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Keynote

ICAP 2014

Keynote Speeches

grahamm
Prof. Graham Turpin

Professor of Psychology
University of Sheffield, UK

I would like to start my presentation by thanking you for your kind invitation to be the keynote for the first International Conference on Applied Psychology in Sri Lanka. I’ve only been associated with Sri Lanka for 12 months but it feels a lot longer. I’ve had the great pleasure to come to the Colombo Institute of Research and Psychology, I think four times now, as the external examiner. I’m very delighted with the Bachelor’s Degree; it has been accredited by the British Psychological Society, that’s no mean thing. I would just like to thank CIRP and also the University of Coventry as well for facilitating my trip here and attendance of this conference.

And what I want to do is to focus on what I consider to be a really important issue, and it’s one that Darshan has already touched on which is about access to psychological therapies and think about that globally, not just in relation to countries. Martin Seligman had identified those that are developing or perhaps poor or affected by famine and war, but also think about access psychological therapies in the so called high income economic countries. When we take a sober look we don’t actually get it right and access to psychological interventions is actually quite poor across the world. So that’s going to be my theme. I’m going to focus on what is called the treatment gap, which is trying to quantify lack of access to interventions. I’m going to look at some developments over the last decade mainly organized by the WHO, World Health Organization; they have actually tried to make a difference in meeting the treatment gap globally. And I think in the last 10 years or so it has actually seen a massive development in terms of global mental health.

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I’ll talk a little bit about the UK. I spent six years helping to setup a big national programme, which was called Improving Access to Psychological Therapies. I was the National Advisor to the Ministry of Health in England and I’ll tell you a little bit, how we spent probably about a 1000 million pounds trying to develop access to psychological therapies, and then finally I’m going to try and share some thoughts about Sri Lanka and pick up on some of the issues Dr. Darshan mentioned. I think recognition; registration and regulation are all actually very important points so I’d like to return to those.

So some contexts if we travel back in time about 14 years or so, the WHO profiled Mental Health globally and published a report in 2001 and it was pretty damning really. 40% of countries had no mental health policy, 25% had no mental health legislation, where it did exist most of those are at least 40 years old. Now couple of months ago, I gave a similar talk in Bangladesh and at that time their legislation was based on the 1928 Lunacy Act. Now I have a suspicion that until this year in Sri Lanka, I think your mental health legislation was also based on the 1928 Lunacy Act, but I’m pleased to say that it is currently being revised and brought up to date. 28% nations had no identified mental health budgets and most of them invested less than 1% of their health budget on mental health. So the overwhelming global picture was really that of neglect.

Now as I’ve hinted the last decade I think I’ve seen some significant improvement so we have an awareness of the importance of mental health, both globally with WHO and also within the UK, one of the big cries if you like, at the moment is equity, there should be equity in terms of the provision of physical health care and mental health care. There has been a whole series of reports that have been published in the last decade or so, about how mental health might be improved. So in 2009 there is a report on looking at systems of delivery of health care globally. A very important report the following year which was about the economic impacts of poor mental health both in terms of the people who experienced poor mental health but also the interactions with a nation’s wealth and that’s something that I’d want to come back to. A very important guide was published again a few years ago called Mental Health Implementation Guide which was all about scaling up mental health interventions within low to middle income economic countries. So if we are saying here are a set of interventions that have an excellent evidence base and here are some ways that you might be able to introduce these interventions within your health systems. So as the minister has already said, very much a practical focus in terms of implementation. Recently there was a mental health action plan that tried to establish set of principles and a set of goals. And very recently, in fact very important from my opinion, is the whole issue of deinstitutionalization. There are far too many large warehouses in our countries for people with mental health or psychiatric problems and if we are really going to seriously think about providing psychological interventions within community, within primary care, then one of the things we need to address is actually trying to reduce our reliance on those large psychiatric hospitals and institutions.

So a lot has happened in the last 14 years or so and a lot has been published as well. So I’m proud to say that The Lancet UK Medical Journal has had a number of issues that have been devoted to global mental health, there’ve also been a series of really quite key articles about developing mental health services in low to middle income countries.

