(Inaugural session, Part 2) 24th World Congress of Psychotherapy

Good afternoon.
I'm Glip Jesse and it's really my privilege to introduce our speaker, doctor Dris Mussai.
Doctor Mousaw has been really center of the development of the World Federation for psychotherapy.
Myself wouldn't be here but for doctor Mosavi.
He was one of the first psychiatrists in Morocco and he developed the Department of Psychiatry at the Casablanca School of Medicine.
He was a chair 1992-2013.
And actually that university became one of the best known universities.
He has written more than 150 papers, a number of books, other articles, and he was the first non European president of the World Federation for Psychotherapy.
In Casablanca, three years ago, he had a great conference, and he was also the president of the World Association of Social Psychiatry.
And his work in psychotherapy overall globally, especially on the psychodynamic side, but also other psychotherapy really has been phenomenal.
It is just an honor and a pleasure to welcome doctor Musaw and for his presentation.
Unless you want to add anything.
Dear, ladies and gentlemen, dear Tip, the honor is mine, the pleasure is mine to be here.
And, um, I'm very pleased also to have Shamari co chairing this session about intergenerational trauma and resilience.
I would like to thank Suhail, who asked me to address this very important issue.
So is it intergenerational, trans generational, or multi generational? We'll try to respond to this question at the end of this meeting.
Probably it's the three of them.
The first thing would like to say is that there is no life without significant trauma.
Saying this, remembering this figure that was given by the United Nations saying that about 80% of the total population of the world, one day or another had a significant trauma.
Okay.
I would like also to insist on the fact that transmission from one generation to another is absolutely cultural and probably genetic as well.
I remember in Thailand, you have one tribe in the golden triangle where this, the individuals do not wash themselves except once a year.
Because down, they had cholera about 800 years ago and the tradition became that water is not safe and could kill.
They went up to the source of the river and they wash themselves only once a year.
This is something cultural that was transmitted from one generation to another.
Um, trauma and violence is probably linked to every form of life.
I remember that there was a study that was conducted by biologists marine biologists who took 2 stones of corals.
Corals are made of unicellular, uh, individuals, I would say, and they put them in water with possibility to be fed and to live with the right temperature and so on.
They grew when they came into contact.
One coral was disturbed and the other one was growing faster.
At the end, one coral killed completely the other coral because they were in competition for the same natural resources in the place.
This exists.
Violence exists in vegetable and animal kingdoms, including human beings.
The so called Homo sapiens, unfortunately, is one of the most aggressive species, not only against other species, but against other groups of homo sapiens, slavery, rape, wars, and so on and so forth.
This place is absolutely, the consequence of the violence of human beings.
Inside the same group and family as well, violence towards the weaker, children, women going from spanking to anthropophy, relatively small and terribly aggressive.
The question is, Is an intergenerational transmission a survival mechanism? Probably.
In animals and probably plants as well, we'll come back to this.
This is a way to adapt to difficult traumatic events that is absolutely essential for Darwinian survival.
For example, just to remind that rice has twice more genes than human beings.
Because it has to adapt to extremely different situations.
When there is the sound of rain, the rice with its roots is multiplied the growth of roots of rice is multiplied by ten because of the sound, not the rain itself, the sound.
This means that there is from one generation to another, the memory of the sound of rain.
Another example, horses.
You have a horse that is born, let's say, half an hour ago and who sees a snake.
He will run away or it will run away.
This small horse, just born, newborn, has never seen a snake, has never been taught, and it is probably in DNA, something like a memory that this small thing on the ground is a terrible danger for the horse.
And in mice as well.
A study has been published on this epigenetic mechanism of stress responsiveness.
If you have a mouse, a female mouse licking and grooming the kids, then it's okay and those when they become adults will do the same to the next generation.
If for some reason the mother does not lick and groom, then the probability that the kids, the small mice becoming less good mothers one generation after is high as compared to the ones who were groomed and licked.
For human beings, same thing.
A mother that takes care well emotionally and physically of the kid and the kid will grow normally.
We know with many studies that postpartum depression, for example, has consequences over the next 30 years or 40 years in kids with mothers with postpartum depression.
First, physical growth.
Second, brain growth.
Third, at school, worse grades.
Third, they find difficult to have a job.
Fifth, they are thrown away from their job more easily and so on and so forth.
You see 25, 30 years after the consequence of this epigenetic mechanism of postpartum depression in humans, Um, it's interesting to remember that in utero, the development of every human being follows the animal conditions for the past 450 million years ago since we started with one cell only before becoming a more complicated organism.
Because we are, it is first in liquid omnous and then after that, being like crocodile or a snake or whatever, then on the four limbs then becoming vertical, I would say, as adult human beings.
Is the memory of all that in our DNA, it is highly probable The other thing also is that a person without trauma is morphogile.
We know the situation of barber kids and the immune system is not solicited, is not functioning because no bacteria and viruses are there to make them function and things that doesn't function die.
Another thing about violence and about crimes is that myths and religions do speak about that, do talk about that.
It's interesting to see that in the two first pages of the Old Testament, that is, the murder of one brother by the other, and the second thing is the incest.
Of the daughters giving alcohol to their father in order to make sex with them thinking that there is no man to have sex with.
The interesting thing also in all cultures is that fairy tales are full of violence and they are mostly aimed at children.
Why is it so? For example, one of the 1001 nights tales is the obligation for the hero to make sex to his mother.
It is there.
I mean, which is terrible world.
He had to do that in order to survive.
The interesting thing also is that horror movies are popular.
I'm asking myself, is it a kind of vaccination against evil? Exactly like bacteria and viruses are good for the immune system.
We have to think about terrible things, crimes in order to improve, to strengthen our psychological immune system.
Um, wars and famines and epidemics are cyclic thing.
In Morocco, in my country, it has been shown that every 30 years there were wars.
Every 30 years, there were famines.
Every 30 years epidemic big ones that kills about half the population of the country.
I was in a North African country and I asked the question, In a country where two civil wars separated by 30 years happened.
I asked the following question.
Does it happen in the same villages during the two civil wars.
I heard a silence.
Nobody thought of that in the audience for 30 seconds or maybe 1 minute.
That's very long when you have many people.
Nobody said a word about that, too afraid to answer the question.
The severity of a trauma, of course, for a person is not the same for a sibling, even for monozygotic twins and some traditions are traumatic for the children, for example, in Jewish religion in Muslim religion, and that is 1.5 billion people.
For males, there is circumcision and without anesthesia is very painful.
Why is it so? We've done a study showing that there are a number of psychological consequences with that.
I never I managed to find somebody in my team to do a study.
We've done a study on circumcision, but never found somebody to make a research study on ad ha.
That is, when we kill the lamb.
Sheep every year, once.
The interesting thing is that for children, when the animal comes home, they become friends.
I heard a father telling his son, you know, why we do that? Because I like him.
Why do you kill him? And the answer of the father was because Abraham had the order to kill his son, and this is why we killed the sheep instead of the son.
And I remember the eyes of the child terrorized.
I mean, a father can kill his son.
How come? Resilience.
It is also part of life.
Trauma is an essential part of the life and resilience as well.
When bacteria are in an aggressive environment, the first thing they do before dying, is to split in two to make the possibility of survival bigger.
Resilience must be collective to recognize, to publicize, and to repair individual with families, friends, psychotherapy, lifestyle, and psychotropic medications.
Pope Francis visited native people in Canada, apologizing for the abuse by Christians.
In Morocco, we had terrible political time in the 1960s with people who disappeared, people who were tortured and so on and so forth.
His son, the current king, Muhammad six, made it possible to reconciliate people, to apologize first, and to give them money in order to financially repair.
Pope Leo X on May 25, this year, apologized in the name of the Catholic Church for its role in the trade of slaves, the crime against humanity.
Slavery, I don't think there is more terrible thing than that.
12.5 million people were made slave and killed like that.
Emmanuel Macron, President of France and the parliament, recently They gave back the stolen cultural treasures to Africa African countries.
On the 28th of May, a few days ago, it deleted the racist laws that's called co noir, Black Code and they are thinking of repairing financially for centuries of slavery.
In individuals, we remember bad events much better than happy moments.
Why is it so? That's why it's called in psychology, negativity bias.
Because it's a survival mechanism.
If you forget where it was bad that almost killed you, then you could die more easily.
Um, concentration camps during World War two, some people survived and others no.
If I had time, I would explain.
Among survivors, some did exceptionally well afterwards, and evil, bad things happening to people may highlight the best part of us.
Here, in conclusion, I would like to say that significant trauma is part of life.
That violence against children is a risk factor for mental disorders.
We know that, especially depression, substance use, PTSD and so on.
That healing must be collective in the family community and in individuals.
But prevention of violence is a necessity for a better mental health.
A few minutes ago with S Awe, we talked about Boris Cyrilk, who is a psychiapist in France, who was a Jewish from Jewish Polish origin, and all his family was killed in concentration camps.
This man is How can I say in a light in the life of many, many, many people and not only patients.
When he smiles, it's, I mean, very smart culturally speaking, professionally speaking, humanly speaking.
This man, one of the things he did in Romania and elsewhere.
But he went to Brazil to favelas.
And their violence is terrible.
He took youngsters, adolescents and talked to them about football and about music.
These young people who were extremely with substance abuse and things like that, they stopped doing bad things and they had teams of football and music and so on and so forth.
It is the son of a family that was killed in World War two in the concentration camps.
That went to Brazil to make difficult moments humanly acceptable and nice not only for these adolescents, but for the whole community as well.
Thank you for your attention.
Thank you, Professor Musawi for this thought provoking presentation.
It does come at a time when maybe now perhaps more than ever, learning about trauma and resilience and the interplay between both is fundamental.
It's a highly relevant topic as we do have a lot of communities who continue to face a lot of adversities, would it be through wars, conflict, distress, among many other profound challenges.
The main idea would be thinking about trauma not mainly as the enemy.
Trauma can also be a way for growth, for hope, for resilience.
Although each and everyone's experience of trauma is unique and determined by so many factors, we still do have as professionals the responsibility to use each and every tool available to us to help the people affected in their healing journey.
Thank you so much.
Eager to know if there's any question in the audience we could take? No.
Maybe we'll keep them for later.
Yes.
Thank you.
So Okay.
What a mind blowing and very, very touching talk and panel and remarks we just witnessed now.
Very, very Deepflt thanks to all of you, all three of you.
I think we'll continue on something of a similar path and of importance, and it's a great pleasure and honor for us, Professor Nick Jaafar and myself, Helena Amundsen Isle, to welcome you to this panel where we will be the recipients of yet another special talk by Professor Vivian Pender.
Entitled Women A Survivors of Systemic Trauma, a Gendered Perspective in this highly important institution, the UN headquarters.
This Congress is truly a once in a lifetime experience for so many of us.
I'm delighted to say a few words about my co chair, Professor Nick Chafar and later Professor Pender, doctor Nick Roz Nick Javi is Professor and Head of Psychiatry at the Department of Psychiatry, Faculty of Medicine, National University of Malaysia, a medical graduate of University College Dublin with a Doctor of Psychiatry.
Her niche interests include psychotherapy, psycho oncology, emotional regulation, and lifestyle psychiatry.
