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World Psychiatry. 2004 February; 3(1): 54–55. | PMCID: PMC1414666 |
The World Federation for Mental Health: its origins and contemporary
relevance to WHO and WPA policies Eugene B Brody1 1Journal of Nervous and Mental Disease, c/o Sheppard & Enoch Pratt Hospital, Baltimore, MD 21285-6815, USA The World Federation for Mental Health (WFMH) is an international, multi-professional
non-governmental organization (NGO), including citizen volunteers and former
patients. It was founded in 1948 in the same era as the United Nations (UN)
and the World Health Organization (WHO). For many years, led mainly by psychiatrists
focused on social, peace-related and human rights issues, it was the only
international mental health NGO consulting with UN agencies. Since the late
1990s, as a global alliance of national mental health associations focused mainly
on traditional mental health issues and on prevention and promotion, it has
continued its long-time collaboration with WHO. Its policy concerns and those
of international professional associations such as the WPA could be mutually
advanced through partnerships aimed at achieving common goals. Keywords: Mental health, policy, WFMH, WHO, WPA In a recent article in World Psychiatry ( 1),
Wolfgang Rutz of the World Health Organization (WHO) Regional Office for Europe
made a plea for policy based on the revival of "social psychiatry and social
mental health approaches". He observed that "mental health and peace in a
society are strongly linked to each other", that "mental health impact assessments
and consequent analysis of political decisions should become a routine", and
that mental health policy requires a major focus on destigmatization and counteracting
discrimination, understood in part as "a reconciliation process" with the mentally
ill. Finally, he noted that modern psychiatry cannot abdicate responsibility
for "promotional and prevention aspects of mental health". Translating this perspective into action has already been enhanced through
partnerships between WHO and international non-governmental organizations
(NGOs), including both professional associations, such as the WPA, and the
World Federation for Mental Health (WFMH), which is a voluntary citizen's
organization including a broad spectrum of professions. To the degree that
NGOs are free from obligations to governmental, inter-governmental or corporate
entities, their formulation and defense of advocacy positions in response to
political decisions may be facilitated. This was given concrete form by Morris
Carstairs, WFMH President from 1967 to 1972, in his belief that the only justification
for an international NGO was for it to take positions in defense of what it
considered just and right. The purpose of this note is to call the attention of WPA members to the
evolving status, current positions, and possible partnerships with WFMH, which
shares some of the WPA policy concerns, as well as those of WHO. A detailed
account of WFMH history from its founding in 1948 until 1997 may be found
elsewhere ( 2). WFMH has twin roots. One was expressed in its predecessor organization,
the International Committee for Mental Hygiene (ICMH), which was first organized
in 1919 by Clifford Beers - a former mental hospital patient ( 3, 4) who planned an
international network of national mental health associations devoted to "the
protection of the insane"- and then reorganized in 1930 with the First International
Congress of Mental Hygiene, which brought an estimated 4000 people (psychiatrists,
psychologists, health planners and others) to Washington. The second and more immediate root of the WFMH lay in the post-World War
II hope for peace through international collaboration. It culminated in 1948
in the founding of the United Nations (UN) and its associated WHO. The WHO
and the United Nations Educational, Cultural and Scientific Organization (UNESCO),
founded earlier, were key sponsors of the Third International Congress of
Mental Hygiene in London (1948) at which ICMH was transformed into WFMH. This
Congress was an opportunity for national mental health associations to resume their
international contact interrupted by the war. But the actual impetus for a
new international mental health entity came from psychiatrists, who conceived
it both as an advocacy agency for world peace and a bridging organization
between the UN and the world's voluntary mental health associations. The concept
of a new NGO, and its name, were first suggested by G. Brock Chisholm, the
Canadian psychiatrist and former Major General who, in 1948, became the first
Director General of WHO. His suggestion came in November 1946 at a small gathering of
psychiatrists in New York City in the office of George Stevenson, Medical
Director of the US national mental health association, convened by Britain's
John R. Rees, a pioneer in social psychiatry, who had founded the Tavistock
Clinic and fostered the use of group methods in the British army. The WFMH founding document, "Mental Health and World Citizenship", understood
"world citizenship" in terms of a "common humanity" respecting individual
and cultural differences, and declared that "the ultimate goal of mental health
is to help [people] live with their fellows in one world". The document was
produced at a special meeting in August 1948, and a key contributor was the
psychiatrist Harry Stack Sullivan, an ardent proponent of "world mindedness",
