In the second half of the last century, Albanian society adopted a totalitarian way of communist thinking, that could not have spared medical disciplines. Psychiatry was and probably remains a stigmatized field, whose problems almost never were discussed openly. Specialized writings on psychiatry were available and could shed light on the themes and questions of concern. A periodical journal entitled Psychoneurological Works circulated in its print edition, with its first issue of 1959, its tenth issue of 1984 till it ceased publishing some years later. The journal was a mixture of neurological and psychiatric contributions, with the latter reflecting consistent time-related shifts in thematic, terminology, and data exposure. The panegyric and enthusiastic statements served as a good disguise for the immense ailing of patients and the ethical challenges that psychiatrists were facing, while exerting their profession in the time of severe dictatorship, when the disrespect of human being reached its apogee.

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Homelessness is an important social determinant of health. The information has been sparse on the relationship between homelessness and mental illnesses in Asian countries. In this perspective paper, we present the synthesis of viewpoints of early career psychiatrists from several Asian countries on the relationship of homelessness and mental illnesses. An online questionnaire was used to gather responses. The definition of homelessness was kept broad and included both temporary and lasting homelessness. The responses were synthesized into paragraphs to describe the perspective for the country. Although difficulties were experienced in the estimation of homelessness, the numbers of homeless individuals varied from practically negligible in Jordan to about 1.77 million in India. Mental health issues were present in the homeless population and included affective disorders, psychotic disorders, and substance use disorders. The psychiatrists generally had a considerate viewpoint toward treating the mentally ill homeless people. There is a need for more literature on the interface of homelessness and mental illness from Asian countries, especially where the homeless populations are substantial.

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Louise Bradley, president and CEO of the Mental Health Commission of Canada, reflects on more than a decade of challenges and opportunities faced by the country's first such commission. She delivered the following speech at the 23^rd World Congress of Social Psychiatry on October 24, 2019, in Bucharest, Romania. Using her own lived experience as a springboard for combating stigma and spurring discussion, Bradley is a mental health advocate who has straddled both sides of the care divide. Amplifying the voices of lived experience and caregivers is among her proudest achievements. Through her extensive international exposure, she is convinced that every country is a developing country when it comes to mental health – and this is particularly true when one trains a lens on the mental health outcomes of Indigenous peoples – in Canada and around the world. As a former clinical practitioner and hospital administrator – and a lauded voice for equity and inclusion – Bradley's goal is to challenge her audience to acknowledge their own biases, confront self-stigma, and find our shared humanity

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The United Nations has recently recognized the magnitude and severity of mental health problems and included the need to deal with them among its universal development goals. The main obstacle to achieving these goals is the stigma and discrimination because of mental illness which is still prevailing in all parts of the world. The presentation referred to the excellent programs against stigma that have started in some countries but recognized that in most countries of the world stigma of mental illness is still not effectively tackled. The main reason for this is that the paradigms which have been the basis for national efforts to combat stigma are no longer valid so that progress now depends on developing and applying approaches different from those used so far. The presentation examined the current paradigms of fighting stigma and proposed their replacements.

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Background: Despite many control trials and meta-analyses proving the positive effect and the economic interest of family psychoeducation in schizophrenia, this practice remains marginal. There may be several reasons behind the clinicians' lack of motivation to implement such programs. Simple and common evaluation tools to compare program efficacy, improve the programs' content, and guaranty the fidelity of the delivery over time by routinely monitoring the efficacy level would be a way (among many) to stimulate clinical interest in psychoeducation. Two common self-administered questionnaires used in combination, the Center for Epidemiologic Studies Depression (CESd) to assess caregivers' depressive symptoms and 20-item Life Skill Profile (LSP-20) to assess patient functioning, would be good candidates for that. Methods: Family caregivers (n = 78) of seven consecutive groups participating in a program named Profamille filled in these questionnaires before and at the end of the program and 1 year later. More than the half of the caregivers have an initial depressive score indicating a higher risk of cardiovascular mortality/morbidity. Results: Both CESd and LSP20 significantly changed 1 year later. The size effect for CESd was 1.4 and for LSP20 was 0.6. These changes were linked to a statistically significant reduction in the number of hospitalized days for the patients (by a factor 3) and a number of days lost at work for the caregivers (by a factor 4). Conclusions: These two questionnaires are therefore useful to compare different programs, obtain preliminary evidence from exploratory trials, like for the Profamille V3 program, and help ensure the fidelity of program delivery.

