A Bus Called Friendship

Manufacturer: My Heart.

Year: 1974.

Seats: Not sure, although in good condition as many unused.

Description:

There are several features that come as standard for this model.

  1. Air conditioning: Blows hot and cold, but with some ENCOURAGEMENT the right temperature is achieved.
  2. Wired for CCTV: We CARE that you have a safe and comfortable journey.
  3. Fully carpeted: It is important to feel SUPPORTed.
  4. To be HONEST generally handles well, being a DEPENDABLE drive, even with bumps in the road.
  5. Can get stuck in a rut now and again, but with SYMPATHY/EMPATHY usually drives out, even with the deep ones.
  6. A GENEROUS luggage compartment comes as standard; it is important make space for the luggage carried rather than cram in to much.
  7. Slower than other models, but this means more TIME to cater to onboard needs.
  8. Recently added some headrests and armrests after LISTENING to some FEEDBACK.
  9. A TRUSTy manual gearbox which we know you will LOVE.
  10. Seat Belts: Fitted as standard to provide a SAFE environment on the journey.
  11. Reclining seats: Fitted as standard to provide a COMFORTABLE journey.
  12. Comes with TV, DVD player, fridge, USB, WIFI, and power sockets to CATER for different NEEDS.
  13. Reverse Camera: Fitted as standard to avoid bumping into any nasty surprises BEHIND you before driving FORWARD.
  14. Ramp access: To AID those having difficulty getting onboard.

Given years of LOYAL service and had a number of modifications over the years that have added VALUE.

Viewing welcome, please contact to arrange.

I will LISTEN to and consider any REASONABLE offers.

What is the American Foundation for Suicide Prevention?

Introduction

The American Foundation for Suicide Prevention (AFSP) is a voluntary health organisation based in New York City, with a public policy office based in Washington, D.C.

The organisation’s stated mission is to “save lives and bring hope to those affected by suicide.”

Refer to Suicide Awareness.

Brief History

Founded in 1987 as the American Suicide Foundation by Herbert Hendin M.D., AFSP is the world’s largest private funder of suicide prevention research. The founding families, alarmed by a combination of increases in death by suicide in the previous four decades and with their personal experience with loved ones dying by suicide, decided to the create AFSP in order to establish a private source of support for suicide research, education, and prevention efforts that could be sustained into the future. According to a Charity Navigator rating published in September 2018, more than 83% of the organisation’s finances went towards programme expenses (based on financial data from fiscal year 2017), receiving a perfect rating for accountability and transparency. AFSP also partners with Aetna (a US managed health care company that sells traditional and consumer directed health care insurance and related services).

For 2018, AFSP received $37 million in financial contributions from 700,000 new and returning donors.

Programmes

Programmes designed to educate the larger public about suicide and prevention best practices, such as Talk Saves Lives: An Introduction to Suicide Prevention, are offered by AFSP under the umbrella of prevention education and provide a general understanding of suicide, including its scope and what can be done to prevent it.

International Survivors of Suicide Loss Day (also known as “Survivor Day”) is one of the most prominent postvention programmes or events organised by AFSP. Originally introduced as “National Survivors of Suicide Loss Day” in 1999, when United States Senator Harry Reid – himself a survivor of suicide loss – formally introduced a resolution to the Senate, the day is officially observed annually on the Saturday before American Thanksgiving.

The Interactive Screening Programme, or ISP, is an online tool offered by AFSP first piloted at Emory University, and has since been implemented in colleges, police departments, workplaces and the NFL Players Union. Francis Levesque created this in Sept-Îles in 1973 in meeting all members of the association.

Criticism

In August 2016, AFSP formed a partnership with the National Shooting Sports Foundation, a gun industry trade association, to educate the firearm-owning community on suicide prevention through outreach at firearm retailers and shooting ranges. In December 2017, The New York Times released an opinion piece written by Erin Dunkerly, a volunteer whose father died by suicide using a firearm. The piece cites that there is a high risk of suicide from keeping firearms in the home, but claims that local AFSP staff told volunteers not to discuss the topic of gun control. The piece goes on to say that AFSP excluded from its walks violence prevention groups that promoted gun control, and that AFSP excludes the Brady Campaign to Prevent Gun Violence from donating or participating. According to a post published on digital health community The Mighty, similar accounts of gun safety groups have been reported in Wisconsin by Khary Penebaker, San Diego by Wendy Wheatcroft, and in Maine by Judi Richardson.

What is the World Health Organisation Collaborating Centre?

Introduction

World Health Organisation collaborating centres are institutions that work with the World Health Organisation (WHO) in disciplines such as occupational health, food safety, and communicable disease prevention.

Overview

There are over 700 such centres across 80 countries. Collaborating centres may be research institutes, parts of universities, or academies. The participating institutions partner with WHO to perform research, provide training, or offer other services in furthering the WHO health agenda. These partners are designated by the WHO director-general as a part of a collaborative network. By using networks of established organisations, WHO is able to strengthen the scientific validity of its work and lower the costs of research.

Centres Worldwide

The WHO has established networks related to a variety of health topics. For example, WHO has put in place centres focused on organ transplants, hearing loss prevention, hepatitis, leprosy, medical ethics, and maternal health. To move the work forward, WHO has numerous designated centres in each inhabited continent. The network of centres for reference and research on influenza draws upon resources from Japan, the United States, the United Kingdom, and Australia. The network of WHO collaborating centres in occupational health is chaired by Dr. John Howard, director of the US National Institute for Occupational Safety and Health, and contains more than 60 designated organisations from across the globe.

The WHO Collaborating Centre on Global Governance of Antimicrobial Resistance has been working on the Coronavirus disease 2019 and is directed by Steven Hoffman.

What is the Convention on Psychotropic Substances?

Introduction

The Convention on Psychotropic Substances of 1971 is a United Nations treaty designed to control psychoactive drugs such as amphetamine-type stimulants, barbiturates, benzodiazepines, and psychedelics signed in Vienna, Austria on 21 February 1971.

The Single Convention on Narcotic Drugs of 1961 did not ban the many newly discovered psychotropics, since its scope was limited to drugs with cannabis, coca, and opium-like effects.

During the 1960s such drugs became widely available, and government authorities opposed this for numerous reasons, arguing that along with negative health effects, drug use led to lowered moral standards. The Convention, which contains import and export restrictions and other rules aimed at limiting drug use to scientific and medical purposes, came into force on 16 August 1976. As of 2013, 183 member states are Parties to the treaty. Many laws have been passed to implement the Convention, including the US Psychotropic Substances Act, the UK Misuse of Drugs Act 1971, and the Canadian Controlled Drugs and Substances Act. Adolf Lande, under the direction of the United Nations Office of Legal Affairs, prepared the Commentary on the Convention on Psychotropic Substances. The Commentary, published in 1976, is an invaluable aid to interpreting the treaty and constitutes a key part of its legislative history.

Provisions to end the international trafficking of drugs covered by this Convention are contained in the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. This treaty, signed in 1988, regulates precursor chemicals to drugs controlled by the Single Convention and the Convention on Psychotropic Substances. It also strengthens provisions against money laundering and other drug-related crimes.

Brief History

International drug control began with the 1912 International Opium Convention, a treaty which adopted import and export restrictions on the opium poppy’s psychoactive derivatives. Over the next half-century, several additional treaties were adopted under League of Nations auspices, gradually expanding the list of controlled substances to encompass cocaine and other drugs and granting the Permanent Central Opium Board power to monitor compliance. After the United Nations was formed in 1945, those enforcement functions passed to the UN.

In 1961, a conference of plenipotentiaries in New York adopted the Single Convention on Narcotic Drugs, which consolidated the existing drug control treaties into one document and added Cannabis to the list of prohibited plants. In order to appease the pharmaceutical interests, the Single Convention’s scope was sharply limited to the list of drugs enumerated in the Schedules annexed to the treaty and to those drugs determined to have similar effects.

During the 1960s, drug use increased in Western developed nations. Young people began using hallucinogenic, stimulant, and other drugs on a widespread scale that has continued to the present. In many jurisdictions, police had no laws under which to prosecute users and traffickers of these new drugs; LSD, for instance, was not prohibited federally in the US until 1967.