She serves on the Council of the International Federation for Psychotherapy.
Then we have our very special guests, doctor Professor Vivian Pender.
Who is a clinical Professor Emerita of psychiatry at the W Cornell Medical College and was a training and supervising psychoanalyst at Columbia University for 25 years.
She was the 148th president of the American Psychiatric Association, where she is a distinguished Li fellow.
From 2007 till 2011, she chaired the NGO Committee on the status of Women in New York when she participated in the establishment of UN Women.
She also founded Healthcare Against Trafficking.
The floor is yours, Professor Bender.
Thank you.
Good afternoon, everyone.
Can you hear me? All the way in the back.
Great.
It's a pleasure to be here today speaking with you.
The title is Women as Survivors of Trauma.
This is, it's going to be very brief skeleton view of the problem.
But the objective is to explore the many ways that women survive trauma every day of their lives.
Whether they acknowledge it or intuitively work around it or succumb to it, women live in a sexist world that traumatizes them simply because of their gender.
The question is, can this be prevented? I think that most of you are familiar with this statistic, one in three women worldwide, and it reflects actual violence, not lesser forms of sexual harassment and sadly, a figure that has barely changed since 2000.
On the 8th of March of this year, on International Women's Day in this very building, the UN Secretary-General Antonio Gutierrez said, Today we are witnessing a dangerous new trend, rising authoritarianism and a renewed push to entrench patriarchy.
Hard won advances for women are being rolled back from work protections to sexual and reproductive rights.
At the same time, the mannosphere is growing with in cells, rape academies, man camps, pronatalist policies, and glorification of violence against women.
When women don't have equality, when half the population's freedoms and rights are at risk of being eliminated, and this subjects them to injury and illness, this should be considered a global public health crisis.
If this were a highly transmissible virus that was suddenly found to be injuring just a third of all women, that's 1.2 billion on Earth, it would be considered an epidemic.
And there are downstream effects.
Patriarchy is the ideological system in which most of us live and sexism is a social determinant, that is the practice of patriarchy.
These are the root causes of trauma and traumatic mental disorders.
I'll give you a brief example.
A 13-year-old living in a rural village in a low income country reported at a recent UN conference that when she began menstruating, it meant a week out of every month that she was out of school.
There were no sanitation facilities at the school, and she was unable to run the 3 miles to get there.
But perhaps worse, she feared she would now be more identified by her gender, at greater risk of having to drop out of school, being sold for marriage, and at greater risk of rape, kidnapping, and trafficking, all severely traumatic experiences.
What is patriarchy? For the purpose of this presentation, most sources define patriarchy as a society controlled by men in which they use their power to their own advantage.
Men hold primary authority over family, property, politics, government, religion, economics, and social life.
It is an ideology, a set of ideas, doctrines, and beliefs that creates systems and structures, many of which are unquestioned and can be internalized by everyone.
What is sexism? It is basically prejudice or discrimination based on gender usually applied to women and girls.
The term originated in the 1960s during second wave feminism and was modeled on the civil rights movement focus on racism.
It is a belief that one gender is superior to another.
Some studies break it down into two kinds.
There's hostile sexism, which is antagonistic and aggressive toward women, and benevolent sexism, which is paternalistic, condescending, and controlling of women.
In the 21st century, sexism now includes the oppression of any gender, including men and boys, intersex, and transgender people.
Regardless of gender, the trauma of sexism takes a toll on the anatomy and function of the brain and the microbiome by stressing its capacity.
Toxic stress on the brain increases cortisol and norepinephrine.
Imaging shows a smaller hippocampus, which is related to memory, an increased amygdala, which is related to fear, and decreased medial prefrontal cortex, which is related to executive functioning.
What we see in a clinical setting is traumatic disorders such as PTSD, personality disorders such as borderline personality disorder, anxiety, depression, suicide, homicide, and I could add eating disorders and addictive disorders.
These are some of the individual family, commercial, and government sponsored forms of sexism.
All except the foot binding, are current.
These are current practices.
Every year, for example, every year, 4 million girls undergo FGM.
Half are under the age of five.
An estimated 230 million girls and women alive today have been forced to have FGM.
It is a painful, dangerous procedure.
Presently, 680 million women live with domestic violence and gender apartheid is the complete exclusion of women from public life.
There is not enough political will to prevent these from happening in the first place.
I'd like to focus for a moment on human sex trafficking because it is a prime example of patriarchy and sexism.
The majority of victims are women and girls, although boys are trafficked too.
The majority of buyers are men.
There's an estimated 24 million being trafficked each year, and it is estimated to be a $50 billion a year industry, more lucrative than trafficking arms and drugs.
Because you can reuse a person again and again.
Example, a 12-year-old living in a high income country, the United States, had been repeatedly sexually abused by her uncle.
Reporting him to her parents didn't stop the abuse.
She ran away at the age of 14, became homeless, addicted to drugs, and was picked up by a trafficker.
He thought of himself as a businessman.
He loaned her out to work for pornographers.
She was then arrested for the crime of prostitution, while she was being trafficked to have sex with 20 to 50 men a day during the World Cup Games.
She died by suicide at the age of 26.
The average age at which sex trafficking begins is 12 to 14-years-old.
They are walking around in plain sight.
Sex trafficking frequently includes this continuum of rampant child sexual abuse, pedophilia, misogyny, pornography, capitalism, and criminalization of a prostituted victim.
Recently, the laws have changed somewhat so that the buyer can now be arrested.
However, prostitution in its many forms such as brothels is legal in many areas of the world and it relies on trafficked women and girls.
A little less brutal but still oppressive is the high cost of economic disadvantage.
Some reports indicate that gender norms appear more egalitarian than ever before.
Yet despite a century of action, women are still being held down by the persistent pay gap, unpaid work, and sexist workplaces.
Also the daily financial stress, old age insecurity, and intersectional income loss.
For women of color, losses often exceed $1 million over a lifetime due to the compounding racial and gender discrimination.
If you investigate Nobel Prizes that have been awarded since 1901, the average in all categories for women laureates is 5%.
In science, it's less than 1%.
This is attributed to The leaky pipeline.
In 2024, in fact, all seven Nobel laureates in science were men, reflecting the larger problem of gender bias in the sciences.
They are talking about how there are hundreds of thousands of women in high income countries leaving the workforce now.
I've been told that investment banks can't find a woman to fill top leadership positions, even though they're giving a year and a half maternity leave.
I remember when I had to choose between putting my kids on the school bus or being at morning rounds, which they wouldn't change from 8:00 A.M.
To 830.
They said, We don't care.
We don't care what you have to do at home or the rest of your life.
We expect you to be here no matter what.
So I quit after suffering a bit, but I quit.
I was one of those leaks in the pipeline.
There is also a cost of patriarchy for men.
Patriarchy as a system not only harms women, although women undeniably bear the greater burden.
For men, patriarchy imposes a different but equally harmful set of expectations.
Many societies require men to be strong, aggressive, emotionally restrained, positioning them as providers with little room for vulnerability.
These expectations significantly impair men's mental health as well as their social relationships.
Perhaps because of this, men are overwhelmingly represented in the military, in prisons, in the police force, in firefighters and professional contact sports, where there is a normalization of violence, jock culture, promoting abnormal pain tolerance, toxic masculinity, as well as traumatic brain injury.
80 to 90% of convicted criminals are men.
So what can we do in 3 minutes that I have left? I want to focus on prevention because I think that this is something that we can all do.
We can do this in our office, our clinics, our hospitals, our workplaces.
Primary prevention aims to prevent disease in the first place, like a vaccine.
We can prevent exposure to hazards by altering unsafe environments.
We can remediate the sex environments, detection systems for incipient violence, and identify risk factors for the abused and the abuser.
And we can create a database of sexist workplaces.
Many of us have gone through systems where we know which workplace is dangerous for women.
We know it and we turn the other way or we don't admit it, and it's unknown as we watch.
Personally, I have watched young women go through residency programs where they were told they couldn't get pregnant.
They were told not to stand too close to that chief because you would get molested.
That's absurd in this day and age.
Secondary prevention is basically early intervention, train health care, regular exams, identify and rehabilitate the abuser, which is also very important, just like the buyer of a trafficked person in order to have sex.
And tertiary prevention is really basically what we all do.
We treat patients after the fact, after the injury and abuse has already occurred.
But we can we can implement safer programs to return people to their original health and function and prevent long term problems.
So to conclude, much of the trauma that women sustain is hidden in plain sight.
The Lancet Commission on Global Mental Health stated that research consistently showed a strong association between social disadvantage and poor mental health.
At the individual level, the commission reported that poverty, childhood adversity, and violence were key risk factors for mental disorders.
As US Supreme Court Justice Ruth Bader Ginsburg famously said, All I ask of our brethren is that they take their feet off our necks.
Rather than just surviving, women need a different social system in which to live and thrive in ways that will benefit all of society.
Thank thank you for your attention and thank you for your comments.
Thank you, Professor Pender, for that very thought provoking and compelling presentation.
So you have actually reminded us how understanding the brutal truth of the women's lived experience goes beyond, individual narratives and consider so many social and structural contexts in which trauma exists, the many layers of it.
We are grateful for these valuable insights, and I think the most important question that you post for us to consider in our everyday life, can we prevent it? Thank you so much.
Thank you so much, everyone for your attention.
Welcome to panel.
Thank you.
Thank you.
Good afternoon.
A pleasure to share this session along with doctor Tims Sullivan and to introduce Professor Alvin Tai, who will talk about building the evidence base for psychosocial risk management in humanitarian workforces.
Professor Tai is the psychosocial well being Program Officer at the United Nations since 2018 and a unt Professor of clinical psychology, a Teacher's College, Columbia and of Psychiatry and Mental Health in Clinical School of Medicine in Sydney.
He works at the intersection of global mental health, implementation science and innovation, focusing on conflict affected populations and the humanitarian workforces.
The floor is yours, doctor Tai.
Okay.
Are we good? Yeah.
Okay, great.
Good afternoon, everyone.
What an extraordinary day for us together here and time and having these invigorating conversations about the mental health of humanitarian workers at a historically critical juncture, really.
I want to start by acknowledging the efforts that have gone into this conference.
The organizing committees at the UN, of course, my team members, WFP, and Ning as well.
Now, I know this is a bit of a graveyard session, our attention wanes as the day drags on, but bear with me.
It's a half an hour talk.
Today, I'm going to take you through Some of the key foundational pieces of our work on psychosocial risk assessment in the humanitarian workforce.
There are three parts to my talk.
First, we're going to look at the epidemigical literature.
What does it say about the mental health and psychosocial well being of humanitarian workers? Drawing on the largest dataset we have established on this particular population, we'll look at in part two, what are the key protective and risk factors impacting on their mental health.
As 19 settings, very different contexts across UN offices, duty stations, humanitarian settings, and so on.
Then in part three, we're going to look at the measurement component of this work.
That is, how do we know we're measuring the same phenomena, the same constructs across different settings, different cultures, different populations, and so on.
We're going to dive into these different topics, and then I will end in closing with the future directions of this work.
How do the findings, insights translate into psychosocial risk management across the UN system.
