NEW DELHI, INDIA / 10 – 12 APRIL 2015 Meeting of the Field Studies Coordination Group Progress of ICD-11 Development since September 2014 Meeting Geoffrey M. Reed DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE

Field Studies Coordination Group10 – 12 April 2015 Countries agree to use the ICD as a framework for health information and reporting: To monitor epidemics/threats to public health/disease burden To assess progress toward meeting public health objectives To define obligations of WHO Member States to provide free or subsidized health care to their populations To facilitate access to appropriate health care services As a basis for guidelines for care and standards of practice To facilitate research into more effective treatments and prevention strategies Why is the ICD part of WHO’s core constitutional responsibilities and why do countries use it? 2

Field Studies Coordination Group10 – 12 April 2015 The mandate of the ICD is a pragmatic one, based on public health and clinical objectives Based on the best evidence that we have available today, what health categories should the world’s global health authority tell its Member States are important to track as a basis for public health reporting and as a basis for structuring clinical care? How should those categories be defined and operationalized? In other words... 3

Field Studies Coordination Group10 – 12 April 2015 Public Health Considerations ICD-11 MENTAL AND BEHAVIOURAL DISORDERS 4

Field Studies Coordination Group10 – 12 April 2015 Neuropsychiatric disorders account for 12.3% of total disease burden Mental and substance use disorders responsible for loss of 184 million disability- adjusted life years (DALYs) worldwide in 2010 They are the leading cause of disability, in terms of years of life-lived with disability (YLDs) Global Burden of Disease Study (2010); Whiteford et al, (2013) Mental Health in a Global Context 5

Field Studies Coordination Group10 – 12 April 2015 Global Causes of Disability GBD,

Field Studies Coordination Group10 – 12 April 2015 Disproportionately high rates of mortality – Cardiovascular disease – Metabolic diseases – Respiratory diseases Mortality rates are 2 – 2.5 times higher than general population Life expectancy is 10 – 25 years less Behaviour factors, and also intervention factors Health of People with Schizophrenia and other Severe Mental Disorders - I 7

Field Studies Coordination Group10 – 12 April 2015 Physical health disparities [among people with schizophrenia and other severe mental disorders] have rightfully been stated as contravening international conventions for the 'right to health’ WORLD HEALTH ORGANIZATION,

Field Studies Coordination Group10 – 12 April 2015 Adopted by the World Health Assembly in May

Field Studies Coordination Group10 – 12 April 2015 To promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. Goal Time frame 2013 to

Field Studies Coordination Group10 – 12 April To strengthen effective leadership and governance for mental health 2.To provide comprehensive, integrated and responsive mental health and social care services in community-based settings 3.To implement strategies for promotion and prevention in mental health 4.To strengthen information systems, evidence and research for mental health Objectives 11

Field Studies Coordination Group10 – 12 April

Field Studies Coordination Group10 – 12 April 2015 Why does the ICD matter? People are only likely to have access to the most appropriate mental heath services when the conditions that define identification, eligibility and treatment selection are supported by a precise, valid and clinically useful classification system. INTERNATIONAL ADVISORY GROUP FOR THE REVISION OF ICD-10 MENTAL AND BEHAVIOURAL DISORDERS, WORLD PSYCHIATRY,

Field Studies Coordination Group10 – 12 April 2015 To provide WHO Member States with better tool to help them reduce the disease burden of mental and behavioural disorders To provide health professionals with better tools for identifying people in need of mental health services and which treatments are most likely to be effective, at the point at which they are most likely to encounter opportunities for care. Most important aims of ICD-11 MBD 14

Field Studies Coordination Group10 – 12 April 2015 Scarcity of Human Resources (N = 157 – 183 countries) 15

Field Studies Coordination Group10 – 12 April 2015 Does one size fit all? 16

Field Studies Coordination Group10 – 12 April 2015 Statistical version of ICD-11 contains hierarchical structure, category names, code numbers, brief definitions, inclusion and exclusion terms; mostly complete for MBD, available on ICD-11 beta platform Current focus is on Clinical Descriptions and Diagnostic Guidelines (CDDG), intended for use in clinical settings by global mental health professionals Primary care version being developed simultaneously, for use by a broad range of global primary care professionals Research version to be developed later; currently in discussions with relevant parties to formulate work plan Current focus of development 17