who arrived just after participating in UNESCO's first conference on reducing the
"tensions which cause war". Along with Chisholm, he hoped that a kind of "world
loyalty" might replace primary allegiance to a nation or ethnic group. In
1945 he had invited Chisholm to lecture at the William Alanson White Foundation
on "The Psychiatry of Enduring Peace and Social Progress". Chisholm's challenge
to his fellow psychiatrists was unequivocal: "With the other human sciences
psychiatry must now decide what is to be the immediate future of the human
race. No one else can" ( 5). Sullivan
published it in the pages of the journal Psychiatry, with an editorial calling
for a "cultural revolution to end war" to be led by psychotherapists and social
scientists ( 6). At its very outset, therefore, the WFMH was concerned with educating both
the public and influential professionals, and with human relations, with a
view both to the health of individuals and that of groups and nations. This
fitted the interests of Rees, who agreed to become the first President and
then, a year later, Director of the WFMH, remaining in that position through
1961. In 1949 he guided WFMH's first recommendation to WHO (then directed
by Chisholm) for the establishment of a mental health section. In the next several
years, he wrote, the joint work of the two organizations "did a great deal
to ... help change the climate of opinion about mental illness and mental
health in many countries" ( 7). This
WFMH emphasis has expanded with education and advocacy carried on since 1992
through an annual World Mental Health Day, celebrated internationally. It
has become a vehicle for transmitting information to local mental health associations
and agencies about a variety of relevant issues. As the family of UN affiliated agencies grew, WFMH consulted closely with
many of them in a broad and diverse range of projects. However, without UN
collaboration, it was able, with the freedom of an NGO, to take independent
stands on some issues. Thus, in 1971, it became the world's first mental health
organization to take a public stand against the totalitarian exploitation
of psychiatry. In the early 1990s it voiced its formal opposition to a UN
endorsement of state mechanisms of social control. Among concerns shared with UN agencies were the mental health casualties
of migrants and refugees, children in armed conflict, human rights in relation
to biomedical technologies, women's rights, and the rights of oppressed minorities.
In 1981-83 WFMH was among the most active NGOs promoting the formation of
a UN working group, culminating in the 1991 General Assembly's recognition
of the human rights of psychiatric patients. It worked with the Pan-American
Health Organization (PAHO) on the 1990 Declaration of Caracas, dealing with patients'
rights and standards of care. In the mid-1990s, the WFMH had a major role
in developing the NGO Committee on Mental Health at UN, today a key platform
for work with units of the Economic and Social Council (ECOSOC). The Federation's
emphasis on promotion and prevention has led to two recent international conferences,
with WHO representation, focusing on these issues. Its past and current concerns with destigmatization and the welfare of
persons diagnosed as mentally ill are reflected in the representation of psychiatric
hospitalization survivors in its programs, membership, and Board of Directors,
and its adoption in 1989 of a Declaration of Mental Health and Human Rights.
However, it has not become primarily a patient advocate organization and psychiatrists
and other professionals continue to be influential in determining its policy
positions. Twenty-three of its 32 presidents between 1948 and 1997 were psychiatrists. In
its first fifty years the leaders who held the post of Secretary General or
an equivalent designation were all psychiatrists. For many years after its founding, the WFMH was the only NGO of its kind
with a close working relationship with UN agencies, particularly the WHO.
In recent decades, though, a number of international mental health organizations,
often limited to members of particular professions, have developed. In varying
degree they have filled needs formerly addressed mainly by WFMH. The WPA,
in particular, has become a powerful global force. In 1983, for example, it
began to deal with issues surrounding the totalitarian abuse of psychiatry. Now,
destigmatization is part of its agenda. Rutz' article in this journal suggests
areas in which fruitful partnerships between the WFMH, the WPA and their component
members, including national mental health associations, might be considered. 1. Rutz W. Rethinking mental health: a European WHO perspective. World Psychiatry. 2003;2:125–127. 2. Brody EB. The search for mental health. A history and memoir of WFMH 1948-1997. Baltimore: Williams and Wilkins; 1998. 3. Beers C. A mind that found itself. New York: Longmans; 1908. 4. Dain N, Clifford W. Beers, advocate for the insane. Pittsburgh: University of Pittsburgh Press; 1980. 5. Chisholm GB. The psychiatry of enduring peace and social progress. Psychiatry. 1946;9:1–44. 6. Sullivan HS. The cultural revolution to end war. Psychiatry. 1946;9:81. 7. Rees JR. Reflections: a personal history and an account of the growth of the
World Federation for Mental Health. New York: United States Committee of the World Federation for Mental
Health; 1966.
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