affects the provision of services.
Cultural dynamics including individuality versus interdependence, existence of
extended family and kinship could all not only affect the care system and delivery but
also the prognosis.
An army of several millions of mentally ill elderly people requires recognition by
authorities and resources allocated to address this problem.
Treating psychiatric disorder in expatriates in Qatar,
Needs wealth of transcultural awareness.
4.
Dr. Majid Alabdalla
Dr Majid is a Consultant Psychiatrist and Assistant Chairman of psychiatry At Hamad
Medical corporation (HMC), Doha, Qatar.
Dr Majid graduated from Allipo University 2002, Syria.
He completed internship training at Hamad General Hospital,
He was awarded Arab Board Psychiatry Certificate in 2009.
He completed his training at South London and Maudsley NHS Foundation Trust in
Nov 2011 as Research Fellow.
He is primarily interested in addiction medicine and Liaison Psychiatry.
His main research area is in the field of Co morbid psychiatric problems and physical
disorders with substance misuse.
He is a member of Qatar Medical Association.
He is a member of Arabic Gulf Psychiatric Association.
He is a member of the Arab Federation Psychiatry.
He has published his research in local, regional and International Journals.
He presented his research locally, regionally and Internationally.
He participates in teaching locally and regionally.
Summary:
Treating Psychiatric disorder in Expatriates in Qatar, Needs wealth of
Transcultural awareness.
He will talk about his experience in transcultural psychiatry in Qatar- Where natives
are the minority.
Qatari society is a multicultural, multi-ethnic and multilingual society where natives
are minority. Imported work force is serving in all aspects of Qatari life, from
household help, construction, transport to medical and other specialised services in
banking and IT. Acculturation and its impact on individuals and the society as a
whole is an important issue needs discussion and appropriate mental health
provision.
.
Psychiatrists are confronted with difficulties understanding the cultural background of
patients and its implications on symptoms and presentations. All these factors have
its impact on the diagnosis, management and acceptance of patients to psychiatric
diagnosis and its stigma and their compliance and acceptance of treatment.
Doctor patient relationship is two way traffic built on mutual understanding and trust,
which can be built by sharing experiences, beliefs and cooperation in efforts to
change false conception and endorse positive aspects of the cultural customs and
beliefs. Practicing psychiatrists should be well equipped with transcultural awareness
to deal with all these intricacies.
Qatar is a rapidly developing country in all aspects of life. Psychiatric services have
and are taking wide strides in order to meet this development.
Dr. Majid is going to talk about the development of psychiatric training services in
Qatar in order to meet the needs of the community and its very healthy diversity. He
is also going to make inference from his experience with other cultures, mainly the
west.
5.
A transcultural flavour of practicing psychiatry in the
conflict zones.
Dr. Mamoun Mobayed
Consultant Psychiatrist
Director of the Dept. of the Prevention Programs
Social Rehabilitation Centre, Doha, Qatar
Formally Lecturer at Queens’ University Belfast
Psychiatrist, Belfast Health & Social Care Trust
Dr Mobayed has worked for more than twenty years with the NHS in Belfast,
Northern Ireland before he moved to Qatar in 2010. He was an Honorary Lecturer at
Queen’s University Belfast. He is a member of several medical and psychiatric
organisations in Ireland, UK, and overseas.
Dr Mobayed has a special interest in PTSD, as he has visited various conflicts and
natural disaster areas including West Bank, Gaza, Lebanon, Kashmir, China, and
Tunisia/Libya recently.
Dr Mobayed has published several psychiatric papers on biological psychiatry, and
his most recent paper “Mental Health in Post-conflict Syria” (Co-Author with Dr
Mohammed Abou-Saleh) has just been submitted for publication in the International
Psychiatry, The Royal College of Psychiatrists.
He has also published ten books (in Arabic) on: mental illness, parenting training,
marital communication, cognitive psychotherapy, child’s identity, and children’ sex
education, emotional intelligence, and psychological care of prisoners of conscience.
He is the chairman of the international accreditation committee, and the chairman of
the Continuous Medical Education program at the Social Rehabilitation Centre.
Practicing Psychiatry in the Conflict Zones
Transcultural psychiatry is challenging enough, practicing it in a conflict or
traumatized region is even more demanding.
There is a significant variation in how people experience trauma, and the literature
rarely illustrates the variation in resilience and response to trauma.
Refugees who flee their country because of fears of violence often have had
extremely traumatic experiences, which may result in PTSD and sometimes chronic
impairment.