I want to focus on a key concept which I mentioned earlier which is the treatment gap. Treatment gap, are the percentage of people with the disorder that go untreated, they received no intervention whatsoever. Generally speaking this is a balance between prevalence of the disorder and resources that are available to treat it or provide interventions. It differs significantly across countries due to both those factors but also there are some other more subtle issues such as the recognition of disorder and also the stigma of mental illnesses that there is. The treatment gap was identified in number of articles within the Lancet and there was focus on Europe, so although 27% of people every year experience some form of mental illness or mental disorder, 74% of those people receive no treatment. So even from a European perspective we are actually doing very poorly in terms of allowing access to treatment intervention. Interestingly within the Lancet the analysis was that actually this is not just a problem for mental health professionals but it’s a problem for the whole of society and they are advocating a socio-political campaign of sustained advocacy in order to overcome the barriers to scale up the mental health provision. Saxena, in the same article looked up the issues globally and the inequalities become even more startling. The US has more psychiatrists than India, China and Africa put together. So access to health professionals – huge inequalities across the world, and globally two thirds of people go untreated, up to possibly 90% in low-middle income countries. So access to mental health treatment is really quite dire.

Now much of this is obviously to do with resources and if we look across different countries in terms of their economic standings, we see huge differences in the provision of mental health services. This is quite a sort of busy slide. You can break it down into different professions again huge disparities between psychiatrists and psychologists, psychiatric nurses, social workers across economic countries. And unsurprisingly this also follows through in terms of provision of services. So this is a very busy table, you can read it in the Saxena article. But again essentially what it saying is low, or lower to middle income countries that develop into specialized services within mental health or the provision of psychiatric meds or community or primary care is very under developed.

However, we shouldn’t t just think of the treatment gap in relation to finance and resources; there are some other really important psychological factors that determine whether people get to see mental health treatment. Probably the most significant is stigma in help seeking. So actually the problem lies with the patient himself or in fact not the patients but people, because many people are reluctant to become patients. So many people are reluctant to seek treatment and intervention. And this is the case even in high income countries such as the UK and the US. So despite a massive investment in availability of psychological therapies within the UK, only about 50 % of people with depression will actually come forward and seek help from some sort of interventional treatment. It’s similar in the US; in fact the figures are more worrying in the US. Only about a third of the people with mental health problems actively seek out treatment. For disorders such as schizophrenia because of its disabling consequences the percentage of people that seek treatment is generally higher. However it’s interesting that in countries such as Australia, because as almost as if you have a fear of the consequences of being treated within mental health systems, the young people with psychoses are actually very reluctant to come forward and to seek treatment. So the percentage of people that are untreated also links to the ability of those folk to come forward and to actually seek help. So it is not just the function of resolve.

There is also another important factor which is if they seek help, are their mental health problems recognized? So this is the whole issues of detection, it’s the issues of detection within primary care and whether our general practitioners, our medical practitioners sufficiently well trained in psychiatry and mental health to actually detect mental health problems. And again treatment avoidance is very common even in high income countries where, such as the UK, where there is free access to mental health treatment. There are also differences in the utilization of psychiatric services, some of these are probably ethnically and culturally determined. So people of some cultures are very mistrustful of psychiatric services and would have a preference to rely on more traditional or perhaps more spiritual or religious solutions. I have already mentioned stigma on the negative effects of diagnosis. The impact of having a mental health problem on employment, the existence of the dehumanizing treatments and fairly inhumane interventions as Darshan has mentioned in terms of big, large psychiatric hospitals or high doses of psychiatric medications but not surprisingly people are very weary of engaging with psychiatric mental health services.

What shall we do about this? Well a lot of it about public perception. So we really need to educate the public about mental health and they need to be positive messages. So we need to talk about the importance of wellbeing, the importance of good mental health and I also think about some of the negative impacts of mental disorders, but to do so in a more constructive way, in terms of what we can do to actually help intrigue. And we should have an emphasis on recovery, the fact that people can recover from mental health problems and to live more fulfilling and positive lives. As I said earlier the average around detection and recognition, so we need to ensure there is greater awareness in both within the public and in the relevant professionals about detecting psychological problems. There is also poor knowledge about the effectiveness about mental health interventions. Again the last 20 years has seen a big emphasis on evidence based medicine and if your look at the measures of effectiveness, the effectiveness of the psychological intervention for depression or any psychological intervention. I’m not just talking about CBT, but also psychodynamic and interpersonal therapy. They are much more effective than many medical interventions that we are commonly aware of. So if you look up the measures of efficacy actually psychological interventions. Are some of the more potent medical interventions we have? And there is ignorance about the efficacy of talking therapies, and also the fact that talking therapies can be used in many different groups.