So This has been a long journey.
We started this journey about eight years ago, and I would be remiss not to acknowledge the contributions of individual members of our team, of course, our regional stress counselors, few counselors who some of whom are with us today, current chief and our former chief as well.
At the time, we did a systematic review and we couldn't find an integrated package that takes into consideration all key relevant recent protective factors impacting on our personnel.
So really, that was the impetus behind developing our own package.
So we developed our own package, which includes a set of standard mental health screening tools for PTSD, anxiety, depression, and burnout.
And hazardous drinking and also an adapted version of the Copsk.
For those of you who don't know about the Copsk, it's a widely used instrument is called the Copenhagen Psychocial questionnaires, a widely used instrument for assessing symptoms of burnout psychosocial hazards in the work environment.
And then we also have supplementary indices in the package assessing traumatic exposure, for example, ongoing adversities, worries about families, relationships, resilience, and general health well being and so on.
And we validated this package.
We adapted it extensively.
To many different populations and validated it initially in a large multinational workforce sample over 125 countries.
Now we have deployed this package in various adapted forms across 19 very different settings.
Today, we're going to look at some of these data insights from this very unique database.
To our knowledge, this is the largest humanitarian workforce mental health dataset that's ever been collected and analyzed.
First, let's look at the epidemiology.
What does the data tell us about the UN workforce in general, across different settings? How does the actual mental health and psychosocial burden look like and how is it distributed and differentiated across different geographical regions, duty stations, locations, social demographic characteristics? We're going to focus on these questions in the next part of this talk.
So the data we have collected, they are drawn from many different ations across very distinctive distinctive geographical regions, including Asia, Africa, Middle East, Americas, and Europe.
And we have also collected data at the HQ at the agency's level as well.
So the regional groupings are used here, they are not They are somewhat different from the UN operational groupings, but rather just to give you a general sense of how the mental health burden varies across regions.
I also for security reasons, intentionally removed the names of specific duty stations.
But if you look closely at this chart, you will see that our personnel from Eastern Europe, you probably figured out the country I was referring to.
But from Eastern Europe and Mya, so that's Middle East and North African region have much higher rates of mental health problems compared to colleagues from the other regions.
That is about roughly 64% screen positive for one or more symptoms of PTSD, anxiety, depression, and burnout.
Then you have colleagues from Africa occupying the middle tiers here, followed by colleagues, personnel in Americas and the frontline security professionals.
The bottom group came up as a bit of an anomaly because they are such a globally dispersed workforce that they are not necessarily restricted to one geographical region.
The variations you see here in some way mirror the heterogeneity that we see in the post conflict epidemiological literature where a combination of historical, social, cultural, political factors really interact with structural vulnerabilities in shaping the mental health and psychosocial responses in local populations.
It's also worth noting that half of the sample in our studies, half of the samples included national humanitarian workers as well.
Who have been exposed to comparable levels of trauma, adversity, socioeconomic challenges, other forms of adversity as the local populations.
Now, if we desegregate the data, the mental health outcomes and compare the prevalence rates between UN personnel and and conflict affected, in general, conflict affected and disaster affected populations, you see that they're roughly comparable.
In the case of PTSD, humanitarian workers, especially those in peacekeeping missions, political missions had higher rates of PTSD.
Of course, this is mostly cross sectional data is subject to the usual caveats, as you know, methodologically, but it's important to note here too that, as I said, half of the personnel from all studies, they are locally recruited national staff members.
There's been increasing emphasis on the mental health of national staff, as some of my colleagues have alluded to and at the highest level to here at the UN.
I think it's evident from my colleagues remarks this morning that humanitarian work takes an enormous toll on our personnel's mental health and well being.
That observation is well supported here by our data If you look at our personnel in peacekeeping or political missions, they have much higher rates of PTSD.
They actually have the highest rates of PTSD compared to personnel in other settings like country offices, agencies and so on.
Whereas personnel in those settings, country offices at much higher rates of burnout, depression, but less exposure to traumatic stress.
This is an interesting and meaningful distinction if you really think about the life experiences of our personnel across these different, very different contexts, right? Personnel in humanitarian contexts in humanitarian settings, peacekeeping settings, they are frequently exposed to cumulative cumulative exposure to trauma and adversity and direct threats to their lives compared to colleagues in other settings.
That experience has translated manifested in very high rates of post traumatic stress.
This is also consistent with other work that's come out of other sections of mother department.
For example, the medical team, they also did a systematic survey With peacekeepers, with the blue helmets and then there was a strategy that's focused on PTSD in uniform personnel that came out of that.
Now, this finding, perhaps it's unsurprising, and I think it's also echoing Professor Bender's talk just now.
Female personnel, we know that this is a striking finding that came out repeatedly in our data is that female personnel consistently recorded higher rates of symptoms across depression, anxiety, PTSD and burnout across all settings.
And these gender differences are particularly pronounced for depression and anxiety, especially for national and local staff members, many of whom are, as I said, exposed to daily adversities, structural vulnerabilities, including gender based violence, sexual violence, inequalities, and socioeconomic challenges as well.
And the pattern here is consistent with the broader occupational mental health literature and our data close to 4,000 female personnel provides further evidence to support that observation.
I think I have 3 minutes left.
Time goes really fast when you're up here.
A mental health professionals, we all know co mobility is extremely common and now this extends to the humanitarian mental health literature as well.
So but the good news here is that almost over half of the personnel in our sample, they screen negative for any of the four symptoms of depression, anxiety, PTSD, and burnout.
So that's good news.
So that shows how remarkably resilient they are.
Now, Quickly going through the predictors of mental health in the humanitarian workforce.
Here, what I wanted to highlight mainly is that we found that there are variations in mental health symptoms at the duty station level and at the individual level.
What we did here was we petition out the variance of each variable and then looked at how each risk factor was distributed across these four conditions.
What we found was that contrary to popular belief, it's not the location of the individuals, but rather the individuals lived experience that really matters here.
That location only accounted for a small amount of variance in each of these variables.
Now, this is where I think the psychosocial context, the work environment really matters here.
And so we did a machine learning model.
We trained it to help us predict the mental health risk in this particular sample.
And what we did was basically as the model to help us predict who would screen positive for PTSD, depression, anxiety, and burnout, and then weighted each of these predictors accordingly.
And it turns out that here work life balance is perhaps unsurprising, was by far the single the single strongest contributor, followed by job satisfaction, getting recognized and treated fairly at work and most critically the level of quality of support they get from supervisors.
Now, if you visualize this data, in this way.
Here, each dot on this chart represents a single respondent and where that dot sits, it gives you an idea of how much a given psychosocial risk moved depending on the individual's predicted risk.
I want to draw your attention particularly to the red clusters.
The red clusters have predictive values as opposed to the blue clusters and the red clusters on the right, they represent higher risk, and then on the left, they represent lower risk.
You see a lot of red dots clustering around job satisfaction, getting recognized, treated fairly at work, and manager support.
On the left.
Then on the right, you see red clusters around work life balance, imbalance, higher work pace, workflow, and work demands.
I'm nearly there, so it's 2 minutes.
Now, part three, this is the last part.
We're coming to the last part of my talk.
Psychometricians in this room I think the slides are moving.
Okay.
All right.
So psychometricians might be familiar with this concept of measurement in variance.
Basically, we want to measure we're measuring when we're measuring a mental health construct, whether it's depression or anxiety using an instrument, especially in cross cultural settings, we're assuming that the underlying construct differs from person to person from setting to setting until proven otherwise.
This is especially important if you consider the characteristics of the humanitarian workforce, the UN security workforce covers 150 plus countries and our personnel speak many different languages, they're from different culture backgrounds.
The key question here really is, was there any systematic variation in the ways our personnel responded to questions about depression, about their mood, depression, anxiety, symptoms, burnout, and so on.
We did a lot of hundreds of tests looking at the Looking at whether and to what extent symptoms of depression, Burnell, anxiety, and psychosocial hazards varied across sites.
What we found was that after accounting for site level differences, both the depression anxiety models show evidence of measurement in variance across sites.
That is, you can say that the personnel across 13 sites responded to these questions share about their symptoms in more or less uniformly the same way.
The last slide here is one of the key implications from this work is that we now have an empirically calibrated model that's based on the largest humanitarian workforce datas that can help us accurately predict mental health risks in our workforce.
This could help organizations, could enable them to optimize their strategies to address those risk factors and mental health symptoms.
Yeah, the need for a common minimum data set for psychosocial risk.
That's clear and I think we have done that here.
Thank you.
Thank you.
Thank you, doctor Tate.
Very fascinating, really well done work.
I think we probably won't have time for questions given.
1 minute.
Okay.
Okay.
I think it raises interesting questions from your data about the differing levels of types of stress, whether environmental stress, vicarious trauma, or direct trauma.
It seems like the population you're looking at may have experienced all of those different varieties and resulting in different outcomes.
Yeah.
Yeah, absolutely.
Any questions? Well, there's a lot to digest from your presentation.
No, it's really we look forward to you publishing it? Well, Sort of interesting to read issues publishing.
Yes.
Yeah, we can talk.
That's that's fascinating.
Yeah.
Thank you.
Thank you.
Thank you.
Thank you.
Good afternoon, everyone.
I'm doctor Alma Jimenez and to my right is doctor Constantin Delia.
We are colleagues from the University of the Philippines, Manila.
We are both chairing this session on safeguarding mental health in the UN workplace.
Let me start by introducing our speaker and then giving a short introduction to her lecture.
What does it take to build effective workplace, mental health support across some of the world's most complex and demanding environments? Doctor Nena Uduque Ertz, UN System Workplace Mental Health and Well being Strategic Lead will give a compelling plenary on Global Workplace mental health.
A chartered clinical and forensic psychologist and scientist.
She brings extensive leadership, research and clinical expertise from UN duty stations in Iraq, Afghanistan, and South Sudan.
Drawing on her experience, leading UN counseling initiatives, doctor Unuke Hertz will examine staff well being, the challenges of delivering mental health services across diverse cultural contexts, and practical strategies for training, supervision, and collaboration that expand access to high quality care.
With that being said, can we welcome doctor Uunduke Hertz by giving her a round of applause? Thank you very much.
Can you hear me? Yes.
Great.
Thank you very much for the warm introduction and it's a real pleasure to brief you on safeguarding mental health in the UN workplace and to really just touch upon what I see or what we see as strategic priorities for quality control, accountability, and collaboration.
You might ask why this topic.
Certainly within the UN, mental health in the workplace is a high priority.
It's certainly one of the Secretary-General priorities.
Mental health within the workplace, of course, consists of a lot of things beyond just counseling.
Leaders clearly have a responsibility.
It takes a multi stakeholder approach to be able to ensure that our staff remain protective.
It's not just a personal issue, but it's more or less a systemic issue to ensure that we have the right protocols in place to safeguard our staff within the UN.
And it's all very well having mental health and well being structures within the UN, but without the right quality and accountability structures, there can be real challenges.
I can assure you today that I will be brief just to give you a snapshot of areas within this intervention.
Um, so many of you will probably be aware that we have a mental health strategy that's within its second iteration.
So it's a 2024 and beyond mental health strategy.