Field Studies Coordination Group10 – 12 April 2015 The ideal: scientific validity and clinical utility At present, neuroscience and genetics evidence is limited in its ability to support support major changes for individual conditions or a specific classification structure Where evidence exists, should be considered WHO views current revision as major opportunity to improve clinical utility of the diagnostic manual Field studies of ICD-11 Mental and Behavioural Disorders guidelines focus on: 1.Diagnostic consistency 2.Clinical utility CDDG: Focus on clinical utility 18

Field Studies Coordination Group10 – 12 April 2015 Health encounters are the source of aggregated health information that provide a basis for health policy decisions at system, national, and global levels Health classifications are the interface between health encounters and health information A classification that is too cumbersome to use at the encounter level or does not provide clinically useful information will not be used, and can’t provide valid data for health policy and decision-making Opportunities for practice improvement will be lost Why does clinical utility matter? 19

Field Studies Coordination Group10 – 12 April 2015 WHO International Advisory Group and all WHO Working Groups include representation of all WHO global regions and high proportion of representatives from low- and middle-income countries All ICD-11 field studies are multidisciplinary and multilingual – Case controlled studies in Chinese, English, French, Japanese, Russian, Spanish – Capacity for Arabic, German, Portuguese for ecological implementation (clinic-based studies) Global applicability 20

Field Studies Coordination Group10 – 12 April 2015 TO REGISTER IN 9 LANGUAGES, VISIT: 21 CURRENT ENROLLMENT AND CHARACTERISTICS Global Clinical Practice Network

Field Studies Coordination Group10 – 12 April ,707 GCPN Registrants from 139 Countries (As of 1 March 2015) Americas North: 1,636 South & Central: 1,223 Europe 4,302 Africa 242 Eastern Mediterranean Mediterranean 361 SoutheastAsia 573 Western Pacific Asia: 2,980 Oceania:

Global Registrants: Distribution by Country Income Level

Field Studies Coordination Group10 – 12 April 2015 Global Mental Health Professionals by Region 24

Field Studies Coordination Group10 – 12 April Case-Controlled Field Studies: Current Status

Field Studies Coordination Group10 – 12 April 2015 Brazil: Universidade Federal de São Paulo China: Shanghai Mental Health Center France: Etablissement Public de Santé Mental, Lille-Métropole Germany: Heinrich-Heine University, Düsseldorf India: All India Institute of Medical Sciences Japan: Tokyo Medical University Lebanon: American University of Beirut Mexico: Instituto Nacional de Psiquiatria Nigeria: University of Ibadan Russian Federation: Moscow Research Institute of Psychiatry Spain: Universidad Autónoma de Madrid USA: University of Kansas Data Coordinating Center: Columbia University International Field Study Centres (Countries represent more than 50% of world’s population) 26

Field Studies Coordination Group10 – 12 April 2015 Evaluate clinical utility and usability of the proposed ICD-11 diagnostic guidelines in natural conditions, in the settings in which they are intended to be used Will also evaluate reliability of diagnoses that account for greatest proportion of disease burden and mental health services utilization Ecological Implementation Field Studies 27

Field Studies Coordination Group10 – 12 April 2015 Identify areas of lower diagnostic agreement Identify specific diagnostic features that contribute to confusion Identify lack of clarity regarding diagnostic threshold and specific differential diagnoses Identify features that are and are not considered to be clinically useful Results across languages compared to identify cultural differences and translation issues Will lead to specific revisions in ICD-11 diagnostic guidelines as well as targeted educational programs Use of Field Studies Results 28

Field Studies Coordination Group10 – 12 April 2015 Over 200 published articles related to development of ICD-11 Mental and Behavioural Disorders Includes publications in top journals in the field (e.g., Lancet, World Psychiatry) Focus on: – Proposals for ICD-11; evidence and rationale – Conceptual issue in ICD-11 development – Results of formative fields testing – Methodological issues for field testing – Current focus on results of evaluative field testing Scholarly output related to ICD-11 Mental and Behavioural Disorders 29

Field Studies Coordination Group10 – 12 April 2015 Work Plan 30