In 1968, “[d]eeply concerned at reports of serious damage to health being caused by LSD and similar hallucinogenic substances,” the United Nations Economic and Social Council (ECOSOC) passed a resolution calling on nations to limit the use of such drugs to scientific and medical purposes and to impose import and export restrictions. Later that year, the UN General Assembly requested that ECOSOC call upon its Commission on Narcotic Drugs to “give urgent attention to the problem of the abuse of the psychotropic substances not yet under international control, including the possibility of placing such substances under international control”.

Circa 1969, with use of stimulants growing, ECOSOC noted with considerable consternation that the Commission “was unable to reach agreement on the applicability of the Single Convention on Narcotic Drugs, 1961 to these substances”. The language of the Single Convention and its legislative history precluded any interpretation that would allow international regulation of these drugs under that treaty. A new convention, with a broader scope, would be required in order to bring those substances under control. Using the Single Convention as a template, the Commission prepared a draft convention which was forwarded to all UN member states. The Secretary-General of the United Nations scheduled a conference for early 1971 to finalise the treaty.

Meanwhile, countries had already begun passing legislation to implement the draft treaty. In 1969, Canada added Part IV to its Food and Drugs Act, placing a set of “restricted substances,” including LSD, DMT, and MDA, under federal control. In 1970, the United States completely revamped its existing drug control laws by enacting the Controlled Substances Act (amended in 1978 by the Psychotropic Substances Act, which allows the US drug control Schedules to be updated as needed to comply with the Convention). In 1971, the United Kingdom passed the Misuse of Drugs Act 1971. A host of other nations followed suit. A common feature shared by most implementing legislation is the establishment of several classes or Schedules of controlled substances, similarly to the Single Convention and the Convention on Psychotropic Substances, so that compliance with international law can be assured simply by placing a drug into the appropriate Schedule.

The conference convened on 11 January 1971. Nations split into two rival factions, based on their interests. According to a Senate of Canada report, “One group included mostly developed nations with powerful pharmaceutical industries and active psychotropics markets . . . The other group consisted of developing states…with few psychotropic manufacturing facilities”. The organic drugmaking states that had suffered economically from the Single Convention’s restrictions on cannabis, coca, and opium, fought for tough regulations on synthetic drugs. The synthetic drug-producing states opposed those restrictions. Ultimately, the developing states’ lobbying power was no match for the powerful pharmaceutical industry’s, and the international regulations that emerged at the conference’s close on 21 February were considerably weaker than those of the Single Convention.

The Convention’s adoption marked a major milestone in the development of the global drug control regime. Over 59 years, the system had evolved from a set of loose controls focused on a single drug into a comprehensive regulatory framework capable of encompassing almost any mind-altering substance imaginable. According to Rufus King, “It covers such a grab-bag of natural and manufactured items that at every stage of its consideration its proponents felt obliged to stress anew that it would not affect alcohol or tobacco abuse.”

Member States

As of February 2018, there are 184 state parties to the convention. This total includes 182 member states of the United Nations, the Holy See, and the State of Palestine. The 11 UN member states that are not party to the convention are East Timor, Equatorial Guinea, Haiti, Kiribati, Liberia, Nauru, Samoa, Solomon Islands, South Sudan, Tuvalu, and Vanuatu. Liberia has signed the treaty but has not ratified it.

Schedules of Controlled Substances

The list of Schedules and the substances presently therein can be found on the International Narcotics Control Board’s (INCB) website.

The Convention has four Schedules of controlled substances, ranging from Schedule I (most restrictive) to Schedule IV (least restrictive). A list of psychotropic substances, and their corresponding Schedules, was annexed to the 1971 treaty. The text of the Convention does not contain a formal description of the features of the substances fitting in each Schedule, in contrast to the US Controlled Substances Act of 1970, which gave specific criteria for each Schedule in the US system. The amphetamine-type stimulants (ATS), a legal class of stimulants – not all of which are substituted amphetamines – were defined in the 1971 treaty and in subsequent revisions. A 2002 European Parliament report and a 1996 UNODC report on ATS describe the international Schedules as listed below.

Schedule IIncludes drugs claimed to create a serious risk to public health, whose therapeutic value is not currently acknowledged by the Commission on Narcotic Drugs. It includes isomers of THC, synthetic psychedelics such as LSD, and natural psychedelics like certain substituted tryptamines. ATS such as cathinone, MDA, and MDMA (ecstasy) also fall under this category.
Schedule IIIncludes certain ATS with therapeutic uses, such as delta-9-THC (including dronabinol, its synthetic form), amphetamine and methylphenidate.
Schedule IIIIncludes barbiturate products with fast or average effects, which have been the object of serious abuse even though useful therapeutically, strongly sedative benzodiazepines like flunitrazepam and some analgesics like buprenorphine. The only ATS in this category is cathine.
Schedule IVIncludes some weaker barbiturates like (phenobarbital) and other hypnotics, anxiolytic benzodiazepines (except flunitrazepam), and some weaker stimulants (such as modafinil and armodafinil). Over a dozen ATS are included in this category, including the substituted amphetamine phentermine.

A 1999 UNODC report notes that Schedule I is a completely different regime from the other three. According to that report, Schedule I mostly contains hallucinogenic drugs such as LSD that are produced by illicit laboratories, while the other three Schedules are mainly for legally produced pharmaceuticals. The UNODC report also claims that the Convention’s Schedule I controls are stricter than those provided for under the Single Convention, a contention that seems to be contradicted by the 2002 Senate of Canada and 2003 European Parliament reports.

Although estimates and other controls specified by the Single Convention are not present in the Convention on Psychotropic Substances, the International Narcotics Control Board corrected the omission by asking Parties to submit information and statistics not required by the Convention, and using the initial positive responses from various organic drug producing states to convince others to follow. In addition, the Convention does impose tighter restrictions on imports and exports of Schedule I substances. A 1970 Bulletin on Narcotics report notes:

LSD, mescaline, etc., are controlled in a way which is more stringent than morphine under the narcotics treaties. Article 7, which sets down this regime, provides that such substances can only be moved in international trade when both exporter and importer are government authorities, or government agencies or institutions specially authorized for the purpose; in addition to this very rigid identification of supplier and recipient, in each case export and import authorization is also mandatory.

Scheduling Process

Article 2 sets out a process for adding additional drugs to the Schedules. First, the World Health Organization (WHO) must find that the drug meets the specific criteria set forth in Article 2, Section 4, and thus is eligible for control. Then, the WHO issues an assessment of the substance that includes:

  • The extent or likelihood of abuse;
  • The degree of gravity in the public health and social problem;
  • The degree of utility of the substance in legitimate medical therapy; and
  • Whether international control measures as provided in the treaty would be appropriate and useful.

Article 2, Paragraph 4:

If the World Health Organization finds: (a) That the substance has the capacity to produce (i) (1) A state of dependence, and (2) Central nervous system stimulation or depression, resulting in hallucinations or disturbances in motor function or thinking or behaviour or perception or mood, or (ii) Similar abuse and similar ill effects as a substance in Schedule I, II, III or IV, and (b) That there is sufficient evidence that the substance is being or is likely to be abused so as to constitute a public health and social problem warranting the placing of the substance under international control, the World Health Organization shall communicate to the Commission an assessment of the substance, including the extent or likelihood of abuse, the degree of seriousness of the public health and social problem and the degree of usefulness of the substance in medical therapy, together with recommendations on control measures, if any, that would be appropriate in the light of its assessment.

The Commentary gives alcohol and tobacco as examples of psychoactive drugs that were deemed to not fit the above criteria by the 1971 Conference which negotiated the Convention. Alcohol can cause dependence and central nervous depression resulting in disturbances of thinking and behaviour, furthermore alcohol causes similar effects as barbiturates, alcohol causes very serious “public health and social problems” in many countries, and also alcohol has minimal use in modern medicine. Nevertheless, according to the Commentary:

Alcohol does not ‘warrant’ that type of control because it is not ‘suitable’ for the regime of the Vienna Convention. It appears obvious that the application of the administrative measures for which that treaty provides would not solve or alleviate the alcohol problem.

Similarly, tobacco can cause dependence and has little medical use, but it was not considered to be a stimulant or depressant or to be similar to other scheduled substances. Most important, according to the Commentary:

[Tobacco] is not suitable for the kinds of controls for which the Vienna Convention provides, and which if applied would not make any useful impact on the tobacco problem. That problem, however serious, therefore does not ‘warrant’ the placing of tobacco ‘under international’ control, i.e. under the Vienna Convention.