This really provides us with a framework to really guide the psychosocial work that we do across the UN on a global level.
The mental health strategy is divided under three different pillars, on the prevent, promote, and support, and you can see here there are 13 and different indicators.
Last year, we had a 13th indicator added for family support because it was recognized that family support is a good indicator to have to support staff members within the UN.
There are 13 different indicators that allow us to ensure how we monitor the work that we're doing across the board.
All these indicators are important to the work of psychosocial and mental health workers within the UN, but also for non mental health professionals across the board.
But my intervention will focus more on the support pillar, eight and nine, access to psychosocial support, but more specifically around quality control for psychosocial support.
Why safeguarding mental health in the UN? You heard from Shal's presentation before the lunch at plenary about the different conditions that staff are exposed to when working across the UN.
Having good mental health is critical for UN staff who are operating in often high risk, stressful environments.
It's important to ensure that staff have good level of well being and in order to perform their organizational responsibilities.
Um, we are often exposed to traumatic situations, working in isolation, often may be affected by different factors related to the way that work is organized and managed and all these can cause high levels of stress for our staff members.
Having a good structure in terms of mental health strategy, but more importantly, having access to psychosocial support services is important to safeguard the mental health of our staff and it's a duty of care obligation for the UN in general.
But more importantly, it's also important to have that support from leaders within the organization who are often there to champion and support and provide the adequate funding to ensure that we're able to work efficiently and reduce those organizational risks.
So what I'm hoping to cover today fairly briefly is to really just provide a snapshot and really promote the importance of the role of counselors.
So those staff members who are assigned to provide psychosocial support across the UN and to really just emphasize the importance of how this role is significant in safeguarding our personnel.
And to really also highlight some of the geographical challenges that may exist such as licensing, language barriers, stigma, but also the challenges that might arise from working in diverse settings and hardship locations.
There's a lot to cover, but I'll try and be brief overall.
Also because of the limits in time, I'll allude specifically to the training opportunities that are available across the UN to promote and support staff development across our staff counselors.
Why counseling matters? A lot of you, this is very much a straightforward question.
Good counseling, of course, supports our staff with coping with stresses such as exposure to violence, displacement, and also workload pressures, and the importance of having staff counseling, of course, aids in recovery and resilience of our staff members.
Without adequate quality control, that can often lead to risks amongst the performance within our staff.
Confidentiality breaches and also lack of support can mean that staff are then inadvertently affected and not able to perform the jobs that they have signed up to.
So the mental health strategy and the work of staff counselors really emphasizes the importance of having adequate access to counseling at the right time and making sure that it's promoted in a fair manner.
And so quality standards are really important to have across the board to ensure that duty of care is not compromised and the risks are reduced.
So the provision of psychosocial counseling services aligns very closely with the mental health strategy.
The strategy emphasizes that mental health is not just a responsibility of mental health professionals.
HR directors, managers within the UN all have a role in ensuring that they provide adequate oversight for mental health and well being and services.
Counseling, of course, is a core pillar an important pillar is there to ensure that risks are mitigated and adequate support is provided to staff when they need it.
Having that system level wide accountability and alignment is increasingly important to ensure accountability across the board.
What should our priorities be? In 2023, the UN's Joint Inspection Unit identified that we needed to strengthen certain areas when it comes to standards for counseling and these are really important areas to ensure that quality counseling is provided across the board to our personnel.
So within the UN, we have the UN Staff and Stress Counselors Group, which really emphasizes the importance of having unified standards and protocols for counselors across the board.
Every counselor has to have at least five years of relevant experience postgraduate.
In countries where there is no licensing, a flexible approach is adopted.
And so we need to ensure that there is that geographical, we reduce the geographic constraints when it comes to licensing and non licensing for our counselors.
The UN also emphasizes the importance of having clear and strong ethical standards, but of course, we also need to ensure that quality assurance and risk management is taken seriously.
I think this is an area that we can continue to strengthen through ongoing training and support that's provided quite regularly by our stress and staff counselors.
Um, the UN Stress and staff counselors group often provides regular forums where there's opportunities to exchange and dialogue, and there's also the regional level, our stress counselors are providing adequate support to national counselors as well to build their capabilities.
Uniform standard and unified standards for counseling services is of high importance.
Priority, number two, I believe that it's important that the governance and accountability is strengthened for staff counselors, there has to be clear governance structures beyond just the technical supervisors.
Within our setting, it's important that there is strong support from leadership in championing and resourcing for the role of counselors within the setting.
Um, Confidentiality, of course, needs to be improved and preserved, especially when it comes to the different types of line management that might be there.
It's important that there's the good technical supervision, but that when there's an exchange in information, that information is kept confidential to the highest standard.
The other thing around accountability and cultural sensitivity is ensuring that our staff counselors continue to adopt culturally sensitive approaches to the work that they are doing on a global level and seek to adhere to the cultural norms within the domains of their work.
What do we need to do then in terms of, I see you have 3 minutes.
Time flies so quickly in terms of strengthening impact.
One of the calls for action is to say that um, It's important to have unified standards.
Within our system, staff counselors come from a plethora of different backgrounds from psychiatry to clinical psychology, from nursing to marriage and family therapist, but using the term staff counselor as their title, but it's important that we continue to adhere to those unified standards and to promote regular supervision because of course, that would then improve the quality of the services that are provided as well.
We also probably need to do better at selling the value of what we are doing in terms of the fact that adequate and quality counseling interventions helps us in improving mission readiness, it reduce risk, and it also helps to foster a healthy workplace culture.
Then also, finally, as well, I said at the beginning that when it comes to mental health within the workplace, counseling is only a fraction of that.
There are different aspects of the workplace that we need to take into consideration when thinking about mental health in the workplace.
Leaders and stakeholders have a key role in championing the importance of hiring the best quality counselors, but also advocating for resourcing and funding to ensure that our services run effectively.
So in conclusion, counseling is a central aspect of UN duty of care and mission effectiveness.
Quality requires adequate standards, governance and accountability.
This is something that we're continuing to work to strengthen in our different domains and it's our collective responsibility to ensure that every UN staff member, regardless of their duty station, have access to safe, ethical and high quality mental health support.
There we go.
I think I've met the 3 minutes.
Thank We have 2 minutes.
Bye.
Thank you, doctor Enuque Hertz, for your insightful lecture, or what you have described, the cumulative weight of witnessing suffering at scale, the moral strain of working within institutional constraints, and the dangerous silence around inner distress.
This is not unique to the United Nations.
It is precisely what we ask psychotherapists to carry every single day.
The parallel is striking.
United Nations personnel the world's pain across nations.
Psychotherapists hold it across consulting rooms.
In both contexts, the helper is expected to remain present, regulated and effective, while rarely being asked, and how are you? Taking care of mental health in the United Nations workplace is at its core, the same task as protecting well being because both are about one fundamental truth.
You cannot sustain the work of healing others if no one is tending to you.
At the WPA psychotherapy section, we have long championed therapist self care as an ethical imperative, not a personal luxury.
Today, we extend that same conviction to every professional whose work requires them to hold human suffering, including the remarkable people in this very building.
The world more than ever needs healthy helpers, helpers who are known, seen, and held in the fullness of their humanity.
Let us begin there.
Thank you.
So with that summary, we would like to thank doctor Wunduk Hertz for her lecture.
The tree enforces the UN's commitment to providing safe, effective, and equitable psychosocial interventions that promotes staff resilience, productivity, and overall organizational health.
Thank you very much, everyone.
Thanks.
Yes.
And you know how to use the microphone if you want to, okay? Good afternoon, everybody.
Thank you to be here until this time.
Firstly, we would like to thank Cesar Alfonso at the WFP for this incredible conference in this amazing and honoring venue.
I'm going to introduce my the chair of this panel, Helen Nelson Lee.
She's Professor of Clinical Psychology and researcher at the University of Oslo.
She's also a practicing psychotherapist and psychoanalyst.
Please.
Thank you so much, Daniella.
Thank you so much.
It's lovely to be back here this soon, I must say, and a warm welcome to this panel.
We have two brilliant presenters with very thought provoking and deeply meaningful talks spanning quite different topics, but yet with some common ground that you'll talk about.
My co chair, Daniella Pérez, is a close colleague, a psychiatrist and a psychotherapist and a junk professor in child psychiatry at Las Pienza, University of Rome, and a professor at the School of Dynamic psychotherapy.
She's also a painter, a graduate of fine art, which I think adds an extra dimension to her work as a child psychiatrist.
Also, Daniela, we have two great presenters.
You'll start with the first one.
We have brought some images for a very brief quick 2 minutes introduction because this panel is particularly important about the topic and it's about women.
And so when we speak about the future of psychotherapy, we often think of innovation, neuroscience, artificial intelligence, and technologies, or new models of care.
But perhaps in order to move forward, we also need to look very far back to the origin of human expression.
Can you switch to the first? Thank you.
Here we are.
The earliest images created by human beings were painted on the walls of caves during the Paleolithic era and many of these images were made by women.
Women were not marginal figures at the beginning of a human culture.
They were central to the creation, not biological, but creation of images.
These images tell us that human beings were not defined only by survival or hunting adaptation, They also represented the memory of affective relationships, as you can see, women were able to transform experience into meaningful images, giving form to an inner world with their imagination.
Perhaps this is where psychotherapy must return.
Women can lead back to the capability that Italian psychiatrist Fagili Massimo identified as the main characteristic of human beings, the capability to imagine the forcelence formorgan present from birth in every person.
That's our talent.
Women psychiatrists have a crucial role in this future.
We must have the strength to rethink and to rewrite the history of the human mind from the past to the future.
The future psychotherapy cannot be only technique.
Reduction of symptom and management but the psychotherapy should give back patients the capability to imagine vitality, affectivity, relationships.
This can be the work of rehumanization for the future society.
To go forward, we need to recreate our childhood.
Thank you so much for this quick introduction and I'm going to introduce Silvio Latino, the next speaker.
Sylvia is a friend.
She is a professor clinical professor of psychiatry in New York Medical College of Alaa, New York.
She is past President of American Academy of Psychoanalysis.
She's past President of the Association of Women Psychiatrist.
Indeed, she's senior attending at Lennox Seal Hospital, New York City.
She's distinguished life fellow of the American Psychiatric Association and fellow of the American Academy of Psychoconomic Psychiatry and Psychoanalysis.
She's been awarded several times.
Since 1999, and she published on many subjects like New psychology of women, sexual abuse of patients by psychiatrists, cross cultural psychodynamic treatment, PTSD, and innovative psychodynamic approaches to outpatient treatments.
Please, Sylvia, thank you.
Thank you very much for that introduction.
I'm going to be talking fast because I want to make sure that I covered the most important aspects of this presentation.
Um, what is domestic abuse? Domestic abuse, domestic violence or intimate partner violence? Are patterns of behavior in any relationship used to gain or maintain power and control over an intimate partner? It can be physical, sexual, emotional, economic, psychological, and it's all to influence another person.
Can include any behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, or wound someone.
It can happen to anyone of any race, any age, sexual orientation, religion, gender, or class.
It can occur within a range of relationships and affects people of all socioeconomic backgrounds and educational levels.