What are the factors that affect the treatment gap, the delivery of mental health services? Well obviously there is whole set of socio economic factor or sociopolitical. So political will, poor funding, again it’s about forcing mental health up the agenda. So the politicians and public become aware of the mental health resources that frequently centralize in big cities and big hospitals and it’s difficult to get those resources out into community or out into country side. In a lot of low middle income countries and I think this goes for Sri Lanka, the focus has been on primary care workers being educated around mental health so they can help to deliver services. The problem there is that those primary care workers actually have their hands full delivering our interventions such as good women’s health, health maternity services, HIV etc. But they don’t really have the time or the resources to devote to mental health. Low numbers of mental health professionals, poor psychotropic medications and poor leadership in public mental health. These are some of the contributing or additional contributing factors.

What are the factors that affect the treatment gap, the delivery of mental health services? Well obviously there is whole set of socio economic factor or sociopolitical. So political will, poor funding, again it’s about forcing mental health up the agenda. So the politicians and public become aware of the mental health resources that frequently centralize in big cities and big hospitals and it’s difficult to get those resources out into community or out into country side. In a lot of low middle income countries and I think this goes for Sri Lanka, the focus has been on primary care workers being educated around mental health so they can help to deliver services. The problem there is that those primary care workers actually have their hands full delivering our interventions such as good women’s health, health maternity services, HIV etc. But they don’t really have the time or the resources to devote to mental health. Low numbers of mental health professionals, poor psychotropic medications and poor leadership in public mental health. These are some of the contributing or additional contributing factors.

So some solutions, this is where The WHO has come in and they have published a whole series of reports and initiatives and joint projects from various different countries about what can be done. So there was a report that identified different services for delivery for mental health and tailoring them to the economic status of different countries. The mental health gap intervention guide is a crucial document that identifies interventions that can be scout on, in low to middle income countries. Interventions are based on the available evidence and they can be implemented within non specialist, primary care, community services. So again if you are not familiar with this guide, I would strongly recommend you look through it. There is a mental health action plan which again about developing this globally, so the principles of universal coverage, human rights, particularly those within large institutions or residential care, evidence based, life course approach. Mental health is not just the province or mental health professionals. Good mental health and wellbeing, we also need to think about housing, education and employment and judicial services. So we need to have a much broader perspective. And also involve people with mental health problems themselves. In the design and the delivery of these services, so the objectives of this action plan is to strengthen leadership, try to create more comprehensive integrated community services, MH prevention and also information systems in research.

On the research note, the national Institutes of Mental Health within the US identify global mental health as one of its grand, challenges and setup a ten year research agenda to take this forward. And in fact here was even a publication in nature which is before more scientific journal within the world actually saying how important these grand challenges are, in terms of global mental health research.

And then finally as I mentioned before about the issue of decentralization producing community services and scaling back and closing there on are large psychiatric hospitals and there is a report about how to try and achieve this. Various different models of care have been suggested. Really important about paper by Thornicroft and Thansella, looking different blending’s of community primary care and especially hospital care across different settings.

Just a word of caution there is quite a nice paper by Ross White who is a psychologist published in the British Journal of Psychiatry that says we should be mindful of what we are doing when we are hoping to advice developing countries about mental health goes without saying that diagnosis is affected by cultural and diversity issues, we need to be careful about transcultural psychiatry and not introduce a new form of western, colonialism within mental health. Far too much over reliance in terms of psychotropic medication. There is a lack of research in the mental health provision, within low middle income countries, we need to find out what works specifically. And there is sort of assumption that high economic countries do it better, and that may not necessarily may not be the case .we know the extended families, we know that factors such as more community involvement and less individuals might actually better indicators of being good mental health. So it maybe the many of the low middle income countries have family structures and community structures that actually support wellbeing, much more effectively perhaps in the west. Involvements of users have been underdeveloped, also when you think about local solutions and also other traditional approaches to mental health. So that my global perspective on the treatment gap.