The Commission on Narcotic Drugs makes the final decision on whether to add the drug to a Schedule, “taking into account the communication from the World Health Organisation [WHO], whose assessments shall be determinative as to medical and scientific matters, and bearing in mind the economic, social, legal, administrative and other factors it may consider relevant”. A similar process is followed in deleting a drug from the Schedules or transferring a drug between Schedules. For instance, at its 33rd meeting, the WHO Expert Committee on Drug Dependence recommended transferring tetrahydrocannabinol to Schedule IV of the Convention, citing its medical uses and low abuse potential. However, the Commission on Narcotic Drugs has declined to vote on whether to follow the WHO recommendation and reschedule tetrahydrocannabinol. The UN Economic and Social Council, as a parent body of the Commission on Narcotic Drugs, can alter or reverse the Commission’s scheduling decisions.

In the event of a disagreement about a drug’s Scheduling, Article 2, Paragraph 7 allows a Party to, within 180 days of the communication of the Commission’s decision, give the UN Secretary-General “a written notice that, in view of exceptional circumstances, it is not in a position to give effect with respect to that substance to all of the provisions of the Convention applicable to substances in that Schedule.” This allows the nation to comply with a less stringent set of restrictions. The US Controlled Substances Act’s 21 U.S.C. § 811(d)(4) implies that placing a drug in Schedule IV or V of the Act is sufficient to “carry out the minimum United States obligations under paragraph 7 of article 2 of the Convention”. This provision, which calls for temporarily placing a drug under federal drug control in the event the Convention requires it, was invoked in 1984 with Rohypnol (flunitrazepam). Long before abuse of the drug was sufficiently widespread in the United States to meet the Act’s drug control criteria, rohypnol was added to the Schedules of the Convention on Psychotropic Substances, and the US government had to place rohypnol in Schedule IV of the Controlled Substances Act in order to meet its minimum treaty obligations.

As of March 2005, 111 substances were controlled under the Convention.

WHO Evaluations of Specific Drugs

Ephedrine

In 1998, ephedrine was recommended for control under the Convention. The Dietary Supplement Safety and Science Coalition lobbied against control, stressing the drug’s history and safety, and arguing that “ephedrine is not a controlled substance in the US today, nor should it be internationally” because it is a soft stimulant similar to caffeine. After a two-year debate, the Expert Committee on Drug Dependence decided against regulating ephedrine. However, the Commission on Narcotics Drugs and the International Narcotics Control Board listed the drug as a Table I precursor under the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances because ephedrine can be used as chemical precursor for synthetize or manufacture amphetamine or methamphetamine, both which are actually controlled substances, a move that did not require WHO approval.

Ketamine

The Expert Committee on Drug Dependence cautiously began investigating ketamine at its thirty-third meeting, noting, “Its use in veterinary medicine must also be considered in relation to its control”. Ketamine remains uncontrolled internationally, although many nations (e.g. USA and UK) have enacted restrictions on the drug.

MDMA

The Expert Committee’s evaluation of MDMA during its 22nd meeting in 1985 was marked by pleas from physicians to allow further research into the drug’s therapeutic uses. Paul Grof, chairman of the Expert Committee, argued that international control was not yet warranted, and that scheduling should be delayed pending completion of more studies. The Expert Committee concluded that because there was “insufficient evidence to indicate that the substance has therapeutic usefulness,” it should be placed in Schedule I. However, its report did recommend more MDMA research:

the Expert Committee held extensive discussions concerning therapeutic usefulness of 3,4 Methylenedioxymethamphetamine. While the Expert Committee found the reports intriguing, it felt that the studies lacked the appropriate methodological design necessary to ascertain the reliability of the observations. There was, however, sufficient interest expressed to recommend that investigations be encouraged to follow up these preliminary findings. To that end, the Expert Committee urged countries to use the provisions of Article 7 of the Convention on Psychotropic Substances to facilitate research on this interesting substance.

MDMA was added to the convention as a Schedule I controlled substance in February 1986.

MBDB

MBDB (Methylbenzodioxolylbutanamine) is an entactogen with similar effects to MDMA. The thirty-second meeting of the WHO Expert Committee on Drug Dependence (September 2000) evaluated MBDB and recommended against scheduling.

From the WHO Expert Committee assessment of MBDB:

Although MBDB is both structurally and pharmacologically similar to MDMA, the limited available data indicate that its stimulant and euphoriant effects are less pronounced than those of MDMA. There have been no reports of adverse or toxic effects of MBDB in humans. Law enforcement data on illicit trafficking of MBDB in Europe suggest that its availability and abuse may now be declining after reaching a peak during the latter half of the 1990s. For these reasons, the Committee did not consider the abuse liability of MBDB would constitute a significant risk to public health, thereby warranting its placement under international control. Scheduling of MBDB was therefore not recommended.

Methcathinone

Circa 1994, the United States government notified the UN Secretary General that it supported controlling methcathinone, an addictive stimulant manufactured with common household products, as a Schedule I drug under the Convention. The FDA report warned of the drug’s dangers, even noting that addicts in Russia were observed to often have “potassium permanganate burns on their fingers” and to “tend not to pay attention to their appearance, thus looking ragged with dirty hands and hair”. With methcathinone having no medical use, the decision to place the drug in Schedule I was uncontested.

Nicotine

Traditionally, the UN has been reluctant to control nicotine and other drugs traditionally legal in Europe and North America, citing tolerance of a wide range of lifestyles. This contrasts with the regulatory regime for other highly addictive drugs. Gabriel G. Nahas, in a Bulletin on Narcotics report, noted:

Some psychotropic substances such as nicotine, myristicin, ephedrine, mitraginyne, salvinorin A, arecoline, theophylline, theobromine, kava, khat, tobacco, L-theanine, or caffeine (in moderate amounts) or in moderate and responsible consumption, or alcoholic drinks (in small amounts or limited consumption) do not produce any measurable symptoms of neuropsychological toxicity, main physical damage, acute physical damage or main physical dependence or addiction, as also acute side effects or several adverse effects. Some pharmacologists have associated the symptoms of neuropsychological toxicity with behavioural toxicity or the toxic and addictive personality, the toxicity of drugs generally and overall depends by several factors as, envinonmental factors, economic factors, the field of the drug use, the place, the date, the time and social, psicological, emotional, mental, spiritual and intelectual factors that if are weak can to contribute as a risk factor or a risk behaviour. which include in addition: suppression of normal anxiety, toxic emotions, toxic relationships, toxic behavior, negative thinkings, reduction in motivation and non-purposive or inappropriate behaviour, illegal offense or inmoral act necessary. However, the latter behavioural symptoms do not present “markers” which may be measurable in societies accepting as “normal” a wide range of life styles.

Nonetheless, in October 1996, the Expert Committee considered controlling nicotine, especially products such as gum, patches, nasal spray, and inhalers. The UN ultimately left nicotine unregulated. Since then, nicotine products have become even more loosely controlled; Nicorette gum, for instance, is now an over-the-counter drug in the United States and in Finland, readily available in Finland from grocery stores and pharmacies. Another nicotine gum sold in Finland is called Nicotinell. All kinds of nicotine products are readily available in Finnish grocery stores and pharmacies.

Tetrahydrocannabinol

Tetrahydrocannabinol (THC), the main active ingredient in cannabis, was originally placed in Schedule I when the Convention was enacted in 1971. At its twenty-sixth meeting, in response to a 1987 request from the Government of the United States that THC be transferred from Schedule I to Schedule II, the WHO Expert Committee on Drug Dependence recommended that THC be transferred to Schedule II, citing its low abuse potential and “moderate to high therapeutic usefulness” in relieving nausea in chemotherapy patients. The Commission on Narcotic Drugs rejected the proposal. However, at its twenty-seventh meeting, the WHO Expert Committee again recommended that THC be moved to Schedule II. At its 45th meeting, on 29 April 1991, the Commission on Narcotic Drugs approved the transfer of dronabinol and its stereochemical variants from Schedule I to Schedule II of the Convention, while leaving other tetrahydrocannabinols and their stereochemical variants in Schedule I.

At its thirty-third meeting (September 2002), the WHO Committee issued another evaluation of the drug and recommended that THC be moved to Schedule IV, stating:

The abuse liability of dronabinol (delta-9-tetrahydrocannabinol) is expected to remain very low so long as cannabis continues to be readily available. The Committee considered that the abuse liability of dronabinol does not constitute a substantial risk to public health and society. In accordance with the established scheduling criteria, the Committee considered that dronabinol should be rescheduled to schedule IV of the 1971 Convention on Psychotropic Substances.

