Global Initiative on Psychiatry

Last century’s Cold War between East and West consisted of more than saber-rattling and nuclear stockpiles. The Soviet Union often silenced political dissidents by giving them phony psychiatric diagnoses and locking them up in mental hospitals for years on end (Psychiatric News, December 10, 2010).

In response to this political abuse of psychiatry, a number of professional groups in the West came together to form the International Association on Political Use of Psychiatry to pressure the Soviet Union on its treatment of such “patients.”

Global Initiative on Psychiatry

“As psychiatrists, we wanted to protect psychiatry, so under the leadership of Mel Sabshin and others, we persuaded the World Psychiatric Association to establish it first ethics committee,” recalled Lawrence Hartmann, M.D, of Cambridge, Mass., who was active in the movement. The Soviet psychiatric society resigned from the WPA before it could be expelled.

When the Soviet empire fell, the organization did not, but instead evolved from aiding political prisoners to improving mental health care in the same regions.

“We looked for ways to strengthen the WPA by supporting those in the organization who want strong ethics standards,” said Hartmann.

Now, after several decades and a couple of name changes, the organization is called the Global Initiative on Psychiatry (GIP) and is dedicated to “the development of mental health care services in low- and middle-income countries” around the world.

The GIP works to improve community-based care for individuals with mental illness or developmental disabilities, as well as those with mental health problems deriving from war, disasters, or HIV/AIDS.

Initially, some historical momentum led the group to a focus on the former Soviet Union and its satellite countries. GIP established offices in Lithuania, Bulgaria, and Georgia, but also works in several other former Eastern Bloc countries, from Poland to Tajikistan. Beginning in 2005, the organization expanded its operations to parts of Africa and Asia.

Decentralized Approach Preferred

The GIP works through its local offices rather than parachuting in experts from other countries.

The approach is deliberately decentralized, said Robert van Voren, Ph.D., the GIP’s executive director, who is based in Hilversum, the Netherlands, and is the author of Cold War in Psychiatry (Rodopi, 2010). “Our approach may take longer, but in the long run is more sustainable.”

“We work within the existing culture and resource structure and, if necessary, within the existing prison systems,” said Thomas Barrett, Ph.D., president of GIP-USA, the organization’s affiliate in the United States. “There’s no point in imposing a solution if it collapses when you leave.”

In fact, the GIP is actually not so much an organization as an idea, van Voren told Psychiatric News.

“Of course to further an idea you need some structure, and that is what we established, although it is a very small, horizontal, and democratic one,” he said. “Our idea is that mental health services should be locally empowered, locally adapted, community based, user oriented, and focused on keeping people with mental illness in society, instead of taking them out.

U.S. Chapter Focuses on Prison Population

GIP-USA is working to revive the organization in this country, and van Voren hopes the newly reinvigorated U.S. chapter will play three roles: supplying expertise, raising funds, and addressing the problems of mentally ill offenders in the U.S. prison system.

Already, it has set as its first task the problem of prisoners who have a serious mental illness. They make up 17 percent of the population in prisons and jails, compared with just 5 percent of the general population, said Barrett.

“The system basically creates criminals—people who are ‘mad and bad’—and that is something that needs to be addressed,” said van Voren. “We work in underdeveloped countries, trying to set up services, applying for U.S. funds, and in the U.S. the situation is sometimes even worse than in the [other] countries where we operate. I think that is unacceptable.”

GIP-USA, in collaboration with the National Association of State Mental Health Program Directors and the National Criminal Justice Association, has submitted a grant proposal to the Open Society Foundation to fund an 18-month study of best practices for working with adult mentally ill offenders in the U.S. criminal justice system.

“Many could be better served in their communities,” said Barrett.

Finally, the GIP remains in touch with its roots in human rights, especially as they apply to psychiatric patients and systems. Fighting stigma and pushing for changes in national health policy are not the only goals. Even small advances, like obtaining the right for forensic patients in Sri Lanka to walk through a hospital garden, are counted as victories. ■