A little about what I think the situation is in Sri Lanka and this is me doing a little bit of searching on the internet and I want to tell you a little about a project that I was involved in, in the UK and then come back and address some of the issues Darshan mentioned about applied psychology within Sri Lanka. First, mental health in Sri Lanka, relatively high prevalence of anxiety and depression particularly in children and young people and I guess that’s not surprising given the sorts of challenges your country has experienced in terms of conflict and the tsunami in the last 10 years or so. What I was surprised at was the high suicide rates and you have one of the highest suicide rates in the world particularly for women. High levels of substance abuse, high levels of domestic violence towards women as well and clearly impact of natural disasters and conflict. So I guess mental health is an issue in Sri Lanka, I mean it’s an issues in every country but I think you have some particular challenges. Policy in budgets, well where the Sri Lanka lie in terms of investment within mental health services and that is quiet difficult to work on. Because your mental health budget is tied out with your overall health budget, so such, it was until couple of years ago, it was difficult to actually to tease that out, it may be clearer now. Rachel Jenkins visited about three years ago and did some really important training of medical practitioners and wrote a really nice positive article about the mental health in Sri Lanka. This was some of the figures that came from, until this year there haven’t been a modern mental legislation. Although I believe now that has change. You do have a mental health policy and that’s been reviewed and will be renewed in 2015. Human resources and staffing, I’m sure there are no surprises here, you train many psychiatrists from the majority of them go abroad to practice. So retaining mental health professionals within your own country is really quite difficult and as Darshan was implying there are very few psychologists who are actually employed within the government, or within the houses. So that’s the situation as it stands at the moment. So what we need to think is, where we are going in the future so I just want to say something about the role of psychological treatment, in psychologists in addressing these gaps. And the first thing I would say, is the about the effectiveness is about the psychological interventions no there is a popular book that was published in the UK/ and it’s called Thrive. It’s about the positive impacts on psychological and evidence based interventions, mainly CBT and this being published by Richard Layard, who is an economist and David Clarke who is a clinical psychologist. And in it they review the evidence of the effectiveness of psychological interventions, and the evidence is overwhelming and it’s reproduced in our clinical guide, which is from an organization called NICE. And what these authors do in this book is to put out the argument for access to psychological interventions on a global basis. There is also an economic case which is people with common mental health problems, quite frequently lose their jobs,. Become unemployed and then various countries become dependent or relying on benefits. So there is a loss of output, income, individual loses income and social status that usually results in problems from themselves and their families and society loses out in terms of productivity and also has to bear the cost of benefits and treatment rehabilitation of those folk.

Layard estimated that the economic impact of anxiety and depression costs the UK 12 billion pounds a year of which 7 billion comes from the treasury and he argued that if we could treat common mental health problems such as anxiety and depression more effectively we would save money as a nation. And this was the argument that he put forward to the treasury within the UK, and was a basis for improving the access psychological programme.

Would psychological treatments be as effective in developing countries or non-western countries? We must ask ourselves that question, and actually when you look at the evidence there is quite a lot of research that suggests that they do pretty well. So there is work in India, Uganda and Pakistan showing the effectiveness of CBT for common mental health problems. Frequently though, the interventions and supervision needs to be more defined, so it needs to be delivered within our local context rather than the context of perhaps UK or US health services. And we also need to think about the impact on culture, on the delivery of psychological therapies. Thoughts on Treatments that should be available are things like psychological first aid, following disasters, psycho education, mental health promotion, so this is whole business of increasing the awareness of the public and the psychological self-help, one to one psychological therapies, group interventions and also specific responses to trauma.

A review of mental health workforce issues, which was published in The Lancet recently. Essentially what they are saying is that in many developing counties we need to think about more flexible approaches to work force development. So we shouldn’t just rely on the idea that we train lots of psychiatrist and lots of psychologists. We need to think about how we can train people in mental health interventions within our communities, within localities, including laid people as well, so suggesting a much more flexible approach in work force development.

In fact I’m pleased to say that Sri Lanka is out there in the lead when it comes to psychiatry training and you have been training medical officers for mental health, who are as I understand general practitioners who have had a short program in psychiatry which offers them a much better informed approach to mental health.