No action was taken on this recommendation. And at its thirty-fourth meeting the WHO Committee recommended that THC be moved instead to Schedule III. In 2007 the Commission on Narcotic Drugs decided not to vote on whether to reschedule THC, and they requested that the WHO make another review when more information is available.

In 2019, the WHO Expert Committee recommended that all isomers of THC be withdrawn from the Schedules of the 1971 Convention and included in the 1961 Convention alongside other Cannabis-related products and pharmaceutical preparations. However, this was rejected by a vote at the United Nations Commission on Narcotic Drugs on 02 December 2020.

2C-B (4-Bromo-2,5-dimethoxyphenethylamine)

2C-B is a psychedelic phenethylamine. At its thirty-second (September 2000) meeting the WHO Expert Committee on Drug Dependence recommended that 2C-B be placed in Schedule II, rather than with other scheduled psychedelics in Schedule I.

The committee stated that “[t]he altered state of mind induced by hallucinogens such as 2C-B may result in harm to the user and to others”, but did not cite any evidence.

From the WHO Expert Committee assessment of 2C-B:

At high doses it is a strong hallucinogen, producing particularly marked visual hallucinations with an intense colour play, intriguing patterns emerging on surfaces and distortions of objects and faces. 2C-B is also reported to enhance sexual feelings, perception and performance…. Apart from its controversial experimental use in psychotherapy, 2C-B, like most other hallucinogens, does not have any known therapeutic usefulness…. The Committee noted, however, that hallucinogens are rarely associated with compulsive use and that abuse of 2C-B has been infrequent, suggesting that the drug is likely to constitute a substantial, rather than an especially serious, risk to public health. For these reasons, the Committee recommended that 2C-B be placed in Schedule II of the 1971 Convention.

Medical and Scientific Uses

Like the Single Convention on narcotic medicines, the Convention on Psychotropic Substances recognizes scientific and medical use of psychoactive drugs, while banning other uses. Article 7 provides that:

In respect of substances in Schedule I, the Parties shall: (a) Prohibit all use except for scientific and very limited medical purposes by duly authorized persons, in medical or scientific establishments which are directly under the control of their Governments or specifically approved by them.

In this sense, the US Controlled Substances Act is stricter than the Convention requires. Both have a tightly restricted category of drugs called Schedule I, but the US Act restricts medical use of Schedule I substances to research studies, while the Convention allows broader, but limited and restriged, medical use of Schedule I controlled substances but scientific or industrial use of controlled substances is normally permitted.

Psychedelic Plants and Fungi

Several of the substances originally placed in Schedule I are psychedelic drugs which are contained in natural plants and fungi (such as peyote and psilocybin mushrooms) and which have long been used in religious or healing rituals. The Commentary notes the “Mexican Indian Tribes Mazatecas, Huicholes and Tarahumaras” as well as the “Kariri and Pankararu of eastern Brazil” as examples of societies that use such plants.

Article 32, paragraph 4 allows for States, at the time of signature, ratification or accession, to make a reservation noting an exemption for:

plants growing wild which contain psychotropic substances from among those in Schedule I and which are traditionally used by certain small, clearly determined groups in magical or religious rites.

However, the official Commentary on the Convention on Psychotropic Substances makes it clear that psychedelic plants (and indeed any plants) were not included in the original Schedules and are not covered or included at all by the Convention. This includes “infusion of the roots” of Mimosa tenuiflora (M. hostilis; which contains DMT) and “beverages” made from psilocybin mushrooms or psychotropic acacias, the latter of which are used in the DMT-containing beverage known colloquially as Ayahuasca. The purpose of Paragraph 4 of Article 32 was to allow States to “make a reservation assuring them the right to permit the continuation of the traditional use in question” in the case that plants were in the future added to the Schedule I. Currently, naught plants or plant products are included in the Schedules of the 1971 Convention.

Commentary 32-12: It may be pointed out that at the time of this writing the continued toleration of the use of hallucinogenic substances which the 1971 Conference had in mind would not require a reservation under paragraph 4. Schedule I does not list any of the natural hallucinogenic materials in question, but only chemical substances which constitute the active principles contained in them. The inclusion in Schedule I of the active principle of a substance does not mean that the substance itself is also included therein if it is a substance clearly distinct from the substance constituting its active principle. This view is in accordance with the traditional understanding of that question in the field of international drug control. Neither the crown (fruit, mescal button) of the Peyote cactus nor the roots of the plant Mimosa hostilis, Peganum Harmala that contains Harmala alkaloids or Syrian Rue, or Hawaiian Baby Woodrose plant and morning glory flowers that contains LSA or Lysergic Acid Amide or the Chacruna, a psychotropic shrub or plant which is used for make the Ayahuasca brew, [Footnote: “An infusion of the roots is used”] nor Psilocybe mushrooms [Footnote: “Beverages made from such mushrooms are used”] themselves are included in Schedule I, but only their respective active principles, mescaline, DMT and psilocybine (psilocine, psilotsin).

Commentary 32-13: It can however not be excluded that the fruit of the Peyote cactus, the roots of Mimosa hostilis, Psilocybe mushrooms or other hallucinogenic plant parts used in traditional magical or religious rites will in the future be placed in Schedule I by the operation of article 2, at a time at which the State concerned, having already deposited its instrument of ratification or accession, could no longer make the required reservation. It is submitted that Parties may under paragraph 4 make a reservation assuring them the right to permit the continuation of the traditional use in question in the case of such future actions by the Commission.

Furthermore, in a letter, dated 13 September 2001, to the Dutch Ministry of Health, Herbert Schaepe, Secretary of the UN International Narcotics Control Board, clarified that the UN Conventions do not cover “preparations” of psilocybin mushrooms:

As you are aware, mushrooms containing the above substances are collected and abused for their hallucinogenic effects. As a matter of international law, no plants (natural material) containing psilocine and psilocybin are at present controlled under the Convention on Psychotropic Substances of 1971. Consequently, preparations made of these plants are not under international control and, therefore, not subject of the articles of the 1971 Convention. However, criminal cases are decided with reference to domestic law, which may otherwise provide for controls over mushrooms containing psilocine and psilocybin. As the Board can only speak as to the contours of the international drug conventions, I am unable to provide an opinion on the litigation in question.

Nonetheless, in 2001 the US Government, in Gonzales v. O Centro Espirita Beneficente Uniao do Vegetal, argued that ayahuasca, an infusion of Mimosa hostilis and other psychoactive plants that is used in religious rituals, was prohibited in the US because of the 1971 Convention. That case involved a seizure by US Customs and Border Protection of several drums of DMT-containing liquid. Plaintiffs sued to have the drugs returned to them, claiming that they used it as a central part of their religion.

In the discussions on Article 32, paragraph 4, noted in the Official Record of the 1971 Conference, the representative from the United States supported the explicit exemption of sacred psychoactive substances, stating: “Substances used for religious services should be placed under national rather than international control”, while the representative of the Holy See observed: “If exemptions were made in favour of certain ethnic groups, there would be nothing to prevent certain organizations of hippies from trying to make out, on religious grounds, that their consumption of psychotropic substances was permissible.”

Organic Plants

The Commentary on the Convention on Psychotropic Substances notes that while many plant-derived chemicals are controlled by the treaty, the plants themselves are not:

The term “synthetic” appears to refer to a psychotropic substance manufactured by a process of full chemical synthesis. One may also assume that the authors of the Vienna Convention intended to apply the term “natural material” to parts of a plant which constitute a psychotropic substance, and the term “natural psychotropic substance” to a substance obtained directly from a plant by some process of manufacturing which was relatively simple, and in any event much simpler than a process of full chemical synthesis.
(…)
Cultivation of plants for the purpose of obtaining psychotropic substances or raw materials for the manufacture of such substances is not “manufacture” in the sense of Article 1, paragraph (i). Many provisions of the Vienna Convention governing psychotropic substances would be unsuitable for application to cultivation. The harvesting of psychotropic substances, i.e. separation of such substances from the plants from which they are obtained, is “manufacture”.
(…)
The cultivation of plants from which psychotropic substances are obtained is not controlled by the Vienna Convention. (…) Neither the crown (fruit, mescal button) of the Peyote cactus nor the roots of the plant Mimosa hostilis nor Psilocybe mushrooms themselves are included in Schedule 1, but only their respective principles, Mescaline, DMT and Psilocybin.