Domestic abuse has existed Throughout the ages, has been condoned by all cultures, traditions, religions, political systems, is present in industrialized countries and in countries in development.
It transcends educational and economic levels, and often it can be traced intergenerationally.
Let's talk about Domestic abuse timeline in the United States, 15 to 1,800.
Early settlers followed an old English common law, explicitly permitted wife beating for correctional purposes.
States tried to break away from that law, and they determined that the husband can only whip his wife with a switch no bigger than his thumb, early 1,500.
Nothing much happened until about the 1,800, when Alabama was first stated that resin the legal right of men to beat their wives, 18 71.
Maryland was the first state to pass a law that make wife being a crime punishable by 40 lashes or one year in jail, 18 82.
With Queen Elizabeth rise to the English throne, lawmakers enacted reforms for women.
Wives could no longer be kept under lock and key.
Life threatening beatings were considered grounds for divorce and wives and daughters could no longer be sold into prostitution in 1,800.
1,919 60s, women with, I have to remember, Women win the right to vote for the first time with the passing of the 19th Amendment, 1919.
This lays out foundation for the feminist movement of 1950 and 1960s.
Civil rights, anti war, and black libération movements challenged the country's judicial system.
Congress began passing laws that prohibited discrimination against women in employment and requiring equal pay for equal work.
1965, the state of Maine opened one of the first shelters in the United States, 1967.
The women's libération movement started.
It claims that what goes on in the privacy of people's homes is deeply political, 1960s, 1970s.
In the 1970s, Domestic abuse, women began the discourse on to expand it to violence against women, spouse abuse, and sexual assault.
Women recognized three major contributors to the violence against them, economic disparity, traditional role expectations for women, and criminal justice systems that did not hold men accountable for violence committed against women.
Battered women movement was born, instilled by realities, for example, in Chicago, married women who leave their husbands due to battering were denied welfare because of their husbands salaries.
Grassroots organizing factors or efforts transform public consciousness and women's lives.
We will not be beaten.
Mantra of women across the country organizing to end domestic violence.
Emerging professional literature highlights the notion that women face brutality from their husbands and indifference from social institutions, 1970s, informal networks between women sharing information, strategies, and support appeared.
Okay.
In 1980, the Pennsylvania Coalition Against Domestic Violence began holding regional retreats and strategic meetings in 1981.
The Pennsylvania Child Welfare Resource Center appeared.
The Victims of Crime Act, the Victims of Crime Act is amended to make awards available for the first time to victims of domestic violence, 1988.
By 1989, though, the United States has 1,200 battered women programs which shelter 300,000 women and children per year.
In the 1990s, stalking first was identified as a crime.
For the first time, judges are required to consider any history of spouse abuse before determining child custody or visitation rights in 1990.
The Surgeon General ranks abuse by husbands to be the leading cause of injuries to women aged 15 and 42 44.
That was in 1992.
The American Medical Association releases guidelines that doctors screen women for science of domestic violence in 1992.
So with all this information, what was happening to the people that were working with victims of domestic violence? In 1979, Leonor Walkers, in her very important 1979 book, The battered women came with a cycle of abuse.
This cycle of abuse is very well recognized by patients, not so much by worker because I think that it's incomplete.
But still, Tension builds.
The abuser creates tension around the victim.
Incident, it can be any kind of abuse of all the ones that I mentioned before.
Reconciliation, The abuser makes some kind of excuse or even maybe some attempt to just to ask for forgiveness and the victim acquiesce, there is calm.
The victim expects that is the only time that it's going to happen, the calm repeats itself.
That's why the name of cycle of abuse.
But the people that were working with this victim decided that this was definitely not enough to define what their cycle of abuse was.
They created what is called the cycle, the will of power and control.
And this happened in 1982 and in Minnesota.
And they described that the The abuser uses intimidation, emotional abuse, isolation, minimize denying and blames, using children, using male privilege, using economic abuse, and coercion and terror.
That's how the abuser prepares the environment.
Now, in in 2026, the FBI reported based on the uniform crime reporting program, the domestic Relation and Violence crime of 2020, 2024 report.
They only took into account the violent crimes of murder, rape, robbery, and aggravated assault, where the victim to offender relationships meet their criteria.
Over the five year period, studied the percentage of violent crimes within women's domestic relationship increased.
Law enforcement reported more than 11,000 domestic murder victims and an additional 1,100,000 victims of domestic violence.
Nearly 75% of the victims were females.
At that time in 2024, they came up with analysis of teen relationship violence.
The reported data showed that, and I'm always late with this, I'm sorry, the reported data showed that more than 70,500 incidents of teen relationship violence happen in one year.
So in spite of all this information, since the 1970s, the education, research, and advancement of prevention and treatment to this ever present possibility of domestic abuse has notoriously increased.
So we are definitely working very hard at it.
Yet, cultural syntonic and traditional behaviors behavioral norms accepted within given cultures, accentuates the need to maintain a vigilant attitude to its possible presence and work diligently on prevention.
And here prevention, CDC, has come with two very interesting resolutions or calls for action.
One is you see here two sides of this diagram.
I'm only going to read the left one because the right one expands on the left one.
They are telling us that those that are working with domestic violence, they have to teach safe and healthy relationship skills.
They have to engage influential adults and peers.
They tried to disrupt the developmental pathways toward partner violence, create protective environments, strengthen economic support for families, and support survivors to increase safety and lessen harm.
Wonderful ideas, extremely difficult to achieve, but at least they exist.
Also, in 2007, the Center for Disease Control gave us two very important screening tools, which was to develop plans to ensure immediate safety of the survivors survival.
One is suicidal assessment.
Suicide, of course, is very high among the victims.
They told us to work with the patient in a safety plan.
This will increase a sense of control and collaboration and to focus on coping strategies for risky situations.
It will help survivors identify and reinforce their strengths, social support, and motivations to seek help.
Now, what are the tools for us to use if we are going to be working with the intimate partner violence.
That's another way of calling this.
The IPV, which is intimate partner violence survivor may feel very misunderstood and unsupported during their interaction with mental health professionals.
If professionals label them with psychiatric diagnosis, may cause them to feel as though the abusive situation is not understood.
This may lead to mistrust of healthcare professionals.
So the best advice they can give us is to use a trauma informed principle.
We have heard about you so far of trauma informed treatment before.
We are all very much We're very much aware of what that entails.
Now, the trauma informed principle here will include acknowledgment of the situation, safety for the victim, trust between, of course, the victim and the therapist, choice and control given to the victim to consider, compassion for the circumstance, collaboration with the victim, and of course, strength based focus.
Now, the main treatment modality use Most successfully is cognitive behavioral therapy.
We all know cognitive behavioral therapy, but I'm just only going to describe the The first paragraph, which is P focus non exposure, cognitive behavioral therapy helps people identify unhelpful thinking patterns and behaviors which can alter emotional response and behavioral patterns, attain safety, and reduce trauma, PTSD symptoms and substance misuse.
Now, it's interesting that for victims, there are many types of CBT that have been the device, but I'm just only going to name them and just briefly describe what it means.
Seeking safety.
Safety is the overarching goal, helping patients attain safety in the relationship, thinking, behavior, and emotions.
Another one is stairs, skill training in effective and interpersonal regulation is primarily focused to reframe the cognition that have emerged as a result of a traumatic experience.
Interpersonal psychotherapy.
Effective is effective non exposure based treatment for PTSD, we know what to focus on, but also is very important for victims of domestic violence.
Cognitive processing therapy, effective treatment for reducing PTSD and depression symptoms when they follow interpersonal victimization.
It is a very specific way of helping them process the trauma.
Eye movement eye movement desensitization, reprocessing EMDR, and it integrates techniques from cognitive behavioral pschdynamic, and body oriented therapy, and the therapy is conducted without any detailed description of trauma veins.
Hope helping to overcome PTSD through empowerment.
The therapy focuses on stability, safety, and empowerment and relapse prevention and relationship safety.
RPS does not try to pressure the women into leaving the abusive relationship.
It focuses on empowerment and safety tactics within the relationship.
The last one, cognitive trauma therapy for battered women.
This one is for women for victims survivors who had no desire to reconcile with their abusive partner.
The intervention includes psychoeducation about PTCSD, stress management, and what is very important here is they have to be helped to mourn the loss of a relationship and the loss of a hope for reconciliation.
Finally, psychopharmacological treatment.
We do know that psychopharmacological treatment can be used when treating mental health consequences of IPV, especially during mood and on anxiety symptoms.
Of course, what do we do? We use antidepressants, anos, and notics.
The most important thing is that the medication alone will not do it.
We have to add combination of CBT in any of the forms that I have just described very briefly and sorry for the speed and the briefness of my presentation.
Thank you very much.
Thank you very much, doctor Silva Olera for your excellent talk.
I now have the pleasure of introducing our next speaker, doctor Nicole Benders Hate, who will give a talk about the future of psychotherapy.
Doctor Benders Hay is a board certified psychiatrist licensed in all 50 states and DC is chief medical officer at Talkspace, which she will tell us about, where she drives clinical strategy and operations to deliver high quality evidence based mental health care.
Leader in responsible AI, she advances technology to expand access, personalized treatment, and improve outcomes.
With more than 15 years of experience, she is dedicated to reducing stigma and empowering patients.
She trained at Johns Hopkins, NYU Grossman, and Columbia University.
The floor is yours, Doctor.
Thank you.
Thank you so much.
Yeah.
Um, and I'll go quickly as well, especially following doctor Olarte's talk on domestic abuse.
I really wanted to focus on the future of psychotherapy and access to care, especially for women as a vulnerable population.
So that's what I'll be talking about today.
If we start with the crisis of access, I wanted to share some numbers to start.
The numbers here really are staggering.
One in five adults experiences a mental illness each year, yet more than half receive no treatment at all.
Globally, over 300 million people live with depression.
But what we see when we dig into these numbers further is that they're not distributed evenly.
Populations most burdened by mental illness are often those least served by traditional in person systems, and women and girls appear prominently in that group.
Um, Other groups most affected include those in rural communities, low income individuals, displaced persons, people with disabilities, LGBTQ plus youth, and incarcerated populations.
In thinking about those groups though, women are nearly twice as likely as men to experience depression and anxiety, yet face really unique barriers to accessing care.
Um, women are disproportionately affected by every major mental health condition that's tied to social determinants.
That are trauma disorders, anxiety, depression, eating disorders, PTSD from gender based violence.
Related are other staggering facts that one in three women globally experience gender based violence in their lifetime and 75% of eating disorder patients are women.
In researching this talk, I did find the group, the UN Convention on the elimination of all forms of discrimination against women explicitly obligates participating states to ensure equal access to health care, including mental health.
But for women, things like caregiver burdens, financial dependence, cultural stigma, mobility constraints really create uniquely gendered barriers to care that in person systems often fail to address.
That's why virtual therapy has a really specific and powerful role to play here.
Here we get just a bit more concrete about where gaps are for women specifically.
Postpartum depression affects 20% of new mothers, yet attendance at therapy while caring for an infant is a significant logistical burden.
For survivors of domestic violence, the privacy of a phone or video session can make the difference between accessing care and not accessing care.
