“America Is in the World, the World Is in America”: APA’s Council on International Psychiatry and Global Health

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SECOND THOUGHTS

At the American Psychiatric Association (APA) Annual Meeting in Los Angeles in May 2025, I had the privilege of beginning my year as Chair of the Council on International Psychiatry and Global Health as the Assembly Representative. I am following in the highly successful footsteps of Pamela Collins, MD, MPH, immediate past Chair of the Council who continues to serve on the Council, and Ricardo Juarez, APA Staff Liaison, who has long been involved with the Council since the Office of International Affairs was reestablished (see Table).¹ We are among the 14 current members of the Council whose history dates back to 1970. The Caucus for Global Mental Health and Psychiatry is a partner of the Council since its founding in 2014 and is currently chaired by Rahn Bailey, MD.

Table. History of the Council on International Psychiatry and Global Health¹

What Is the Council on International Psychiatry and Global Health?

The APA has approved this significant charge for the Council:

The Council on International Psychiatry and Global Health facilitates understanding of problems facing international psychiatrists and their patients. It does so by focusing on international membership in APA, and through increased membership in APA, availing all members of the opportunities in education, advocacy, prevention and clinical care that membership in APA provides. The Council brings to the mission of APA the global perspectives of individual, family, culture, and population-based approaches for understanding mental health well-being and the treatment and prevention of psychiatric illnesses.

This charge is operationalized through these specific responsibilities:

• Collaboration with APA and other national and international organizations
• Developing partnerships with other organizations to foster international programs
• To support psychiatric education to integrate a global perspective that include population-based research and prevention strategies
• Ensuring that APA policies and positions respond constructively on international issues affecting global and population health
• Collaboration with other APA Councils to develop global strategies in all aspects of our activities
• Promoting human rights advocacy and recognize that there can be no mental health when human rights are violated

I come to the Council having been a cofounder (2014) and past chair of the Caucus on Global Mental Health & Psychiatry (2016-2017) and a first stint as an appointed member of the Council (2017-2020). As a Canadian medical school graduate, I am not considered an International Medical Graduate (IMG) but I identify with their situation as an Italian who trained and consults in several countries. I trained in global mental health at the Harvard Program in refugee trauma and work with migrants, asylee, and refugee children and families in trauma-informed care.

Recent Highlights of the Council’s Work

A recent report (November 2023) by immediate past Council Chair, Pamela Collins, MD, MPH, highlights the Council’s key commitments and achievements:

1. Migration and mental health: “The Council and workgroup received feedback and support from organizations during initial discussion around this topic including the National Institute of Mental Health, the Royal College of Psychiatrists, and the World Psychiatric Association, as well as guidance from the APA Joint Reference Committee. In addition to existing APA resources providing guidance on delivering culturally competent care to immigrants, refugees, and asylees, the workgroup is also identifying practical tools and resources for emergency settings from the World Health Organization and relevant United Nations agencies such as the UN Refugee Agency, the International Organization for Migration, and U.S. agencies such as the HHS Office of Refugee Resettlement and SAMHSA.”
2. Global mental health education and training: “At the 2023 APA Annual Meeting, the Council met to discuss initiatives to support global mental health education and training and identify groups for coordination and collaboration on resource development. The Council connected with the APA Caucus on Global Mental Health and Psychiatry which established a Work Group on Global Mental Health Curriculum comprised of Dr. Kenneth Fung, Dr. Seeba Anum, Dr. Victor Pereira-Sanchez, and Dr. Rick Wolthusen. Over the past year, the workgroup reviewed and discussed the APA resource document on developing a global mental health curriculum in psychiatry residency programs, solicited input and feedback at the 2023 American Association of Directors of Psychiatric Residency Training (AADPRT) Annual Meeting and presented their findings at the 2023 APA Annual Meeting.”
3. Misuse of psychiatry and human rights: “The Council continues to review and update position statements that address the misuse and abuse of psychiatry and human rights violations.” In light of the current wars around the world with their attendant cascade of negative consequences for the mental health of populations and the potential abuses, the Council will remain vigilant and inform APA leadership and our members about them.

The recent work of the Council included the issues addressed in the Council Work Group reports and the development of the Resource Document on Developing a GMH Curriculum and the Resource Document on the MH Response to Migration Emergencies.

A Personal View

The history of social psychiatry reveals a movement from the individual to the social and back now to the individual in social context.² As President of the World Association of Social Psychiatry (WASP), I see the social determinants of health and mental health (SDH/MH) as a way to move beyond the binary opposition of the individual vs the society to see the individual in social context. The real challenge of social psychiatry—and all wide-angle, large-scale approaches from psychiatric epidemiology to public mental health and community psychiatry—is to bring us securely down from cruising altitude to where we live and practice.³ The SDH/MH is social psychiatry’s basic science that needs to be translated into clinical practice, training and research, and advocacy and policy-making.⁴

As Chair of the Council on International Psychiatry and Global Health, I see social psychiatry, cultural psychiatry, and the global mental health (GMH) movement, among others, as allies in the work of the Council. Similarly, I seek to get beyond the binaries of “us and them” in our own borders or “America and the world” beyond them. The history of the APA, starting at the top with medical directors, presidents, and other leaders, demonstrates a pragmatic internationalism. Past APA medical director Melvin Sabshin, MD, for example, asserted that, “Whether it is recognized or not, all psychiatrists are internationalists and the field of psychiatry is international.”¹

America is in the world; the world is in America.

