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The tsunami of demand

For me one of the themes of the sessions I have been to is a sense of defending ourselves against being overwhelmed by demand. Vikram's session on big ideas included big numbers about unmet demand and I went to a session this afternoon on the pointy end of mental health care in the emergency departments of Australia and New Zealand. A familiar story was told of rising numbers of people presenting to emergency departments with mental health problems linked to increased demands for shorter length of stays. This has now got to the point that what is valued in clinicians is cr

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eating empty beds rather providing good quality care. However there are some potential answers also being talked about at the Congress - there have been two sessions on e-therapies today (The Lowdown/The Journal and SPARX) which probably have a role at being part of the fence at the top of the cliff rather than (the literal) ambulance at the bottom of the cliff. Jim Crow's keynote this morning also described lessons from other countries in Asia where families and consumers have found ways of empowering themselves to provide some of the psychological and social support often missing in the ways that we practice psychiatry in New Zealand and Australia. So to cope with the tsumani of demand as psychiatrists we probably need to step back from "the next patient" identify what we uniquely do and start helping others do the rest.

Local solutions for global problems

The whakatau was handsomely done then Vikram Patel got us off to a storming start with his keynote on global mental health. Jim Crowe managed to speak for less than 3 minutes in his introduction which must be some sort of record. We're all looking forward to him making up for it with his keynote speech tomorrow. Vikram introduced big ideas to big problems including "spreading the love" - sorry that should be scaling up - so that Consultant psychiatrists should see themselves as public health physicians addressing the needs of those who can't get to their clinics as well as the in

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dividuals who do. What this may mean for us in practice is splitting off parts of our job and

supervising the people who consequently do them - for example supervising assistants who deliver only brief psychotherapies. This along with attention to human rights and principles of equity were the key messages from Sunday night.

We're off

Well we're off. After 18 months of planning and nearly 1000 emails the Congress gets under way today. Down at Sky City at 8am this morning for the first daily committee meeting to anticipate any last minutes glitches. There don't seem to be any - most of the keynote speakers are in the country although we're not entirely sure where... After this a round of checking the workshops to make sure that everything is working - the troublesome buhdists in the meditation workshop want to know when the coffee break is s

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o they can get first in line for the food. Gary Schoener has a USB stick with his vital videos on it that the sky city computers refuse to open and spit out all sorts of warnings because they say it has a virus on it - refrain from telling Gary that if this had happened in the US the speaker would now be having intimate conversations with Homeland Security and a one way trip to Guantanomo Bay. Thankfully a work around is found. Meanwhile in the exams workshop the Queensland Health clickers (not a band but an instant polling device) seem to have got sick crossing the Tasman but enough are found that work. The registrars in the audience will have to share which I'm sure they will suggest is something that should be carried over into the exams themselves. So 9.30 the workshops are underway and there is a steady stream of people coming through to register. Time for breakfast and to prepare for the opening ceremony.