As the President of the Singapore Psychiatric Association (SPA), I was invited by Prof AfzalJaved, the Congress Director of the 6^th World Congress of Asian Psychiatry (WCAP), organized by the Asian Federation of Psychiatric Associations (AFPA) to be a co-chairman as well as a presenter at the session on ‘Community Psychiatry’ at the above conference held in Abu Dhabi, United Arab Emirates  from 24 to 26 March 2017.

I presented the topic of ‘Frequent Visitors to the Emergency Services (ES) of the Institute of Mental Health in Singapore’ at the conference. This oral presentation explores the ES staff perceptions of the reasons for frequent visits. Frequent visit was defined as five or more visits in a year. The top 3% of users accounted for 16% of service use. Frequent users were more likely to have a diagnosis of a psychotic disorder, personality disorder, or alcohol use disorder. Service provider groups (physicians, nurses, and assistants) described similar groups of frequent users and noted that frequent use was related to lack of social supports outside the hospital and feelings of belonging within it. The service providers’ perspectives highlight how societal pressures influence the way in which individuals with mental illnesses use services.

There were a number of plenary lectures in this conference. The first plenary was by Prof Shigenobu Kanbu (Japan) which touched on the phenomenon of ‘Hikikomori’ in Japan. This type of depression is commonly seen in younger people who express chronic fatigue and loss of interest in work and dislike to be confined into rules or morals.

There was a joint symposium on ‘Developmental Disorders’ which discussed about developmental disorders and offending as well as the role of pharmacological interventions in Autism Spectrum Disorder. The speakers emphasized on the need for comprehensive assessment, working with the family and the individual and the importance of non-pharmacological (mainly behavioral approaches). When medication is indicated, they should be started at low dose and titrate gradually as persons with ASD are more sensitive to side effects.

There was a number of lectures on well-being, mental capital and the need for building strength and resilience which include supported employment, debt interventions, housing improvement and even availability of green spaces (such as community gardens for physical activities and exercises). The emphasis on enhancing mental capital and intervention which address inequality also promote population mental health, prevent mental ill-health and promote recovery.  Enhancing individual competence and self-esteem increases perception of personal control and has positive effect on health and other domains.

As SPA President, I also attended the AFPA Board Meeting held during the conference.

SPA President Dr. Lee and his Phillipines co-chair and fellow presenters

It was more than a quarter of century that the Royal Australian & New Zealand College of Psychiatrists (RANZCP) last held a Congress outside Australia or New Zealand. This year the Congress was held in Hong Kong from 8 to 12 May to support the growing relationships and collaborations within the region. I was indeed delighted and honored to represent Singapore Psychiatric Association (SPA) for the Congress. The theme of the Congress is ‘Regional challenges worldwide influence’ and there were seven high calibre international keynote speakers along with many invited speakers from around the world who presented a diverse range of psychiatric topics.

I particularly enjoyed the keynote speech by Prof Naomi Fineberg of the Hertfordshire Partnership University NHS Foundation Trust. The lecture was on the relationship between compulsivity and impulsivity in Obsessive Compulsive Related Disorders (OCRDs), the evidence based treatment currently available and highlighted some of the randomized controlled trials showing efficacy against placebo in Resistant OCD.

As my current interest is on Peer Specialist programme and movement, I also attended the symposium on ‘Recovery and the Psychiatrist: The Way Forward’. Central to all descriptions of recovery are: Hope, Self-determination, Self-management, Empowerment and Advocacy. Psychiatrists have a key role to play in applying the principles of recovery and they need to be aware of the key elements of concept of recovery, review their approach in clinical practice to ensure they are knowledgeable and competent and that their practice is recovery-oriented.

Another related symposium was ‘Psychosocial Interventions (PSIs) for People with Severe Mental Illness (SMI): perspectives on current practice realities and implications for training and implementation’. Despite PSIs having robust evidence and are recommended in clinical practice guidelines for SMI, these interventions are yet to be widely available in routine care. It is recommended that a multi-level systems approach is required to implement PSIs – taking into account characteristics of the patients, staff factors and the organizational culture variables of leadership and planning.

One of the closing lectures was on ‘Psychiatric leadership and courage in volatile times’. Clinical leadership is akin to a conductor of an orchestral concert. The primary duties of the conductor are to set the tempo and to ensure correct entries by various members of the ensemble. Invariably the applause goes to the singer and the conductor does not try to get the attention by ‘outsmarting’ the team or ‘claiming’ the credits. The other take-home message is: ‘Volatility hurts at times, but it can also make us stronger’.

I must say the Congress was well organized with its eclectic scientific programmes. I must also say I have benefited from the networking sessions which allow SPA to continue its friendship with the other regional and international associations and societies.

Photo with Dr Kym Jenkins – President Elect RANZCP

Photo with current President, RANZCP Prof Malcolm Hopwood