Mexico, in particular, argued that “production” of psychotropic drugs should not apply to wild-growing plants such as peyote cacti or psilocybin mushrooms. The Bulletin on Narcotics noted that “Mexico could not undertake to eradicate or destroy these plants”. Compared to the Single Convention on Narcotic Drugs (which calls for “uprooting of all coca bushes which grow wild” and governmental licensing, purchasing, and wholesaling of licit opium, coca, and cannabis crops), the Convention on Psychotropic Substances devotes few words to the subject of psychoactive plants.

On 02 July 1987, the United States Assistant Secretary of Health recommended that the Drug Enforcement Administration initiate scheduling action under the Controlled Substances Act in order to implement restrictions required by cathinone’s Schedule I status under the Convention. The 1993 DEA rule placing cathinone in the CSA’s Schedule I noted that it was effectively also banning khat:

Cathinone is the major psychoactive component of the plant Catha edulis (khat). The young leaves of khat are chewed for a stimulant effect. Enactment of this rule results in the placement of any material which contains cathinone into Schedule I.

Precursors

A 1971 Bulletin on Narcotics notes:

Article 2, in paragraph 4 of the original text, carried over the concept in Article 3 (3) (iii) of the Single Convention, and required the application to a “precursor ” – i.e. a substance “readily convertible” into a substance under control – of measures of control. In Vienna the complexity of controlling precursors of psychotropic substances was agreed to be so overwhelming that no absolute obligation to control them was provided. The new article 2 in paragraph 9 asks Parties “to use their best endeavours” to apply “such measures of supervision as may be practicable” to substances which may be used in the illicit manufacture of psychotropic substances, i.e. their precursors and possibly also substances essential in the chemistry of manufacture.

This provision was eventually judged to be inadequate, and was strengthened by the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances’ precursor control regime, which established two Tables of controlled precursors. The Commission on Narcotic Drugs and International Narcotics Control Board were put in charge of adding, removing, and transferring substances between the Tables.

Analogues

Circa 1999, the Government of Spain proposed amending Schedules I and II to include isomers, esters, ethers, salts of isomers, esters and ethers, and any “substance resulting from modification of the chemical structure of a substance already in Schedule I or II and which produced pharmacological effects similar to those produced by the original substances”. The WHO opposed this change. The Commission on Narcotic Drugs did amend the Schedules to include stereoisomerisms, however, with the understanding that “specific isomers that did not have hazardous pharmacological activity and that posed no danger to society could be excluded from control, as dextromethorphan had been in the case of Schedule I of the 1961 Convention.”

Penal Provisions

Article 22 provides:

  1. (a) Subject to its constitutional limitations, each Party shall treat as a punishable offence, when committed intentionally, any action contrary to a law or regulation adopted in pursuance of its obligations under this Convention, and shall ensure that serious offences shall be liable to adequate punishment, particularly by imprisonment or other penalty of deprivation of liberty.
  2. (b) Notwithstanding the preceding sub-paragraph, when abusers of psychotropic substances have committed such offences, the Parties may provide, either as an alternative to conviction or punishment or in addition to punishment, that such abusers undergo measures of treatment, education, after-care, rehabilitation and social reintegration in conformity with paragraph 1 of article 20.

Conspiracy, attempts, preparatory acts, and financial operations related to drug offenses are also called on to be criminalised. Parties are also asked to count convictions handed down by foreign governments in determining recidivism. Article 22 also notes that extradition treaties are “desirable”, although a nation retains the right to refuse to grant extradition, including “where the competent authorities consider that the offence is not sufficiently serious.”

As with all articles of the Convention on Psychotropic Substances, the provisions of Article 22 are only suggestions which do not override the domestic law of the member countries:

  • The provisions of this article shall be subject to the provisions of the domestic law of the Party concerned on questions of jurisdiction.
  • Nothing contained in this article shall affect the principle that the offences to which it refers shall be defined, prosecuted and punished in conformity with the domestic law of a Party.

Treatment and Prevention

Article 22 allows Parties, in implementing the Convention’s penal provisions, to make exceptions for drug abusers by substituting “treatment, education, after-care, rehabilitation and social reintegration” for imprisonment. This reflects a shift in focus in the war on drugs from incarceration to treatment and prevention that had already begun to take hold by 1971. Indeed, in 1972, a parallel provision allowing treatment for drug abusers was added to the Single Convention on Narcotic Drugs by the Protocol Amending the Single Convention on Narcotic Drugs.

Article 20 mandates drug treatment, education, and prevention measures and requires Parties to assist efforts to “gain an understanding of the problems of abuse of psychotropic substances and of its prevention” and to “promote such understanding among the general public if there is a risk that abuse of such substances will become widespread.” To comply with these provisions, most Parties financially support organisations and agencies dedicated to these goals. The United States, for instance, established the National Institute on Drug Abuse in 1974 to comply with the research requirement and began sponsoring Drug Abuse Resistance Education in 1983 to help fulfil the educational and prevention requirements.

Rise in Stimulant Trafficking

Control of stimulants has become a major challenge for the UN. In 1997, the World Drug Report warned:

Since the mid-1980s the world has faced a wave of synthetic stimulant abuse, with approximately nine times the quantity seized in 1993 than in 1978, equivalent to an average annual increase of 16 per cent. The principle synthetic drugs manufactured clandestinely are the amphetamine-type stimulants (ATS) which include the widely abused amphetamine and methamphetamine, as well as the more recently popularized methylenedioxymethamphetamine (MDMA), known as ecstasy.” It is estimated that throughout the world 30,000,000, people use ATS. This is 0.5 per cent of the global population and exceeds the number using heroin and probably those using cocaine.

A 1998 UN General Assembly Special Session on the World Drug Problem report noted:

Between 1971 and 1995, there was a nearly fivefold increase in the number of amphetamine-type stimulants under international control. . . ecstasy and related designer drugs are under schedule one of the 1971 Convention, because they have virtually no medical use, while amphetamine and methamphetamine are under schedule 2 because they began life with medical use. But even though they are scheduled, the system is not really working for these illegally produced drugs. One of the main limitations of the control system is that the Psychotropic Convention was not designed to control illicit markets. It was designed to control and regulate legitimate pharmaceutical markets to prevent their diversion into illicit markets.

The report mentioned proposals to increase the flexibility of scheduling drugs under the Convention and to amend the drug-control treaties to make them more responsive to the current situation. Neither proposal has gained traction, however. Due to the ease of manufacturing methamphetamine, methcathinone, and certain other stimulants, control measures are focusing less on preventing drugs from crossing borders. Instead, they are centring on increasingly long prison sentences for manufacturers and traffickers as well as regulations on large purchases of precursors such as ephedrine and pseudoephedrine. The International Narcotics Control Board and Commission on Narcotic Drugs help coordinate this fight by adding additional precursors to the Tables of chemicals controlled under the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

In 1997, ECOSOC called on nations to help enforce international law by cooperating “with relevant international organizations, such as Interpol and the World Customs Organization . . . in order to promote coordinated international action in the fight against illicit demand for and supply of amphetamine-type stimulants and their precursors.” That resolution also called on governments overseeing precursor exports “to inquire with the authorities of importing States about the legitimacy of transactions of concern, and to inform the International Narcotics Control Board of the action taken, particularly when they do not receive any reply to their inquiries”.

Pockets of high-intensity clandestine production and trafficking, such as rural southwest Virginia, exist in most industrialised nations. However, the United Nations Office on Drugs and Crime believes that East Asia (particularly Thailand) now has the most serious amphetamine-type stimulant (ATS) problem in the world. A 2002 report by that agency noted:

For many countries the problem of ATS is relatively new, growing quickly and unlikely to go away. The geographical spread is widening. . . Abuse is increasingly concentrated among younger populations, who generally and erroneously believe that the substances are safe and benign. The abuse of ATS is threatening to become part of mainstream culture. The less optimistic suggest that ATS is already embedded in normative young adult behavior to such an extent that it will be very difficult to change, notwithstanding the issues of physical, social and economic damage.

The Office called on nations to bring more resources to bear in the demand reduction effort, improving treatment and rehabilitation processes, increasing private sector participation in eliminating drugs from the workplace, and expanding the drug information clearing house to share information more effectively.