Rural women often lack both transportation and access to female or culturally matched therapists available for them, and refugee women face confounded trauma with almost no local infrastructure there to support them.
Again, that's where virtual care can really come into play.
Why don't people get help? These six barriers on this slide apply broadly across vulnerable populations.
But notice that highlighted in red here, caregiver burden is a barrier again that falls disproportionately on women.
Women perform an estimated 75% of unpaid care work globally, and that means are simultaneously the population most likely to experience mental health challenges and be the most structurally constrained from accessing care.
Okay.
What exactly is virtual psychotherapy? It's what we do at Talkspace.
Again, in the innovation front, I think is provided access to care in ways that focus on high quality as well.
I think we're all used to talking to patients, but again, the use of technology as a tool to talk to patients and improve clinical outcomes may be new for some.
Essentially, virtual therapy is delivery of therapy through digital platforms.
That's primarily through live video sessions, phone sessions.
It can be through text based platforms where a patient is able to send messages back and forth to their therapist either synchronously or asynchronously.
What's important from a rights based perspective is that it removes the need to physically travel to see a provider.
That opens up care options for people who can't do that.
For women managing children or recovering from a trauma or living in remote areas, that shift is not a downgrade, but it's access to care where there wasn't access previously.
The research is also clear.
We have 14 years of research behind the data that I have access to in my day to day role at Talkspace and the research is clear that virtual therapy works.
Effectiveness rates are nearly identical to in person treatments for anxiety, depression, and PTSD.
Women in particular report higher satisfaction, likely because being able to access care from the comfort of home is more feasible for them.
When looking at things like no show rates, no show rates can plummet up to 50% through the use of telehealth, which matters because missed appointments are one of the leading predictors of poor treatment outcomes.
Finally, I have to also talk about therapeutic alliance, which is something that we've studied as well.
What we see is that because people feel more comfortable opening it up from the comfort of their home, virtual care enables a wider range of mental health professionals to have access to.
It's because they're not limited by location, patients are able to find more culturally concordant care and so the therapeutic alliance that we see building through virtual care models performs equally well to in person care, if not better.
What starts to get really interesting for me, we also do a lot of AI work, building an AI tools and AI machine learning algorithms and LLMs to analyze all this data that we have at our disposal.
And so when using AI to look at psychotherapy outcomes, it starts to become really interesting because you can measure things like fidelity to CBT.
You can measure things like similarities in how a patient and therapist speak the specific language that they're using, and we see that the more similar that language is, the better the therapeutic alliance that can be formed there.
Really interesting.
Who benefits most? Note here again in red that women and girls lead this list, really a primary focus of our presentation here today on women.
But each of these populations really carries compounding layers of disadvantage.
A rural refugee woman who is also a survivor of gender based violence faces barriers from every single one of those categories at the same time.
Virtual therapy's power is precisely in its ability to reach people at the intersection of multiple forms of vulnerability.
When we think about implementation of virtual care delivery, we should be asking, how does each of these models really serve women specifically? In a standalone platform, you can do things like have gender matching filters to give women control over who they see.
In hybrid models where it's virtual care and in person care, something that works well for a perinatal population where the transition from an OB visit to ongoing therapy really needs to be seamless.
There's also hub and spoke models where care is delivered with a patient in a community location, and then the telehealth provider consulting in from another location, that's particularly exciting because domestic violence shelters and women's centers can become safe access nodes.
Then embedding mental health into reproductive health care settings directly also removes the stigma associated with seeking psychiatric care.
We can't celebrate virtual therapy without being honest about its risks as well.
For our purposes today, and again, coming back to where doctor Olarte started, for women in abusive relationships have to recognize that home is not always a safe therapy space.
Therapists delivering virtual care have to conduct thorough safety planning, asking questions about access to their devices, who else is in the home.
Whether sessions can be overheard and telehealth platforms that don't have those safety protocols in place aren't going to be safe for domestic violence survivors.
All of this needs to be a clinical and regulatory standard, not an afterthought.
Okay.
As far as policy recommendations, we have to take a gender responsive lens when building telehealth frameworks.
So things like broadband access have to be framed as both a health issue and a gender equity issue.
Safety protocols, like I just mentioned, have to be mandatory, not optional.
Parity laws have to explicitly cover things like perinatal mental health and mental health services have to be embedded in spaces where women are already seeking care so that seeking that help doesn't require navigating an entirely new system.
I'll close with this.
I believe mental health disparities are not inevitable.
They're really the product of a system that wasn't built with everyone in mind.
Women, particularly those at the intersection of poverty, displacement, violence, cultural marginalization, have borne the cost of those gaps for too long.
I believe virtual therapy gives us a tool to close those gaps if we have the will to really deploy it properly.
So advocate for telehealth parity and gender responsive safety standards at your institutions, integrate virtual options into your own practices, support training in trauma informed, culturally responsive virtual care for women, and engage policymakers on broadband coverage, perinatal coverage, and women's mental health as a human rights issue.
With commitment to all of this and our advocacy, I think we can improve the system together.
Thank you so much.
You now have the forefront in two very important fields, intersecting fields, and I'm sure the audience will have comments or questions.
So please.
Questions? 10 minutes.
Good afternoon.
My name is Edward, and I'm from Toronto Canada.
So this question is for doctor Nicole.
I know briefly you mentioned about implementing psychotherapy through a domestic violence shelters.
A, one of the pilot projects that we're trying to do within Toronto is to figure out a successful model to implement psychotherapy and put homelessness at that forefront and being very intentional with our psychotherapy.
I just wanted to ask if there's been any in your experience, if you've seen any really successful programs that have been able to integrate shelter with psychotherapy.
I appreciate the question.
I don't have any specific examples of that that come to mind.
We'd be happy to talk about what some of those components really need to look like.
I think that the access piece to the personalization and individualization of care becomes important.
Then there's a quality component too.
When you talk about fidelity to specific psychotherapies, doing really trauma informed work in that kind of care setting becomes critically important as are wraparound services in case of escalation.
No specific examples of programs come to mind, but it's great to hear about what you're building.
I'm Joe So from Bethesda, Maryland.
I have a question, and that is, could you comment on what really facilitates a therapeutic alliance? It's a great question.
Historically, and what we've started off doing in traditional in person care settings is looking at engagement as a proxy for therapeutic alliance.
How often are people coming back for visits? How often are people missing visits? Things like clinical assessment score, improvements, that type of thing.
I think that when you go a bit deeper to talk about therapeutic alliance, what's really interesting was that one study that I mentioned and how closely language is aligned between a patient and their therapist seems to have a significant impact on patient reported satisfaction scores.
But of course, in psychotherapy, it's very complicated.
You can't have sycophantic care where we're just telling patients everything that they want to hear in order to get them to like us.
I think that there's the opportunity to do some more work on exactly what those specific components are as far as therapeutic alliance.
Some of the other factors at that particular study I mentioned looked at were things like word counts, how much is the therapist talking at a session versus how much the patient is talking, a proxy for patients feeling heard and understood in therapy.
There's a couple of other factors that that study is looking at as well comes to an end.
Thank you so much both of you.
It's been wonderful to listen to you.
Thank you all.
Hey, how are you? Number one on the opposite side of the your Tuesday Nikki or That's what I said.
I.
I'll start with some housekeeping.
We've been advised that they turned off the microphones at 6:00 P.M.
So use your time in the best possible way.
Thank you.
Good afternoon.
We're going to open this panel Vice President for Academic Affairs and the provost of the Graduate Center say a few words of welcome because tomorrow and Saturday our event continues there.
He's going to be our host for the remainder of the event.
Doctor Joel Christensen, please.
Thank you.
All right.
Now, that's not working.
Hello.
Hi, I'm Joel Christensen.
I'm the provost of the Cune Graduate Center and I'd like to welcome you all here and thank you for the work that you're doing at this conference.
I want to speak a little bit about what the Cy Graduate Center is and why the work that you are all doing together is especially appropriate to our mission.
Um, so for those of you who don't know, the City University of New York is the largest urban university in the country.
It's unique in the United States for its scope.
We have over 240,000 students who go through our system and the variety of opportunities that we offer students.
Students in New York City can start at a community college out in Brooklyn and Kingsboro and work their way up to the Advanced Science Research Center at City College and do almost anything you can imagine.
It's an unrivaled opportunity and it's a great institution to be able to join.
One of the things that I really value about Kuni is that its mission is to serve the public good.
We serve the people of the city of New York and as one of the most international populations in the United States in the world, we through them serve the world.
We serve all five boroughs, we serve the state of New York and some of the most dense linguistic groups on the planet.
Now, it's especially important as well that our mission is to serve the people of the city and to serve and to help you serve because the world is not what it was when we were being trained and when we were learning to make our space in it.
I gave a commencement address this week where I talked to the graduating students and I reflected on the fact that when I was in their place, Google didn't exist, Facebook didn't exist, we hadn't thought about AI unless we were watching science fiction.
I mention this now in this conference because when we think about mental health, and where we are in the world, we are in a paradigm shifting moment.
Not only are we seeing the erosion of the trust of expertise, whether it's medical or scientific, but we're seeing a breakdown in the assumption of world order that we all grew up believing in.
Our mental health crises are often those that you weren't prepared to face.
We need to always think about belonging in agency, but how do we do this in a world in which we are facing amounts of information that we are not cognitively armored to face.
The world that we are witnessing is unparalleled when it comes to the access to the knowledge of human suffering and human activities that we can have at the touch of a finger.
The questions we're asking now about mental health and our future are crucial.
Are we cognitively and socially emotionally capable of handling our knowledge of the world? Can we continue to handle the breakdown in our commitments to each other in politics and international governments? What does it mean for us to readily lose the sense of community and certainty that gave us a sense of who we are in prior generations? I thank you for the work you're doing because it's crucial to facing the challenges that we need to.
Also, I thank you for doing it in a world in which working for the public good is increasingly seen as a fool's game.
You are doing the work of your people and for your people and you are helping to safeguard and advance the mission of uni.
I thank you for that.
Okay.
And one small note, I'll be sneaking out in a bit.
No disrespect men, but I have to catch a train to Boston.
So I appreciate you.
Thank you very much.
I'm very glad you were able to come and join us today.
Please get out of course.
Now we are advancing to the actual Q and panel.
We're going to ask Jean Mojandz to open the plenary panel, please.
Good afternoon.
Is my mic on? Yes, it is now.
With the chance that a trapdoor is going to open at exactly 6:00 us into the bowels of the United Nations, I thought that perhaps I will shorten introductions and move to the topic of the day.
This is the last presentation today, so you must be very exhausted and if you don't mind, I will say we can all stand up if we need to and lay our arms in the air and make ourselves comfortable if you need to.
There you are.
I see some mental health people here who responded to the call.
Thank you.
I appreciate you very much.
I know we all needed it right.
Back to your seats.
The topic of the day is not less heavy than what we have been listening to throughout the day, but does present a certain level of urgency.
Today we're going to be talking about public health diplomacy and its impact on the future mental health of the global population.
This is truly becoming a very important topic.
There is no question that many of our governments have failed us.
We have to confront this reality.