Just want to briefly say what I have been involved in, in the UK and in some ways its quite similar to what you have been doing in Sri Lanka because we’ve been trying to increase access to psychological therapies but it hasn’t been profession led, we haven’t been trying to up the number of psychiatrists and psychologists per say but what we’ve been trying to do is to train specific therapies to deliver particular therapies. So I would describe as a client led bottom up approach. So we start with the needs of patients and the thoughts of services that they require, we think about the type of workforce that can deliver that. We think about the thoughts of skills and competences that workforce needs, and then we think about how we going to train and also the quality assurance and registration and regulation. So rather than starting with the profession, we start with the needs of individual clients and sorts of therapies and sorts of therapeutic competencies and scales that they require. Another important thing is a stat-care service which is about delivering to people, a sufficient intervention that’s affective. But it might be, well it has a number of principles, one is least burdened. It’s a little bit like therapeutic dose, like in pharmacology like you get the smallest affective dose that gives you a positive outcome. And we can think about this in terms of mental health provision. This is within the NICE guidelines, and it’s about interventions for depression. There are 3 columns and there are different steps in each column. So if you look up the columns in the far side, you’ve got different sorts of interventions. So it goes from watchful waiting, up to inpatient care. In the middle you have different severities of depression. So people with moderate to severe disorders clearly need quite major interventions, such as medical or psychological support. Whereas, those with fairly mild disorders can be treated perhaps within primary care. Perhaps by counselors or practice nurses. So what won’t you see in different steps, different dosages, different grades of intervention depending on how severe the disorder is. This is the principle that underly improving access to psychological therapies in the UK. Also we’ve developed new roles. So we’ve actually created a bit like medical officers in mental health. We have created a new profession, like we call psychological wellbeing practitioners. So essentially we have a skills mix, a group of people who deliver low intensity, brief interventions for anxiety and depression. So this might be guided self-help, computerized CBT, behavioral activation. Usually about 4-8 sessions, quite often, quite brief sessions. And these folk are trained a day a week every year. So on the other hand we trained CBT therapists. These are folk that would give 16 sessions. They are trained to a much higher degree of competencies. Their training is 2 days for a 12 month period. And great focus on supervision and we tend to train our therapists. So we are not starting from scratch. What we are trying to do is to upscale evidence based personal therapies, psychodynamic therapies, couples therapies and counseling as well.

What have we achieved well in about last 5 years? In all areas in England now have an improving access to psychological services. By next year we will have trained 6000 therapists’ within UK. Over 1.5 million people would be seeing, about a half of those would have completed treatment. And from an economic point of view, the thing that hits a button from treasury is quite a number of large people, and back into employment. Current recovery rates are a bit low it’s about only 46%. And at the moment, we are probably accessing about 10% people within those services if you are interested in our act, then go to the website. There is lots and lots of information’s, about training, workforce development etc.

Few thoughts about applies psychology from a Sri Lankan perspective, and I think there is some sort of key questions. So what we should be thinking about, in terms of psychology workforce. Whether the different roles of applied psychology, and how these roles should be reflected in education and that we design. On a rather psychologist role, so just as you develop new roles for psychiatry and medics within Sri Lanka, should we be thinking of developing new roles around psychologists within Sri Lanka. What about this notion about psychological wellbeing practitioner, which is like an assistant psychologist. How much effort should we spend on training other professionals in psychological approaches? What are the implications in terms of registrations? I think some of these questions are really tricky and if we ask ourselves, what should the psychology workforce look like. We look at countries like such as the UK, Australia and New Zealand. Clinical psychologists tend to train for at least 3 years. There required to perform supervised placements for an internship. Within the UK the majority of our registered practitioner psychologists now have to have a doctorate within psychology. And again have to meet the three year requirement.

So I think one of the challenges for Sri Lanka is whether you wish to aspire, to that international standard. And I put it that way because, there is a question there. I would suggest also that you think about different steps, that you don’t poke all of your eggs, in the doctoral basket. I think you need a flexible workforce. Unfortunately although there is a Sri Lankan workforce plan, and survey conducted by the Ministry of Health, psychology doesn’t feature in that at all. I think you need to think about recognition issue. How do you get on the map? What should a doctoral clinical psychologists be, they should provide both public mental health and clinical treatment, they should help design and evaluate. They should be expert trainers. And they should supervise other. And I think there is challenge in Sri Lanka, about how you’re going develop that class of clinical psychologists. I’m aware, that there’s a 2 year MPhil. At the university of Colombo, and how does that fit in, with the diverse landscape of applied psychology.