Canadian Noncompliance

In 2000, the International Narcotics Control Board chastised Canada for refusing to comply with the Convention’s requirement that international transactions in controlled psychotropics be reported to the Board. INCB Secretary Herbert Schaepe said:

From Canada there is just a big, black hole. We don’t know what is going into the country, nor coming out. We cannot monitor the international movement of these substances, which is our mandate. The lack of controls in Canada means that they could be destined for fake companies that will divert them into the hands of traffickers. Traffickers in third countries could be getting them through Canada. Normally, Canada has a very good reputation for fulfilling its international obligations, but here it is just breaking the treaty – a treaty that it ratified a long time ago. It is very disturbing.

Licit Drug Problems

In an unusual departure from its normally pro-industry leanings, the INCB issued a press release in 2001 warning of excessive use of licit psychotropics:

. . . the Board points to loose regulation, unreliable estimates and information regarding medical needs, aggressive marketing techniques and improper or even unethical prescription practices as the main reasons for the oversupply of such controlled substances as benzodiazepines and various amphetamine type stimulants. Easy availability leads to overconsumption of such substances, either in the form of drug abuse or by fuelling a culture of drug-taking to deal with a variety of non-medical problems. . . Insomnia, anxiety, obesity and child hyperactivity as well as various kinds of pain are listed among the most common problems to be treated by prescribing psychotropic substances. The Board is especially concerned that preference is given to quick solutions without looking at the long-term effects, as prolonged, excessive consumption of such drugs could result in dependency and other physical and mental suffering.

The Board also warned that the Internet provides “easy access to information on drug production and drug-taking,” calling it “a growing source of on-line drug trafficking.” The Board pointed out that some Internet suppliers sell controlled drugs without regard to the Convention’s medical prescription requirements.

List of Controlled Psychotropic Substances

Statistics

All Schedules consist of 116 positions and common generalization clause for salts. Schedule I also contains generalization clause for stereoisomers. There are also 2 specific generalizations, both for tetrahydrocannabinol stereochemical variants. There are no exclusions.

  • 116 positions:
    • 20 psychedelics.
      • 14 phenethylamine psychedelics.
      • 5 tryptamine psychedelics.
      • 1 ergoline.
    • 28 stimulants (excluding lefetamine).
    • 2 synthetic cannabinoids.
    • 2 positions representing 7 tetrahydrocannabinol isomers and their stereochemical variants.
    • 4 dissociatives.
    • 56 depressants.
      • 12 barbiturates.
      • 36 benzodiazepines (including 1 z-drug).
      • 2 carbamates.
      • 2 qualones.
      • 4 other depressants.
    • 1 position – zipeprol.
    • 1 position – lefetamine (with stimulant and opioid effects).
    • 1 semisynthetic opioid.
    • 1 synthetic benzomorphan opioid.

Schedule I

Contains 62 positions (including 1 position for six tetrahydrocannabinol isomers), generalisation clause for stereoisomers, specific generalisation for tetrahydrocannabinol stereochemical variants and common generalisation clause for salts.

  • 28 positions:
    • 19 psychedelics.
      • 13 phenethylamine psychedelics.
      • 5 tryptamine psychedelics.
      • 1 ergoline.
    • 3 stimulants.
    • 2 synthetic cannabinoids.
    • 1 position representing 6 isomers of tetrahydrocannabinol and their stereochemical variants.
    • 3 dissociatives.
  • Phenethylamine psychedelics:
    • 2,5-Dimethoxy-4-bromoamphetamine (DOB).
    • Dimethoxyamphetamine (DMA).
    • 2,5-Dimethoxy-4-ethylamphetamine(DOET).
    • methylenedioxyhydroxyamphetamine (MDOH).
    • methylenedioxyethylamphetamine (MDEA).
    • 3,4-methylenedioxy-N-methylamphetamine (MDMA).
    • Mescaline.
    • MMDA.
    • 4-MTA.
    • Para-methoxyamphetamine (PMA).
    • DOM (STP).
    • Tenamfetamine (MDA).
    • Trimethoxyamphetamine (TMA).
  • Tryptamine psychedelics:
    • Diethyltryptamine (DET).
    • Dimethyltryptamine (DMT).
    • Etryptamine (αET).
    • Psilocin.
    • Psilocybin.
  • Stimulants:
    • Cathinone.
    • Methcathinone.
    • 4-methylaminorex.
  • Synthetic cannabinoids:
    • Dimethylheptylpyran (DMHP).
    • Parahexyl.
  • Isomers of natural tetrahydrocannabinol:
    • Tetrahydrocannabinol, the following isomers and their stereochemical variants:
      • (9R)-Δ6a(10a)-tetrahydrocannabinol – 7,8,9,10-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
      • (9R,10aR)-Δ6a(7)-tetrahydrocannabinol – (9R,10aR)-8,9,10,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
      • (6aR,9R,10aR)-Δ7-tetrahydrocannabinol – (6aR,9R,10aR)-6a,9,10,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
      • (6aR,10aR)-Δ8-tetrahydrocannabinol – (6aR,10aR)-6a,7,10,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
      • (6aR,9R)-Δ10-tetrahydrocannabinol – 6a,7,8,9-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
      • (6aR,10aR)-Δ9(11)-tetrahydrocannabinol – (6aR,10aR)-6a,7,8,9,10,10a-hexahydro-6,6-dimethyl-9-methylene-3-pentyl-6H-dibenzo[b,d]pyran-1-ol.
  • Dissociatives:
    • Eticyclidine (PCE).
    • Rolicyclidine (PHP, PCPy).
    • Tenocyclidine (TCP).
  • Ergolines:
    • LSD.

The stereoisomers of substances in Schedule I are also controlled, unless specifically excepted, whenever the existence of such stereoisomers is possible within the specific chemical designation.

Salts of all the substances covered by the four schedules, whenever the existence of such salts is possible, are also under international control.

Schedule II

Contains 17 positions, specific generalisation for tetrahydrocannabinol stereochemical variants and common generalisation clause for salts.

  • 19 positions:
    • 12 stimulants.
    • 1 phenethylamine psychedelic.
    • 1 position representing an isomer of tetrahydrocannabinol and its stereochemical variants.
    • 3 depressants.
      • 1 barbiturate.
      • 2 qualones.
    • 1 dissociative.
    • 1 position – zipeprol.
  • Stimulants:
    • Amineptine.
    • Amphetamine and its isomers (dextroamphetamine and levoamphetamine).
    • Fenethylline.
    • Methamphetamine and its isomers (dextromethamphetamine and levomethamphetamine).
    • Methylphenidate and its isomers (dextromethylphenidate and levomethylphenidate).
    • Phenmetrazine.
    • a-PVP.
    • N-Ethylpentylone.
  • Phenethylamine psychedelics:
    • 2C-B.
  • Natural cannabinols:
    • Δ9-tetrahydrocannabinol – (6aR,10aR)-6a,7,8,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo[b,d]pyran-1-ol, and its stereochemical variants (dronabinol is the international non-proprietary name, although it refers to only one of the stereochemical variants of delta-9-tetrahydrocannabinol, namely (−)-trans-delta-9-tetrahydrocannabinol).
  • Depressants (qualones):
    • Mecloqualone.
    • Methaqualone.
  • Dissociatives:
    • Phencyclidine (PCP).
  • Other:
    • Zipeprol.

Salts of all the substances covered by the four schedules, whenever the existence of such salts is possible, are also under international control.

Schedule III

Contains 9 positions and common generalisation clause for salts.

  • 9 positions:
    • 6 depressants.
      • 4 barbiturates.
      • 1 benzodiazepine.
      • 1 other depressant.
    • 1 semisynthetic opioid.
    • 1 synthetic benzomorphan opioid.
    • 1 stimulant.
  • Depressants (barbiturates):
    • Amobarbital.
    • Butalbital.
    • Cyclobarbital.
    • Pentobarbital.
  • Depressants (other):
    • Glutethimide.
  • Semisynthetic agonist-antagonist opioids:
    • Buprenorphine.
  • Synthetic agonist-antagonist opioids – benzomorphans:
    • Pentazocine.
  • Stimulants:
    • Cathine.

Salts of all the substances covered by the four schedules, whenever the existence of such salts is possible, are also under international control.