The crude diagnosis of post-traumatic stress disorder (PTSD) (with its set criteria)
can’t factor in human complexity.
What role does culture, language, tradition, attire, spirituality, and other factors play
in psychosocial trauma work in transcultural psychiatry?
Although much is known about the effects of violence and trauma, competent
culturally sensitive services for survivors of trauma remain inadequate to meet the
needs.
In this paper, I will present my experience from working with various groups who are
survivors of different conflicts or traumas including war, earthquakes, and more
recently public uprising in the Arab Spring.
What lessons do we learn from such work, and how we can make this type of
intervention more accessible?
This presentation highlights my experience of practicing psychiatry and in particular,
psychosocial support in different conflict zones, from Gaza, West Bank, Kashmir,
Lebanon, Libya and more recently with the Syrian refugees. I will try to clarify the
main challenges facing psychiatric practice in a traumatised region.
The picture isn’t all negative, as there are some factors which facilitate such work,
and make it not just interesting but even appealing and rewarding.
Mental health challenges in The Arab Area – United Arab
Emirates perspective.
6.
Dr. Adel Karrani
Adel Karrani is a Consultant Psychiatrist in the Department of Psychiatry at Rashid
Hospital in Dubai, United Arab Emirates (UAE).
Dr Karrani completed his undergraduate training at the Royal College of Surgeons in
Dublin, Republic of Ireland.
He has a Master’s in Medical Science from the University of Wales, Cardiff, UK.
He is a member of the Royal College of Psychiatrists, UK.
Dr Karrani is the Director of the Training and Residency Programme at Rashid
Hospital, Dubai. He led the department for re-accreditation by the Arab Board. The
academic programme has proven extremely successful.
He was Specialist Psychiatrist at the Ministry of Health at Al Kuwaiti Hospital and Al
Amal Hospital’s Mental Health Services.
Dr Karrani represents Rashid Hospital and the Dubai Health Authority in local and
regional events.
Dr Karrani has delivered several lectures at regional and international conferences
and is a member of the expert committee for the development of practice guidelines
on the pharmacological treatment of major depressive disorder in the Middle East.
He is the current president of the Arab Federation of Psychiatrists.
He is the president of Psychiatry division at Emirates Medical Association.
He represents UAE in the Arab Board of Health Specialization.
Mental Health Challenges in The Arab Area - United Arab Emirates
Perspective.
SUMMARY
United Arab Emirates is the fastest developing Arab country. The umbrella of
Modernisation has covered nearly everything in the society including health
provision. Americans developers and policy makers have the lion share of this
development, lacking awareness of the cultural needs of the population might have
led to have left them unmet or at least partially unmet.
As a universal phenomenon, mental health provision continues to lag behind the
acute medical care, UAE is not an exception, for that reason, mental health service
provision, continue to dominate the top of the list of the challenges of the health of
the nation.
Historically, mental health is a neglected area in the region, despite the development
of several modern international facilities, mental Health services continue to struggle
compared to physical specialities.
It is always easy to explain it by the prejudice against mental health and stigma, but
to be fair; there are other more subtle challenges which need attention. I.e. The
transcultural diversity of the country: It has 142 nationalities, with their linguistic,
religious, ethnic and educational differences which have its implication of the
presentation and response to treatment of mental illness.
The massive increase in population has increased from 2 to 5 million in 5 years. This
explosion in the population and its diversity has put a significant strain on the
providers from language barriers to different presentation of the mental illness.
All these issues should be addressed, in order to, provide inclusive, comprehensive
and effective mental health services, which will be satisfactory for the population and
the mental health professionals.
Dr. Kurrani should be applauded for his carriage to try to elucidate all these
intricacies to audience in West who are not acquainted with cultural let alone
psychiatric issues of the area.
7.
Trends of faith healing among people with psychiatric
disorder in Iraq: a comparative study of Arabic and
Kurdish ethnicities in Iraq.
Dr Zerak Al-Salihy MBCHB, MRCPsych
Specialist registrar ST5 in Old age Psychiatry at Norfolk and Suffolk
Foundation Trust. He was born in Kurdistan of Iraq and graduated from
University of Salahaddin in Erbil in 2000. He moved to the UK in 2002 and
started training in Psychiatry in 2005. He is involved in research projects in
Kurdistan and published a paper in the international journal of Psychiatry. He
has contributed to the development of mental health services in Erbil and
gave numerous lectures to trainees and medical students at Hawler medical
university in Iraq.