Let’s move from a pragmatic recognition of internationalism to a more robust engagement with world associations of psychiatry and mental health to respond to the problems we share and the solutions we can forge together. I will cite just 2 examples. I am inspired by Adalberto Barreto’s integrative community therapy in Brazil where he has trained thousands of workers in their own communities, a movement that is growing throughout South America, in Europe, and with the support of noted community psychiatrist Kenneth Thompson, MD, and the Visible Hands Collaborative based in Pittsburgh, PA, in the US as well.^5,6 Another inspiration comes from Africa with the Friendship Bench, an approach which is both intuitively appealing as a way to anchor the individuals with mental illness in their communities and has been shown to remediate treatment gaps in low- and middle-income countries such as Zimbabwe.⁷

Critics of the GMH movement^8-10 warn about uncritically exporting American or Western notions of mental illness and treatments to the Global South in a new kind of colonialism.¹¹ American Journalist Ethan Watters frames this provocatively as seeing the rest of the world as “crazy like us.”¹⁰ Social and cultural psychiatry have been aware of this for decades. Raymond Prince, MD, a pioneer of those fields and of international health who worked in Canada, Nigeria, and Jamaica, recommended that mental health workers should be trained at home.¹²

A more constructive view is the transfer of knowledge and skills among communities and countries of practice that cross borders and boundaries to create an international tool-kit of best practices, adapted locally.¹³ In fact, fully one third of America’s psychiatric physician workforce is composed of IMGs, trained in languages and cultures other than mainstream North American cultures. In fact, too little has been written about both the challenges and the unappreciated advantages of bilingualism and biculturalism among psychiatrists.¹⁴

Again, as Melvin Sabshin, MD, wrote, “An American psychiatry that is respected and admired across the world will be more likely to achieve equity than will an organization that functions as a self-absorbed, isolated trade union.”¹

Concluding Thoughts

Finally, let me conclude with an open question to the readers of Psychiatric News—What projects should we undertake at the Council on International Psychiatry and Global Health?

The Council will continue to work and promote our GMH curriculum and how to respond to the mental health challenges of migration around the world. Thomas Nail, a leading American philosopher who has made a career of doing programmatic research on migration, calls “the figure of the migrant” the “dominant political figure of our time” which he argues is not the exception but the rule in human history.^15,16

My goals for my year as chair of the Council are:

1. To develop a “clearinghouse” for resources in international psychiatry. This would parallel the Council’s work on an international psychiatry curriculum. What I have in mind is to identify resources and create links between the APA and allied national and international organizations. Highly connected and engaged humanitarian workers have a working knowledge, skills sets, and a resource base which does not circulate easily. The Harvard Program in Refugee Trauma (HPRT) trains and supports this community and we need more such programs. The Council can collect such knowledge, skills set, and resources for humanitarian workers “on mission,” as UN workers say, in the field.
2. For my own interest and for the charge of the Council, I will undertake a review of the related concepts and organizations that invoke these terms:

• International psychiatry
• World psychiatry (the most highly rated psychiatric journal is called that, edited by Italian psychiatrist Mario Maj)
• Global health and mental health (a whole movement with people like Vikram Patel, MBBS, at Harvard)^8,9,17,18
• Social psychiatry (WASP)
• Cultural psychiatry (World Association of Cultural Psychiatry, WACP)
• Comparative psychiatry (this was Emil Kraepelin, MD’s pioneering term from more than a century ago, adopted by HBM Murphy, MD, as the title of his textbook Comparative Psychiatry, which he defined as “the international and intercultural distribution of mental illness”)¹⁹

We should also warmly embrace world associations in psychiatry and mental health that have other foci yet have an international reach such as the World Association of Dynamic Psychiatry, the World Federation for Mental Health, World Federation for Psychotherapy, always in collaboration with the World Psychiatric Association.

Resources

APA Council on International Psychiatry and Global Health. https://www.psychiatry.org/about-apa/meet-our-organization/councils/international-psychiatry

Resource Document on Developing a Global Mental Health Curriculum in Psychiatry Residency Programs. https://www.psychiatry.org/psychiatrists/search-directories-databases/resource-documents/2020/developing-a-global-mental-health-curriculum-in-ps

Resource Document on the Mental Health Response to Migration Emergencies. https://www.psychiatry.org/Psychiatrists/Search-Directories-Databases/Resource-Documents/2023/Mental-Health-Response-to-Migration-Emergencies

Social Determinants of Mental Health Task Force. https://www.psychiatry.org/psychiatrists/diversity/governance/social-determinants-of-mental-health-task-force

More information on the Council on International Psychiatry and Global Health is available by contacting Ricardo Juarez at rjuarez@psych.org.

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addictology at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych) and Fellow of the Royal Society of Canada (FRSC). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).

Acknowledgements

The author is grateful for the mentorship and support of the late Eliot Sorel, MD, with whom he cofounded the Caucus on Global Mental Health & Psychiatry; the inspiring leadership of immediate past Council Chair, Pamela Collins, MD, MPH; and Ricardo Juarez, APA Staff Liaison for providing the history and documentation of the Council on International Psychiatry and Global Health.

References

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