Schedule IV

Contains 62 positions and common generalisation clause for salts.

  • Schedule IV (62):
    • 47 depressants.
      • 7 barbiturates.
      • 35 benzodiazepines (including 1 z-drug).
      • 2 carbamates.
      • 3 other depressants.
    • 14 stimulants.
    • 1 position – lefetamine (with stimulant and opioid effects).
  • Depressants (barbiturates):
    • Allobarbital.
    • Barbital.
    • Butobarbital.
    • Methylphenobarbital.
    • Phenobarbital.
    • Butabarbital.
    • Vinylbital.
  • Depressants (carbamates):
    • Ethinamate.
    • Meprobamate.
  • Depressants (other):
    • Ethchlorvynol.
    • Gamma-hydroxybutyric acid (GHB).
    • Methyprylon.
  • Stimulants:
    • Amfepramone.
    • Aminorex.
    • Benzphetamine.
    • Etilamfetamine.
    • Fencamfamine.
    • Fenproporex.
    • Mazindol.
    • Mefenorex.
    • Mesocarb.
    • Pemoline.
    • Phendimetrazine.
    • Phentermine.
    • Pipradrol.
    • Pyrovalerone.
  • Drugs with both stimulant and opioid effects:
    • Lefetamine (SPA) – open chain opioid having also stimulant effects.

Salts of all the substances covered by the four schedules, whenever the existence of such salts is possible, are also under international control.

Regulated Elsewhere

  • Ephedrine (as well as pseudoephedrine and norephedrine) is regulated as an UN-controlled drug precursor.

The following are scheduled by Single Convention on Narcotic Drugs.

  • Cannabis:
    • Cannabis – the flowering or fruiting tops of the cannabis plant (resin not extracted).
    • Cannabis resin – the separated resin, crude or purified, obtained from the cannabis plant.
    • Extracts and tinctures of cannabis.
  • Coca leaf, cocaine and ecgonine:
    • Coca leaf – the leaf of the coca bush (plant material), except a leaf from which all ecgonine, cocaine and any other ecgonine alkaloids have been removed.
    • Cocaine (methyl ester of benzoylecgonine) – an alkaloid found in coca leaves or prepared by synthesis from ecgonine.
    • Ecgonine – its esters and derivatives which are convertible to ecgonine and cocaine.

All other drugs scheduled by the narcotic convention are agonist-only opioids (and natural sources of them).

Not Scheduled by UN Conventions

Plants being the source of substances scheduled by this convention are not scheduled (see Psychedelic plants and fungi and Organic plants sections).

Partial list of psychotropic substances currently or formerly used in medicine, but not scheduled:

  • Ketamine (dissociative) and its stereoisomer esketamine.
  • Modafinil (stimulant), its stereoisomer armodafinil, and a similar drug adrafinil.
  • Dextromethorphan (dissociative, used medically as a cough suppressant) and its metabolite dextrorphan.
  • Diphenhydramine and dimenhydrinate (deliriants).
  • Benzydamine (deliriant and stimulant, used medically as a non-steroidal anti-inflammatory drug).
  • Propofol and fospropofol (anaesthetics).
  • Sodium thiopental (barbiturate).
  • Zaleplon (depressant z-drug).
  • Zopiclone (depressant z-drug) and its stereoisomer eszopiclone.
  • Nalbuphine (agonist-antagonist opioid).
  • Butorphanol (agonist-antagonist opioid).

Of course there are also many designer drugs, not used in medicine.

What is Smile Mask Syndrome?

Introduction

Smile mask syndrome (Japanese: スマイル仮面症候群, Hepburn: sumairu kamen shōkōgun), abbreviated SMS, is a psychological disorder proposed by professor Makoto Natsume of Osaka Shoin Women’s University, in which subjects develop depression and physical illness as a result of prolonged, unnatural smiling.

Refer to Honne and Tatemae.

Background

Natsume proposed the disorder after counselling students from the university in his practice and noticing that a number of students had spent so much time faking their smiles that they were unaware that they were smiling even while relating stressful or upsetting experiences to him. Natsume attributes this to the great importance placed on smiling in the Japanese service industry, particularly for young women.

Smiling is an important skill for Japanese women working in the service industry. Almost all service industry companies in Japan require their female staff to smile for long periods of time. Natsume says that his female patients often talk about the importance of smiling when the topic of the conversation is on their workplace. He relates examples of patients saying that they felt their smile had a large effect on whether they were hired or not, and that their superiors had stressed the effect that good smiles had on customers. According to Natsume, this atmosphere sometimes causes women to smile unnaturally for so long that they start to suppress their real emotions and become depressed.

Japanese author Tomomi Fujiwara notes that the demand for a common smile in the workplace emerged in Japan around the 1980s, and blames the cultural changes wrought by the Tokyo Disneyland, opened in 1983, for popularising the demand for an obligatory smile in the workplace.

The smile mask syndrome has also been identified in Korea. Korean writer Bae Woo-ri noted that smiling gives one a competitive advantage over the others, and has become a necessary attribute of many employees, just like a “neat uniform”. Yoon-Do-rahm, a psychology counsellor, compared the current society, which is full of smile-masks, to a clown show; both are characterised by plentiful, yet empty and fake, smiles.

Smile mask syndrome can cause physical problems as well as mental ones. Natsume relates that many of his patients developed muscle aches and headaches as a result of prolonged smiling, and says that these are similar to the symptoms of repetitive strain injury.

What is Self-Discrepancy Theory?

Introduction

The self-discrepancy theory states that individuals compare their “actual” self to internalised standards or the “ideal/ought self”. Inconsistencies between “actual”, “ideal” (idealised version of yourself created from life experiences) and “ought” (who persons feel they should be or should become) are associated with emotional discomforts (e.g. fear, threat, restlessness). Self-discrepancy is the gap between two of these self-representations that leads to negative emotions.

Developed by Edward Tory Higgins in 1987, the theory provides a platform for understanding how different types of discrepancies between representations of the self are related to different kinds of emotional vulnerabilities. Higgins sought to illustrate that internal disagreement causes emotional and psychological turmoil. There were several previous theories proving this concept such as the self-inconsistency theory, the cognitive dissonance theory, and the imbalance theory (e.g. Heider, 1958); however, Higgins wanted to take it one step further by determining the specific emotions that surfaced as a result of these internal disagreements. Previous self-imbalance theories had recognised only positive or negative emotions. The self-discrepancy theory was the first to assign specific emotions and affects to the disparity.

The theory proposes how a variety of self-discrepancies represents a variety of types of negative psychological situations that are associated with different kinds of discomfort. A primary goal of the self-discrepancy theory is to create an understanding of which types of contrasting ideas will cause such individuals to feel different kinds of negative emotions.

The structure of the theory was built based on three ideas. First classify the different kinds of discomfort felt by those people holding contrasting ideals experienced, as well as the various types of emotional vulnerabilities felt by the different types of discrepancies. Lastly, to consider the role of the different discrepancies in influencing the kind and type of discomfort individuals are most likely to experience.

Domains of the Self

The theory postulates three basic domains of the self.

DomainDescription
ActualActual self is one’s representation of the attributes that one believes one actually possesses, or that one believes others believe one possesses. The “actual self” is a person’s basic self-concept. It is one’s perception of their own attributes (intelligence, athleticism, attractiveness, etc.).
IdealIdeal self is one’s representation of the attributes that someone (oneself or another) would like one, ideally, to possess (i.e. a representation of someone’s hopes, aspirations, or wishes for one). The “ideal-self” is what usually motivates individuals to change, improve and achieve. The ideal self-regulatory system focuses on the presence or absence of positive outcomes (e.g. love provided or withdrawn).
OughtOught is one’s representation of the attributes that someone (oneself or another) believes one should or ought to possess (i.e. a representation of someone’s sense of one’s duty, obligations, or responsibilities). The ought self-regulatory system focuses on the presence or absence of negative outcomes (e.g., criticism administered or suspended).

Standpoints of the Self

Self-discrepancy theory initiates the importance of considering two different standpoints (or vantage points) in which “the self” is perceived. A standpoint on the self is defined as “a point of view from which you can be judged that reflects a set of attitudes or values.”

Own

An individual’s own personal standpoint.

Other

The standpoint of some significant other. Significant others may comprise parents, siblings, spouses, or friends. The “other” standpoint is what the self perceives their significant other’s standpoint to be.