Summary:
Background: Faith healing is commonly practiced in the Middle East. Little is known
about trends of faith therapies among patients with psychiatric disorders in Iraq.
Aims: To determine and compare rates and predictors of faith healings by
individuals with psychiatric disorders, and the practiced rituals among Arabic and
Kurdish ethnicities in Iraq.
Method: Patients, aged 18 year and older attending out-patients in Erbil and
Najaf were assessed for their prior contacts with faith healers.
Results: 48.9% had faith healers consultations before visiting their Psychiatrist;
the figure was three times higher among Arabs than Kurds. Higher consultation
rate was found among younger and less formally educated patients. Fourteen
types of religious therapeutic rituals have been practiced.
Conclusions: Faith healing is widespread in Iraq. It’s more common among
Arabs, younger and less educated people with psychiatric disorders. Participants
Considered faith healing for their psychiatric more than non-psychiatric disorders.
8.
Transcultural experience of an International volunteer in
Sudan.
Dr. Peter Hughes
Dr Peter Hughes is a graduate from UCD Dublin. He is now a General Adult
Psychiatrist in St. George's London.
He has worked in Australia, Ireland, Haiti, Chad as well as assignments in many
other countries.
His main overseas interest is in the WHO MH GAP implementation Guide and
integration of mental health in primary care in low resource settings including conflict
and disaster zones.
He is a fellow of the Royal College of psychiatrists, member of International advisory
Committee of college and founder of Volunteering Special Interest Group of College.
Dr. Hughes is talking about Psychiatry in Sudan specifically and socio-cultural
aspects of establishing a programme of integrated mental health into primary care
partnering with WHO and Sudan Ministry of Health.
9.
Update of transcultural psychiatry SIG
Dr Hellme Najim, Basildon Essex, United Kingdom.
Graduated from Mosul Medical College 1977.
Membership of the Royal College of Psychiatrists 1983.
Assistant Professor of Neuropsychiatry Mosul University Iraq 1989 - 93.
Assistant Professor in Neuropsychiatry Sana'a University Yemen 1993 - 94
Lecturer at The Institute of Psychiatry London 1996-8
Consultant Psychiatrist South Essex University Foundation Trust 1998 - present
Special interest:Psychopharmacology, Service provision of people with severe mental illness,
Interface between primary and secondary care.
He was elected as a chair for the Transcultural Psychiatry Special Interest Group
at the Royal College of Psychiatry in July 2012.
Transcultural Psychiatry SIG Update.
The Transcultural Psychiatry Special Interest Group SIG has been running at the Royal College for
the past few years. Unfortunately, it was dormant for a few years. The changing demography of
the United Kingdom, the global village communication revolution and the mobilisation of
masses of people from one country to another due to different reasons, has put pressure on
psychiatric services and made transcultural awareness mandatory for psychiatrists in general and
those working in the United Kingdom in particular.
The Transcultural Psychiatry SIG has the responsibility of taking this rule, in addition to , leading
this field as an academic institution in the United Kingdom and all over the world.
Symposia about psychiatry in different parts of the world was started this year. The first
symposium was psychiatry in Asia on the 22nd of March at the Royal College. This is the second,
about psychiatry in the Middle East 21.06.2013
Planning ahead is paramount in academic. Multiagency and International work, for that reason,
plans were put for symposia for the following three years as follows:
1.Psychiatry in Africa 4.10.13
2. Psychiatry in Eastern Europe 21.3.14
4. Psychiatry in South America 20.6.14
4. Psychiatry in South East Asia 19.9.14
5. Transcultural Aspects of Schizophrenia 20.3.2015
6. Transcultural Aspects of Eating Disorder 19.06.2015
7. Transcultural Aspects of Perinatal Psychiatry 25.09.2015
8. Transcultural Aspects of forensic Psychiatry 25.03.2016
Plans for multicentre research and collaboration in different parts of the world and interesting
psychiatric fields i.e. faith healing in psychiatry, first episode psychosis, perinatal psychiatry, early
intervention, psychiatric sequel of epilepsy and eating disorder.
Liaison with the European and World transcultural Psychiatry special interest group is done.
Plans to revamp the Transcultural Psychiatry Newsletter has been started and relevant
interested and experienced colleagues were contacted and hopefully the first issue will be
posted on our college webpage soon.
Any suggestion or effort for any of the activities or other suggested plans are welcome in the
symposium or email to Sue Duncan sduncan@rcpsych.ac.uk or to hellme.najim@sept.nhs.uk