Governance has not proven to be able to protect populations and nations at the current moment, especially from the perils of war.
The current evaluation of how many people are impacted by wars indicates that approximately in war zones around the world today, we have approximately 277 million people suffering from post traumatic stress disorder and at least 199 million suffering from depression.
This is not to mention about 500 million children currently living in war zones.
For those of you that have experienced war, you know the trauma that's associated with it.
The fear, the stress, the uncertainty, and the danger that a whole generation of children, half 1 billion of them are suffering from on a daily basis, be it in Africa, be it in Europe, be it in the Middle East, be it in Asia, be it in Latin America, this is the new generation that we will entrust with our future.
There couldn't be a more urgent call for us to stand up and take responsibility, at least at an individual, institutional, and organizational level.
The question becomes, what are the vehicles for population health diplomacy and how prepared are we to take the responsibility for what I'm just describing? Who is training us to be health diplomats? What is our recipient audience? What is the conduit for interaction? How do we measure success? The current investment in mental health, as you all know, as professionals in the field, remains critically limited, particularly in these conflict affected areas.
Today, I have the privilege of being surrounded by experts more knowledgeable and perhaps more effective than I.
You met me this morning.
There is absolutely no need for me to reintroduce myself.
But I have the pleasure of introducing a panel to you.
First, doctor Sahil Ali, and we have, I'm sure a slide.
As you have met him also this morning, I will not linger, but as the Chief of the United Nations Department of Safety and Security, Critical Incident Stress Management Unit, Um, there could be very few people that are probably more qualified to talk to us today, and he will represent the organizational institutional level.
We also have on the panel with us, If we can move the slide forward, doctor Ashish Joshi, who is also a dean and distinguished professor of the School of Public Health at the University of Memphis.
But you may ask yourself, why two Deans of public health is that too many.
But there is none like Ashish in this domain because I would call him the new father of population health diplomacy.
This terminology has been used at the WHO, but is being reinvented.
And very fortunately, Aisha has played a tremendous role in bringing Global South into the conversation.
So that is not a conversation that is secluded to some of the traditional players, but opening the doors more widely.
More importantly, Aisha is responsible for highlighting the importance of developing competencies to students in public health to be able to chart this new domain.
The next panelist with me is my dear Professor Victoria No.
Vicki now is the Director of the Center for Innovation and Mental Health and is a professor of Community Health and Social Sciences at the Cune Graduate School of Public Health and Health Policy.
I know her very well.
And she has been funded very generously by the National Institute of Health to conduct two domains very different, the one from the other.
One in the Harlem Strong Project in Harlem, where our school resides, dealing with task shifting in training community health workers within the rubric of faith based organizations to support the healthcare delivery system in providing mental health services, as well as the work that she does in Vietnam, also supported by the NIH, going to the grassroots level where people continue to suffer from the consequences of war generation ago.
Here you are.
You have three panelists and with us, we have our very brilliant graduate student from the Cuni Graduate School of Public Health.
I will involve her in the conversation.
Do we have a slide about you, Francesca? Well, Francesca is the spark plug that keeps that engine going.
So our representation today is organizational, institutional from the academic perspective, and also personal.
These are the levels that we hope that diplomacy in the area of population health can be exerted.
We also believe that their intersection allows for the possibility of change.
Hale, forgive me for using your first name, but we are now friends.
The United Nations perspective on coordinating humanitarian mental health response in conflict and climate affected settings and supporting the resilience of humanitarian personnel that work in these areas is very much under threat.
We heard it today from United Nations representatives and our hearts go out for people that are risking their own safety playing that role.
But we also see the United Nations as an important bridge between scientists and practitioners on the ground in a multidisciplinary care framework.
I would like for you to tell us, open your heart to us.
This is hopefully a session where people will go home with real life impressions rather than scripted ones.
Tell us more about the challenges as you see them so that we can be better informed.
Thank you so much.
I hope you can hear me.
Very clear.
Well, in response to eons it's the afternoon shift, so we'll be candid so that everybody is awake.
I'll make one confession and three comments.
The confession is that over the last three years, we've often been led to soul search.
What can the UN do? Because we've been very starkly shown what the UN cannot do.
We realized the UN does not have the power of tariffs.
The UN does not have an army.
The UN does not have a stick, a global stick to stop human rights abuses or mental health trauma around the world.
Then we were forced to think, what can the UN do when the UN cannot do those three things.
We realized the UN can do three things.
It's very basic ABC.
The UN is an architect.
It designed systems that then other players, multilateral players can work on.
So we designed the systems.
We are architects.
We build bridges to bring partners, enemies, people disagreeing together.
We have the power to convene.
Like we are doing today.
So the UN can be an architect, it can build bridges, it can convene, but it doesn't have the power of tariffs or an army.
It's not the global policeman.
So if you look at that confession, and I have three points for global health diplomacy that we are able to do.
One, we are able to try to build a bridge between science and practice because in low and middle income countries, the only science that is relevant is the one that can be converted to practice within their resources.
The second is that as scientists, we need to standardize things.
We need them to be evidence based.
But as global practitioners, we need things to be contextualized and culturally acceptable.
Otherwise, they will not be effective, even if they're very effective in evidence based trials.
That's the second bridge that we try to build in global health diplomacy.
The third point that I'm going to share takes a lot of courage because it will reveal my age and what I was trying to hide with my hair color.
It will reveal all of that.
For those from my generation, they might remember in the 1980s, there were some very seminal studies published in the British Journal of Psychiatry called the Pathways to Care Studies.
Those who have read it, you know how old we are now.
The pathways to care studies in the British or of psychiatry, they studied in many different communities around the world.
What is the pathways to care that patients use before they get to a mental health professional? Those pathways to care are multi nodal and each node can include family, friends, faith healers, community leaders, school teachers, village elders before they eventually come to the mental health professional.
Those nods, they can either be filters for the people who need help or they can be facilitators for people who need help or partners for the mental health professionals.
One of the tasks of global health diplomacy is to see how we can prevent those filters from choking up and converting them into partners and facilitators that can help people who need help overcome that pathway to care and get to the professionals who can provide help and help with those nods by making them partners and more skilled in facilitating that pathway to care.
For the next generation, the pathway to care will probably include their cell phone as well.
That will be the first point of contact.
My own daughter is more likely to talk to Siri than to me, but that's the pathway to care for her eventually.
We will have to see as we go through and I was thinking of doctor Philip Justice's work on converting artificial intelligence to artificial wisdom.
That new pathway to care, how do we make sure it doesn't become a choke point, rather becomes a facilitator for mental health care.
So I'll stop at that.
Thank you.
Thank you so much.
In all honesty, we just completed a global survey in 30 countries with 30,000 respondents, asking them about what they considered to be quality health information, but also asking them about their vehicles.
This is in response to your last point, Sall.
We found amongst our respondents that actually digital literacy was higher in the Global South than it is in the global North.
So people are very dependent on digital vehicles to receive information and the thing that's very linked to that is age.
Obviously, we found that the older generations are less digitally dependent and digitally literate than the younger generations.
Nations by definition that are young or younger are more digitally literate.
It was surprising to see, for example, that Japan within the population itself was less digitally illiterate than some of the African countries.
That depended very much when we corrected for the age of the population, we were able to see how age impacts that.
Your point is very well taken here.
Now, Ashish, public health schools are supposed to be a neutral entity, and we're supposed to be data driven.
We are convening platforms, and Some people have accused us of being very north centric, where attitudes, experiences need to be more facilitated across the globe and that we need to be a vehicle for change.
As today's leader in the area of public health diplomacy, and I say that with full confidence, Give us a perspective of how we can move forward with a more democratic approach towards the conceptual framework of population health diplomacy, but also of the skills that are needed across the globe.
Thank you so much.
Good evening.
Good evening.
Good evening, sir.
Yeah.
Thank you for allowing me to come here just share my passion and compassion about public health.
I'm just humbled to be here among all of you.
All this work comes from lived public health experience.
I'll come straight to the point that we are living in a world of uncertainty, complexity, unpredictability, and to be honest, a geopolitical shift.
And I don't use the word geopolitical crisis.
I use the word shift in my conversation.
As schools of public health, our goal is to train students and public health professionals and practitioners, to learn about the disease burden, the spread and everything, and none other than the times when we saw the COVID, the public health students really felt that they are maybe not well trained to respond to the crisis that might have come because they were never trained to be diplomat.
They were having the best skills to analyze the data, but they were not having the skills how to communicate the data.
I think from that lens and as Sahil mentioned, if you may allow me to say that we've heard the term global health diplomacy and global health diplomacy is where negotiations are happening between and among the nations in a much more formal way.
But there are two other forms that are critical.
One is a multilateral, which is not requiring any binding agreements, but still people can engage.
But then the third is a very important pillar and that's called informal conversations.
That's where the community organizations come together, educational institutions come together, people to people come together, and also that that plays a very important role.
I just wanted to first articulate where public health diplomacy lies in that spectrum.
So public health diplomacy is a way or vehicle which allows informal and multilateral multi stakeholder collaborations to happen.
There are five Cs we have learned about it.
It's called consensus.
We have to agree on making consensus, which is not easy, but at least we can coordinate, we can cooperate, we can collaborate, and we can communicate.
And the role of schools of public health, I feel is a very as hill mentioned, I was writing the notes of being a bridge and a convener.
I think being an academic entity which is bound to train, bring the data, bring the science has a very significant role to bring people together and bring the best practices around the world to a common sharing platform.
With that backdrop, in 2024, I will say it was not easy.
There was no term public health diplomacy.
The term is used global health diplomacy and then there was some people saying, is it like any other term that you're coming up with or what? I would say that I'll just share two examples of what we've been able to do.
In the space of public health diplomacy, the most important thing is if you want to define something, you need to first engage everyone.
It cannot be just a definition coming up in a closed door, in a closed room, and all of a sudden one night, you say, this is a new definition of public health diplomacy.
What we did, there is a global network of academic public health that represents seven regional public health associations, which represents about 100 countries and 500 institutions of schools and programs of public health.
So the first approach was to approach to the segment of all representation because inclusivity is a very important element.
Whether we may agree or disagree, that's a separate thing.
But bringing everybody on the table is a very important element.
So I would say that in 2024, we were able to build a consensus to bring all the representation of the regional associations and schools and programs of public health around the world to Memphis.
Each representation came and that's the first time the definition of public health diplomacy came in.
How it was defined, that it is a multidisciplinary approach.
We need to train our practitioners to know how to build consensus, how to do negotiations, how to engage both the policymakers and the politicians, and very importantly, how to be problem solvers by bringing the data to policy to action.
Now, I don't use the word global or local.
I like to use the word glocal.
Public health diplomacy is glocal.
Which means local is influencing the regional and the global context, and we must build around ourselves around that space.
We were able to convene together a common definition that was published so that everybody is agreeing on that, bringing the lens of equity, bringing the lens of human scentedness, bringing the lens of representation.
The second component was that the summit was done.
There was a nine point action agenda that was agreed.
A lot of people came with excitement and then they thought that next year, nothing is going to happen.
Because in academia, we sometimes fail to continue be consistent with the trust that the community owes us.
Everything cannot be just reliant on research funding.
