The World Psychiatric Association (WPA) World Congress of Psychiatry is one of the largest psychiatric meeting in the world whereby attendees benefit not only from the scientific programs but also the global networking. As President of Singapore Psychiatric Association (SPA), I was honored and privileged to attend the congress held in Berlin, Germany from 8 to 12 October 2017 as well as the WPA General Assembly and the Asian Federation Psychiatric Associations meetings. WPA has issued a number of position statements that are of relevance to psychiatric practice and training; these include that of Mental health in the workplace, Rights for Persons with Mental Illness, Suicide Prevention, Roles and Responsibilities of the Psychiatrist in the 21^st Century and Promoting Psychiatry as a promising medical specialty for medical students.

I have enjoyed the plenaries and keynote speeches at the congress. An example was the notion of the subsequent reduction of lifestyle habits (such as smoking), binge drinking, use of drugs (such as cannabis and heroin) and violence victimization and violence perpetuation by the prevention of adverse childhood experiences (ACE) in future generation. There was also the emphasis on social justice whereby the society should treat all equally well by Prof Dinesh Bhugra, the outgoing WPA President and an interesting talk on ‘Shell Shock – the British Experience ’ by Sir Simon Wessely which also highlighted the controversy behind Post Traumatic Stress Disorder.

The other sessions were as interesting and educational. There was a talk on ‘Aggressive obsessions i.e. Harm OCD’ – the model behind the condition – ‘autogenous’ without any identifiable trigger and ‘reactive’ which is triggered by environmental factors and its treatment including mindfulness. Another topic that was especially relevant to our local context since Singapore is currently embarking on training and certification of peer support specialists was the session on ‘Peer support: foundation of experiential knowledge’ which touched on the differences in its intervention work and sharing experiences. It also emphasized on the need to embark on research methods to allow peer specialists to capture collective benefits and social change.

The poster sessions have been useful as there were a number of posters on addiction psychiatry such as the use of Varenicline and Combination Nicotine Replacement therapy in a smoking cessation clinic in Taiwan and the use of a bed occupancy management in an addiction unit in a German psychiatric hospital. I presented the findings of the Home Treatment Team (HTT) pilot programme of the Institute of Mental Health and there was wide interest and discussion amongst the attendees especially from the European countries. There was also a poster on HTT in a Swiss population looking at the differential characteristics of patients treated under the programme.

Finally, I would like to congratulate the newly elected members of the WPA Executive Committee and the Zonal Representatives.

I have always found the APA Annual Meeting to be of high standards and offered a variety of topics ranging from clinical, education, research and even technological advances in the delivery of healthcare services. The theme for this year meeting was ‘Prevention Through Partnerships’ which is timely as we are also looking at prevention and early detection of psychiatric conditions and developing a relationship based healthcare system in Singapore. Working together with different parties is crucial to the success of clinical programmes and clinicians need to be mindful of the integration of care of psychiatric and medical conditions. After the Opening Session by APA President, Prof Maria A Oquendo, there was a special lecture by Susannah Cahalan, a New York Times bestselling author of ‘Brain on Fire: My Month of Madness. She shared her experience as a psychiatric patient when she was misdiagnosed to suffer from Schizoaffective Disorder and Bipolar Disorder when she presented with paranoia and erratic behavior. Her actual diagnosis was Anti-NMDA Receptor Autoimmune Encephalitis. It was a powerful speech and it highlighted the need for treating psychiatrist to stay abreast of current medical knowledge and to have a high level of suspicion especially when encountering atypical clinical presentations.

At the conference, I have deliberately chosen a few topics of special interests especially with my current role in National Addictions Management Service in the Institute of Mental Health. The sessions on addictions and alcoholism which were co-organized by the National Institute on Alcohol Abuse and Alcoholism renewed my understanding of these disorders especially the sessions on alcohol screening and brief intervention for youths as well as the use of mobile phone- and web-based technology to enhance treatment and support recovery for patients with addiction problems. There were also presentations on the use of wearable alcohol biosensor which would provide feedback to the wearer to keep him/her honest and motivated. Other sessions that interested me included that of promoting physician competence across the lifespan by identifying the learning gaps and through a targeted lifelong learning and continuous practice assessment and improvement method. As clinicians we need to provide the best clinical care to our patients – not just knowing recent findings from the literature but to implement good practices from evidence-based medicine. Another topic that I found useful was on attaining leadership and mentorship roles while being a clinician – readiness to serve, deep determination, ‘recalcitrant’ persistence, commitment to quality, openness to feedback, devotion to developing people and unfailing honesty.

Other clinical sessions that I have attended included that on the role of psychiatrists on end of life option (e.g. physician assisted suicides versus euthanasia), assessment of malingering using tools like Rey I, Rey II, B test, coin-in the-hand and Miller forensic assessment of symptoms test (M-FAST) and antidepressant treatment for pregnant women etc. Beyond the clinical updates, I was honored to be invited to the Presidential Reception hosted by Prof Maria A Oquendo. It was a memorable night as I made new friends and also re-established the relationship with the existing ones.

With Ms Susannah Cahalan, author of ‘Brain on Fire: My Month of Madness’

With Prof Maria Oquendo, President of American Psychiatric Association’

The VIII National Congress of Indonesian Psychiatric Association and the 15th ASEAN Federation of Psychiatry and Mental Health Congress was held from the 25th to 27th August 2016 at Semarang, Indonesia and I was privileged to attend the meeting in the capacity of the Vice President of the Singapore Psychiatric Association. The meeting was organized by PERHIMPUNAN DOKTER SPESIALIS KEDOKTERAN JIWA INDONESIA and ASEAN Federation for Psychiatry and Mental Health (AFPMH). The theme for the meeting was “New Challenges in Psychiatric Care in ASEAN Economic Community” and was chosen to meet the learning, networking and latest needs of regional psychiatric services.

Dr. DanardiSosrosumihardjo, Sp.KJ(K), the President of Indonesian Psychiatric Association and the President of AFMPH welcomed the delegates from ASEAN countries to the meeting on the first day with an elaborate ceremony consisting of Indonesian dance and music.There were different tracks in the program to meet the needs of the participants. Examples of the tracks included Alcohol and Substance Abuse Disorder, Biological Psychiatry, Community Psychiatry, Consultation Liaison Psychiatry and Forensic Psychiatry etc.

I was invited to give a sharing on Singapore’s approach in reducing the treatment gap of mental disorders. Delegates from Indonesia, Philippines, Vietnam and Malaysia also share their countries’ endeavors in addressing this issue. Some of the common themes echoed from them werethe difficulties in translating a lot of their governments’ healthcare policies due to the size of their country, the geographical barriers and the level of literacy. Singapore was privileged in comparison as we do not face such difficulties but there was still more work to be done to improve mental health awareness.

The meeting provided an excellent platform in getting to know the leaders in the ASEAN Psychiatric community as well as create more awareness for the need to do more for mental health. The meeting ended with the formal passing of the host country from Indonesia to the Philippines for the 16th ASEAN Federation of Psychiatry and Mental Health Congress.

SPA Vice President and country delegates during session discussion

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