We also need to think as I hinted before about training other folk, at different levels, at different types of psychological interventions. There is a question as to where one year masters in applied psychology fits into all of this. Because that’s a lot broader, than just clinical psychology. Which in my aspect and how this fit into the clinical psychology work force. The big problem again registration and regulations? Most of the ethic in the west has gone into trying to regulate clinical psychologists or the Applied Psychologist, And Health Care or Assistant Psychologists. In UK psychological wellbeing practitioners are currently unregulated. So we need to think about how we regulate below that level of professional psychology. And now I was kind of surprised, and I think are 5 registered clinical psychologists.

Implications for sort of degrees, qualifications, associated curricular. I think essentially they should be fit for purpose. So I think you should design your curricular, in terms of what people are going to do. And I think the issues that you face. And I think it’s similar to some things Darshan said, is I think you need to come up with a common approach to a common platform within Sri Lanka. And I think you need to think carefully about the differences, qualification, length of training, access to placements. I wouldn’t pretend to know, the about the provision of undergraduate psychology education, I think there is an important issue, there about how undergraduate and postgraduate host together. In the UK we are fortunate that undergraduate psychology is one of the most popular disciplines. And interestingly, it’s not just dedicated to privilege classes; I mean psychology is attracted to everyone, in terms of lower, working class kids and kids from ethnic backgrounds. The only people we see not to attract are most men. So there is huge gender difference. I think you need to think about, how you can integrate some of your applied psychology specialism and think about the professional stand of other psychologists such other forensic.

How you are going to train other professions? And I think training other professions is important. And there is a whole impression of autonomous practice as well. Some possible solutions, you probably need psychologists to embrace all of this. And I think you need to work more closely with your National Institution of Mental Health. And you need to ask the question where psychology fit in the next mental health, which is going to be published within a years’ time. I would think about developing a workforce plan in psychology. Review of training within your training, to revisit registrations and regulations issue. If you are interested in psychology in other lower and middle economic countries, the BPS vision of clinical psychology published a few months ago, which you can download from their website.

Finally I got one little thought to leave you with, which is not to underestimate the challenge we’ve been talking about. It’s really nice little thing, I grew up in the states and a lot of thinking is associated with Obama care and access to health care generally and it’s called the Iron Triangle of health care and it’s got cost, it’s got quality and it’s got access. And obviously we would like to improve all 3 of those, we would like to decrease costs, we’d like to increase access and we’d like to increase quality but in reality you can really only do 2 sides of the triangle. So if you want to increase access and quality cost goes up tremendously, if you want to decrease cost then that’s usually at the cost of quality and access. So it’s good a thing to think about. So thank you very much.

In conclusion, treatment gaps exist across the world, we are not doing particularly good in the west. Improving access to psychological therapies requires a public health approach, adequate services need financial and political support, flexibility is required in terms of sorts of interventions that people have access and who delivers them, interventions have to be acceptable to communities and to cultures and applied psychologists of all levels of training have an important role to play.

ICAP 2014

Welcome Speech

darshan
Dr. Darshan Perera

Director of Academic Affairs
Colombo Institute of Research & Psychology

I’m very proud of myself as the academic director of Colombo Institute of Research and Psychology to address you today at the opening ceremony of ICAP Sri Lanka 2014. This is a significant achievement in our path to become an international reputed and a credible academic and a research institute. We have a very short history as an academic institution, but a history that we are certainly proud of. We have pioneered many initiatives that have positively contributed to the development of the field of psychology and research in Sri Lanka. We’ve launched the first internationally recognized BSc program in psychology that could be completed in Sri Lanka and the first internationally recognized Applied Psychology Master’s degree that could be completed in Sri Lanka also from January we have planned to start the PhD program as well. Through these efforts, we have increased the number of qualified psychology practitioners in Sri Lanka, from just 22 in 2012 to around 80 by 2014, a threefold surge. We’ve attracted students from many neighboring countries, in fact out of 450 currently studying at CIRP, around 30% are international students and I’m so proud to say that we have just achieved British Psychological Association accreditation for the BSc program we offer in collaboration with University of Coventry. We are the only university college to be awarded the accreditation by BPS outside UK anywhere in the world. So we are indeed proud of our achievement.