We must come up with ways on how things can continue to build and amplify with the collaboration.
Lastly, I would say that we were able to continue our second summit.
We were able to demonstrate that the points that we agreed on the nine point, we followed through that and things are moving forward.
I will just lastly end by saying this that to train the workforce, especially dealing with the issues of mental health, there are four things that come to my mind.
We give them all the credentials of counseling, psychology, psychiatry.
But to me, the four things are very important.
That's coping, adaptability, being resilient, and being empathy.
Care is a very important element that will help us to build good health and well being not just for the community, but for ourselves, for the families we are serving and the communities we are living in.
Thank you for giving that space.
Thank you, Rashi.
That's very inspirational.
And truly is a very good lead to the next presenter because Vikio lived this experience.
We're talking about organizational, we're talking about institutional, we're talking about individual.
Vicki as a child, lived the experience as a Vietnamese refugee, leaving her homeland on a boat, landing in a refugee camp in the Philippines and look at her now.
She does actually deserve this applause.
You know why? Because she does have that resilience.
But in her stories to me, she talked about resilience in a broader sense of the family supporting her dad, of her family supporting her, of she and her sisters supporting their brothers and vice versa.
That kind of network allowed her not only to survive but take leadership and then go back She could have seen that as a nightmare chapter of her life that she'd never wanted to engage again.
But she's spending her life now as a population health diplomat and a mental health specialist.
Vicki, tell us that the personal level, I've seen you in Vietnam.
I've seen how people's hearts open to you because of your lived experience and your credibility.
I'd like you to talk a little bit about that.
Thank you.
Thank you.
It's especially meaningful for me to be here at the United Nations because I was a refugee and we came to the United States with the help of UN HCR.
I'm very thankful for that.
I Yeah.
It's really great to see the work that S Hill has been leading around the world, 180,000 people served every year.
That's just amazing.
My family came on a boat.
My father bought a compass a week before we left, learned how to use the compass, navigated a small fishing boat with 30 people, and we ran out of food and fuel.
We were helped along the way.
We were helped by an Argentine ship.
Captain brought food over for us and filled up our tank.
We ended up landing in Batayan in the Philippines and the kind folks there brought us in.
They took us on and resettled us.
You know, neighbors just came and helped, and Chinese family associations also came out and gave our family $500 so that we could settle and buy necessary supplies.
All of these people were strangers.
They did not come because of a program.
They came to help us without any kind of formal agreement.
I think that's the the heart of the work that we do in the humanitarian space and what I think for me, diplomacy is about and what drives the work that I do.
None of this came from any any formal agreements, any MOUs, this is out of solidarity across languages, cultures, national borders.
And so for me, this work is very personal and it makes a huge difference.
I wouldn't be here today without that.
I wouldn't this has totally changed the trajectory of my life.
I am now doing mental health work because of the support that my family received.
I've also seen mental health problems, challenges completely destroy families, including my own.
I have a niece that became homeless as a result of not getting appropriate care.
But the work that we do you know, now what we call mental health task sharing is actually work that has been happening around the world in these humanitarian spaces, in these refugee camps.
I was just in Batayan in February and I was very fortunate to be accompanied by a psychiatrist there and happen to be there at a time when there were volunteers where the folks who volunteered at the refugee camp in the 70s and 80s happened to be touring the campgrounds or coming back to the campgrounds, so I got to hear about their stories and, you know, they were building communities.
They were, you know, just drawing strength from the community, folks who came from Vietnam who were barbers or cooks or you know, doctors, they helped tap into those strengths and but the community around those strengths.
They were already doing task sharing in many ways without calling it.
They were peer workers, community health workers, providing education and promotion and helping newer folks adjust to the life, helping folks, um, you know, learn the ropes of what to do to apply to get resettled in another country.
And so I think in many ways, these systems, these pathways to care, you know, he'll mentioned, already exists and we don't need to replace them.
What we need to do is strengthen them.
And so much of the work that we do in mental health task sharing and implementation science around that is figuring out how do we strengthen these systems? How do we build this capacity and leverage the strengths and the supports that already exist within these communities.
And so for me, that's really my life's work.
And I think one thing that I've learned from doing the work that I've done in Vietnam for the past 20 years is that it's the trust that scales the evidence, you know, it's these partnerships.
It's folks opening their doors and believing that you're there to help and there to support and there to work together collaboratively that actually allows that evidence to grow.
Much of what I'm doing now in the United States in Harlem is based off of the 20 years of work I've done in Vietnam.
And when we started there, I think the assumption was that that was care that we were providing in the context where nothing existed and therefore was lesser quality care because it was a stopgap to address the needs when mental health specialists weren't available.
But in many ways, I think it is in some ways, care that is necessary and what we need to do is we need to not see that as lesser care, but see that as a necessary complimentary component to the formal system.
This informal system that already exists everywhere around the world, we should really be strengthening Because when a person is in trouble, they're not going to a psychiatrist, they're not going to a counselor.
They're going to their neighbor, they're going to their parent, they're going to their teacher.
And so, they're already the de facto counselors in many ways.
Why are we not tapping into that? They're already doing the job, not calling it that.
So that's a very important part of the work that I now do.
And so I think for me, diplomacy is really not about not only about governments and multilateral agreements and international frameworks, but it really starts with the individual and it starts with the partnerships, the trust, the communication.
And that's really what has allowed the work that we've been able to scale in Vietnam.
We've been able to implement in 32 communities or 36 communities over the last five years and trained over 400 providers and that would not have been possible.
You know, without that trust and without the community working together with us.
And I know certainly that they did not open the door to me because I had a PhD in clinical psych.
You know, that really probably the door was open mostly because I was Vietnamese and could speak the language and could communicate and they, you know, felt like I was part of their family.
So thank you very much.
So I'm going to make an executive decision.
Okay.
I could ask three questions to our panelists, but I think I would like to open it to you to communicate with our panelists.
We have only 10 minutes left.
So these are precious 10 minutes and I'd like more interaction.
Furthermore, that concept of the psychoanalyst sitting in a leather chair behind a desk with a Persian rug on the floor and and the patient on their back, we want to see you out there Indiana Jones with shorts and compasses.
Let's.
Let's keep the pressure, keep the Persian rug.
We keep persons rug.
There's going to be a flying rug, a magic carpet.
I have a comment, maybe a question.
My understanding is that in low income countries, 70% of people do not have Internet access.
Not only there's a lack of mental health providers, but we cannot reach them via teletherapy.
So something that comes to mind that I think hasn't been mentioned all day today is task shifting and training volunteers to provide group psychotherapy interventions.
We have a colleague in Uganda who's doing that effectively with persons living with AIDS.
She was going to be here today, but unfortunately, because of the Ebola travel restrictions, she wasn't able to come.
I'm wondering if you're aware of similar work that is happening specifically in low income countries.
So definitely there's so much most of the evidence is in the country.
Press on the white button up there.
Okay.
Um, there's so much work.
There's probably over 50 studies at this point on mental task sharing in low income countries.
Most of the evidence is from there and what I found really surprising is across the board, the rates of improvement have been about 70 to 80%, which, when I did my first study, I was shocked at how much of an impact that difference made or the intervention made, that I kept reviewing the data over and over again and then over time, I started looking at other studies and they all had very large intervention effects.
I think part of the issue is that when there is nothing, a little something goes a really long way and so we see a really big impact, but we've seen it work with behavior activation, problem solving therapy, IPT, and more simplified CBT as well.
But also just basic coping, stress management skills or other interventions that are now have a very strong evidence base when you're training folks without mental health formal education.
However, you do need to have good training and good supervision and good structures in place to support them.
But that evidence is quite strong.
Thank you.
Thank you.
Thank you for your answer.
Any comments or questions? Good evening and thank you, everyone.
Very inspiring reflection.
This is just a comment I had listening to the friend of your reflection and thoughts because you mentioned the pathway to care.
That is very important that people meet friends and family and teachers and also doctor Go was very interested in your thoughts.
I was wondering because in Italy we are starting implementing some training for teachers in high schools and middle schools, also as a form of prevention for mental health.
So the idea is that if we really want to make prevention, we need to go where psychiatry is not there yet.
So what do you think in America, are you implementing some kind of programs this kind? It's just a trans cultural question.
I was wondering if you are implementing something also in schools.
Yeah.
Thank you so much for this is a very good question actually to be frankly.
I'm very delighted to share that we are actually establishing public health clubs at the high schools level.
One of the things that I would like to say where? Yeah, I Memphis, we have about 16 high schools now and we have now 95 high schools around the world.
I will also say that we are going one step further.
We are offering now for the first time 15 university credits.
As an undergraduate certificate in public health to high school students.
That has never happened before.
I know that in Portugal and Malta, we are getting our public health clubs established in those two countries right now.
That's great.
In terms of.
The early interventions in school, that's actually happening quite a bit.
There's social emotional learning that was scaled up in New York City.
I also lead another program with the Department of Health in New York City where we're integrating mental task sharing into youth serving CBOs and then they work in schools and they partner with mental health providers to provide the higher level care when that's necessary.
But, it's definitely growing because the shortage is here as well.
It is astounding that the new mayor of New York City ran on a platform of universal pre kindergarten childcare.
It is amazing that the response was so overwhelmingly positive, nobody expected it.
Politicians said, What a cockamamie idea that is.
If you were to ask about it was housing and early childcare.
This is an opportunity if, in fact, early childcare will be implemented in New York City universally.
This is an incredible opportunity for us to do what you are thinking about.
We have 5 minutes left, so time for 1.5 questions.
Meet in the middle.
There's diplomacy here.
You're younger too.
Thank you very much.
My name is Amar Razi.
I'm a case worker in California.
I'm working with refugees who are being resettled in the United States from war torn countries such as Afghanistan and Myanmar and some other countries.
My question is about the accessibility to psychotherapy for these refugees who are undergoing very severe mental pressures when it came to the United States.
So in the organization in the areas that we are working, the access to psychotherapist is limited, or if it is, it's very expensive.
What do you suggest for making a psychotherapist more available to these refugees? Thank you.
Thank you.
Yes, there are programs in the different UN organizations like the UN High Commission for Refugees.
Part of their refugee Protection program includes mental health support for refugees.
Same thing with the International Organization of Migration, IOM, in their health clinics also, the World Health Organization as well.
There are programs where basic psychosocial support is made available to populations in need.
However, the caveat there is that we don't provide psychotherapy through those programs.
What we have seen at the mass community level is the most effective interventions are often the most basic ones.
Very few people at the tip of the pyramid require specialized psychotherapy.
Most of the population requires self care information, a sense of empowerment, connection of families, and restoring of community structures that provide that social support.
Most of the programs are focused on basic psychosocial support and restoring community based resilience and cultural resilience while psychotherapies are reserved for the more severe cases.
Thank you.
Well, this brings us to the last 2 minutes of our discussion and I would be doing all of us wrong if I didn't spend these 2 minutes to thank our panelists for their personal experiences, their openness, their vulnerability, and their truthfulness.
I hope that you enjoyed this last session and that although I know you must be super exhausted, super talked to.
You still had a place in your mind and in your heart to listen to us.
I also would like to extend my thanks to you.
Thank you so much.