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Psychiatric and neurological disorders are now considered among the first contributors to the global burden of disease. In low- and middle-income countries (LMICs), insufficient specialized human resources, inadequate training of primary care workers, traditional beliefs, stigmatization, and discrimination are the most common barriers to access to care. Availability and cost of medicines are also common problems. Although in many cases effective treatments exist, 76%–85% of patients with mental disorders or epilepsy living in LMICs are not treated. Over the last 8 years, through the Interactive Meetings Promoting Access to Care and Treatment (IMPACT) forum, the Institute of Epidemiology and Tropical Neurology UMR 1094 INSERM, the World Association of Social Psychiatry, and Sanofi Global Health Programs have convened every year a group of approximately forty people from about twenty countries (not only from Africa, Asia, and Latin America, but also from Europe), and from various backgrounds (public, private, associative, and academic sectors), who are all involved in developing access to care for people living with mental disorders or epilepsy in LMICs. The meeting held in Versailles, France, on September 13 and 14, 2018, focused on “Scaling Up Interventions for Better Access to Mental Health and Epilepsy Care.” Through didactic presentations based on the World Health Organization-ExpandNet “Nine steps for developing a scaling-up strategy” guide, as well as case studies and workshops around three pilot projects implemented in Cambodia, Guatemala, and Madagascar, this forum provided participants with an opportunity to gain in knowledge and understanding of scaling-up theories and to apply these to practical cases.

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During 2018 monsoon, Kerala received 256% excess of rainfall resulting in floods affecting 5.4 million people, leaving 483 dead, 14 missing, and 140 hospitalized. The UN estimated a loss of Indian National Rupees 310,000 million. Our teams worked from the affected sites to the relief camps. As the disaster struck rapidly, prompt actions were taken based on quick assumptions. Mental health teams exposed to disaster preparedness manual and worked in tandem with health workers. Medical student volunteers indulged children in recreational activities. Feedbacks of their experiences were collected. Status in the rehabilitation centers was ascertained systematically, and services rendered were recorded. Postgraduate students of mental health discipline were trained using the WHO Tool Problem Management Plus (PM+), and their feedback was gathered. About 2086 people from 296 households in the relief camp were studied. Medicines were refilled for the psychiatric patients and psychological first aid was offered to those in distress; all of them had sought mental health services openly. Alcohol withdrawal syndromes observed were not severe. Children emboldened the adults. Out of the 13 long-term care centers, inmates had to be shifted out in three. PM+ workshop was rated beneficial by the participants. This is the report of experiences and action from the affected sites from day 1 of disaster. When hit by disaster, stigma against mental illness becomes less conspicuous. Expeditious orientation in disaster preparedness is feasible and advantageous for mental health professionals. Children are pivotal for suicide prevention in adults. Unlicensed care centers pose delay in providing support. Inclusion of disaster preparedness and intervention modules in the curriculum is to be considered.

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Although psychiatric and neurological disorders are among the first contributors to the global burden of disease, they remain among the most neglected topics of Global Health. There is a real need to raise their profile, to improve advocacy so that the impact of these diseases is better understood, and greater political efforts are made to improve access to health care for mental disorders and epilepsy. This is the reason why in September 2019, the Interactive Meetings Promoting Access to Care and Treatment (IMPACT) Forum co-organized by the Institute of Epidemiology and Tropical Neurology UMR 1094 Inserm, the World Association of Social Psychiatry (WASP), and Sanofi Global Health was focused on “Advocacy: how to create political will for mental health and epilepsy in low- and middle-income countries?” This forum involved 40 people from 20 countries (from Africa, Asia, Latin America, but also from Europe), from various backgrounds (public, private, associative, and academic sectors), all committed to developing access to care for people living with mental disorders or epilepsy in low- and middle-income countries. The 2-day meeting combining plenary didactic sessions and group workshops provided participants with an opportunity to get a better understanding of advocacy, of its importance to drive policy and societal changes, and encouraged them to develop local advocacy plans. A survey conducted at the start of the IMPACT Forum, to evaluate the baseline understanding and attitudes toward advocacy, and repeated at the end, showed improvements in the overall score, as well as in every single item.

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