Coming back to the conference, the goal of ICAP is to bring together regional and international psychologists and researchers to a common platform, to share their knowledge, experience and expertise on that would nurture the field of psychology in South Asia, and inspire younger generations to start and get on with research which facilitates our final goal of making psychology an established field of study and practice in Sri Lanka as well as in the South Asian region.

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Psychology in South Asia has a long way to go to match its developed counterparts. In my perspective there are three main issues that have stalled the development of psychology in Sri Lanka, as well as in the entire region. They are lack of awareness, lack of recognition and lack of regulation. These are interdependent issues connected to each other in a cyclic manner. If you study the demographics of the students who apply for psychology programs, and the individuals who seek psychotherapeutic help, you will see that most of them belong to certain upper socio-economic classes of the society. These are very good examples that demonstrates the depth of penetration of psychology in our society.

Reason is very simple. The decision, what to study in a university, whether it’s decide by the individuals in the west or whether it’s decided by parents like in most of the cases in the part of our region, depends on few factors. The most influential being in this region is employability and prestige. In Sri Lanka, I’m sure most of you are aware, that we have only one psychologist for every million of people. So that means there would be lot of jobs available and psychology should be one of the most demanded Bachelor’s degree in the country, but it’s not like that. What is the reason? Children or people, most of them do not know about a profession called a Psychologist. Children or the adults have never seen a psychology clinic in their town, never seen a psychologist at a hospital, never seen a job vacancy for a psychologist appearing on papers. They have not heard of a psychologists who have helped and saved people to inspire them or create passion. So no wonder, that no one aspires to become a psychologist in this part of the region. Therefore lack of awareness across socio-economic classes is a major obstacle to the development of psychology in this region, because, when you talk about lack of awareness, most of the individuals only consider about the lack of awareness about the therapy available or whatever the help available through psychology, but people don’t talk about this aspect which actually stalls the development of psychology in the region.

And then the lack of regulation of profession, that’s one of the most important issues. This allows individuals who are interested in the field for many different reasons, to refer to themselves as psychologists, therapists and counselors. Lack of regulation would allow people to practice whatever they call psychology. So those few individuals of the society who are aware of psychology would seek help with these therapists and the results would not be very good. But what we are to understand is that this not only harms the client but also the profession. Because in most these cases the people would not understand that what they underwent is not proper psychology. So as a result rather than saying that the individual is not capable, they would say that psychology is not capable of solving their issues, which would repel even the few individuals who are aware about the solutions that they could get from psychology.

So that’s the second issue to my understanding. And both lack of awareness, lack of regulation then leads to lack of recognition. Governments would not recognize psychology as a serious profession, general public would not recognize psychotherapy as a credible treatment option, and the other academics would not recognize psychology as a reliable science. For example this is one of the reasons why psychiatrists in the region are not taking psychology seriously; or not giving its due place as an equal perspective rather than an inferior perspective, because they have seen the individuals who call themselves psychologists and counselors failing more than being successful in whatever the interventions they do. So like I told you, this is one of the biggest obstacles since the profession is not regulated. It would never allow us to get a chance to get recognition from the institutions as well as from the general public. Therefore I strongly believe that as individuals who are passionate about psychology, we should work together to overcome these three main issues if we are to receive credibility to psychology in this region and that is one of the main aims of this conference.

It is unfortunate that still many psychology enthusiasts in this region are unable to come together at least for the sake of the profession. Psychologists in Sri Lanka are divided by the university they graduated from, the professor who supervised them, their favorite therapy method, if you are a local or foreign graduate, or if you’re from capital or suburb. What they don’t realize is that while we stick to our camps and frown at each other there are thousands of innocent people in our community committing suicide, put on life-long heavy medication for life issues, being given ECT from non-compliance drug therapy.

I believe for most of us benefitted from the tax money of these citizens, our moral responsibility is to come together to do the least with our knowledge, qualification and expertise. As long as we don’t do that I do not believe that we should call ourselves intellectuals, or we’re worthy of the title “healers”.

Therefore as organizers of ICAP I invite all of you to use ICAP as a forum to discuss these issues, built partnerships, network to establish a strong community of psychology professionals to overcome those issues.

Once again welcome to ICAP 2014 and have a successful conference and a pleasant stay in Sri Lanka.

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