Except for theories focusing on the actual self, previous theories of the self had not systematically considered the different domain of self in terms of the different standpoints on those domains. These two constructs provide the basis from which discrepancies arise; that is, when certain domains of the self are at odds with one another, individuals experience particular emotional affects (ex: one’s beliefs concerning the attributes one would personally like ideally to possess versus your beliefs concerning the attributes that some significant other person, such as your mother, would like you ideally to possess).

Discrepancies

Discrepancies create two major types of negative physiological situations: absence of positive outcomes, which is associated with dejection-related emotions, and the presence of negative outcomes which is associated with agitation-related emotions.

ActualIdealOught
OwnSelf-ConceptSelf-GuideSelf-Guide
OtherSelf-ConceptSelf-GuideSelf-Guide

Self-Concept

Actual/Own vs. Actual/Other

These self-state representations are the basic self-concept (from either or both standpoints). Discrepancies between own self-concept, and other self-concept can be described as an identity crisis, which often occurs during adolescence. Guilt is a characteristic result of discrepancy from the own perspective. Shame is a characteristic result of discrepancy from the other perspective.

Self-Guide

Actual/Own vs. Ideal/Own

In this discrepancy, a person’s view of their actual attributes does not match the ideal attributes they hope to develop. Discrepancy between these self-guides is characterised by dejection-related emotions such as disappointment and dissatisfaction. Actual/ideal discrepancies are associated with low self-esteem and characterised by the threat of absence of positive outcomes. Specifically, an individual is predicted to be vulnerable to disappointment or dissatisfaction because these emotions are associated with people believing that their personal wishes have been unfulfilled. These emotions have been described as being associated with the individuals’ own standpoint and a discrepancy from his or her hope, desire, or ideals. The motivational nature of this discrepancy also suggests that it could be associated with frustration because of these unfulfilled desires. Emotions such as blameworthiness, feeling no interest in things, and not feeling effective was also associated with this discrepancy. In addition, this discrepancy is also associated with dejection from perceived lack of effectiveness or self-fulfilment. This discrepancy is uniquely associated with depression.

Actual/Own vs. Ideal/Other

Here, one’s view of their actual attributes does not match the ideal attributes their significant other hopes or wishes for them. The ideal self-guide is characterised by the absence of positive outcomes, and accompanied by dejection-related emotions. More specifically, because one believes that they have failed to obtain some significant other’s hopes or wishes are likely to believe that the significant other is disappointed and dissatisfied with them. In turn, individuals will be vulnerable to shame, embarrassment, or feeling downcast, because these emotions are associated with people believing that they have lost standing or esteem in the eyes of others. Analysis of shame and related emotions have been described as being associated with the standpoint of one or more other people and discrepancies from achievement and/or status standards. Other analyses describe shame as being associated with concern over losing the affection or esteem of others. When people have a sense of the difference between their actual self and their social ideal self, an individual will experience feelings of shame and unworthiness. Shame that is often experienced when there is a failure to meet a significant other’s goals or wishes involves loss of face and presumed exposure to the dissatisfaction of others. Feeling lack of pride, lack of feeling sure of self and goals, feeling lonely, feeling blue, and feeling not interested in things was also associated with this discrepancy. This discrepancy is associated with dejection from perceived or anticipated loss of social affection or esteem.

Actual/Own vs. Ought/Other

This discrepancy exists when a person’s own standpoint does not match what they believe a significant other considers to be his or her duty or obligation to attain. Agitation-related emotions are associated with this discrepancy and results in the presence of negative outcomes. More specifically, because violation of prescribed duties and obligations is associated with punishment, this particular discrepancy represents the presence of negative outcomes. The individual experiencing this discrepancy will have an expectation of punishment; therefore, the person is predicted to be vulnerable to fear and feeling threatened, because these emotions occur when danger or harm is anticipated or impending. Analyses of such emotions have described them as being associated with the standpoint of one or more other people and discrepancy from norms or moral standards. The motivational nature of this discrepancy suggests that one might experience feelings of resentment. The feeling of resentment arises from the anticipated pain to be inflicted by others. The person might also experience anxiety because of apprehension over negative responses from others. This discrepancy is associated with agitation from fear and threat. In addition, it is also associated with agitation from self-criticism. Social anxiety is uniquely associated with this discrepancy.

Actual/Own vs. Ought/Own

A discrepancy between these self-guides occurs when one’s view of their actual attributes do not meet the expectations of what they think they ought to possess. This discrepancy is associated with the presence of negative outcomes and is characterised by agitation-related emotions such as self-dissatisfaction. An individual predicts a readiness for self-punishment. The person is predicted to be vulnerable to guilt, self-contempt, and uneasiness, because these particular feelings occur when people believe they have transgressed a personally legitimate and accepted moral standard. Analysis of guilt have described it as associated with a person’s own standpoint and a discrepancy from his or her sense of morality or justice. The motivational nature of this discrepancy suggests associations with feelings of moral worthlessness or weakness. Transgression of one’s own internalised moral standards has been associated with guilt and self-criticism because when people attribute failure to a lack of sufficient effort on their part, they experience feelings of guilt.

Ideal vs. Ought

Ideal self and ought self act as self guides with which the actual self aspires to be aligned. The ideal self represents hopes and wishes, whereas the ought self is determined through obligation and sense of duty. In terms of the ideal or ought discrepancy and specific to self-regulatory approach vs. avoidance behaviours, the ideal domain is predisposed to approach behaviour and the ought domain is predisposed to avoidance behaviour.

Another Domain of Self

In 1999 Charles Carver and associates made a new amendment to the theory by adding the domain of feared self. Unlike the self guides proposed by Higgins which imply an actual or desired (better) self, the feared self is a domain that measures what one does not desire to be. In many cases, this may have a different level of influence in terms of priority on the self than previous domains and self-guides. It is human nature to avoid negative affect before approaching positives.

Availability and Accessibility of Self-Discrepancies

Beliefs that are incongruent are cognitive constructs and can vary in both their availability and accessibility. In order to establish which types of discrepancies an individual holds and which are likely to be active and produce their associated emotions at any point, the availability and accessibility of self-discrepancies must be distinguished.

Availability

The availability of a self-discrepancy depends on the extent to which the attributes of the two conflicted self-state representations diverge for the person in question. Each attribute in one of the self-state representations (actual/own) is compared to each attribute in the other self-state representation (ideal/own). Each pair of attributes is either a match or a mismatch. The larger variance between the number of matches and the number of nonmatches (i.e. the greater the divergence of attributes between the two self-state representations), the larger the magnitude of that type of self-discrepancy that is available. Furthermore, the greater the magnitude of a particular discrepancy produces more intense feelings of discomfort accompanying the discrepancy when activated.

The availability of the self-discrepancy is not enough to influence emotions. In order to do so, the self-discrepancy must also be activated. The variable that influences the probability of activation is its accessibility.

Accessibility

The accessibility of a self-discrepancy depends on the same factors that determine the accessibility of any stored construct. One factor is how recently the construct has been activated. The more often a construct is activated, the more likely it will be used later on to understand social events. The accessibility or likelihood of activation, of a stored construct also depends on the relation between its “meaning” and the properties of the stimulus event. A stored construct will not be used to interpret an event unless it is applicable to the event. Thus the negative psychological situation represented in a self-discrepancy (i.e. the “meaning” of the discrepancy) will not be activated by an explicitly positive event. In sum, the accessibility of self-discrepancy is determined by its recency of activation, its frequency of activation, and its applicability to the stimulus event. The theory posits that the greater the accessibility of a self-discrepancy, the more powerfully the person will experience the emotion accompanying that discrepancy.

The theory does not propose that individuals are aware of the accessibility or availability of their self-discrepancies. However, it is obvious that both the availability and accessibility can influence social information processing automatically and without awareness. Thus, self-discrepancy theory simulates that the available and accessible negative psychological situations embodied in one’s self-discrepancies can be used to provide meaning to events without being aware of either the discrepancies or their impact on processing. The measure of self-discrepancies requires only that one be able to retrieve attributes of specific self-state representations when asked to do so. It does not require that one be aware of the relations among these attributes of their significance.

Self-discrepancy theory hypothesizes that the greater the magnitude of a particular type of self-discrepancy possessed by a person, the more strongly the person will experience the emotion associated with that type of discrepancy.

Application and Use

Self-discrepancy theory becomes applicable when addressing some of the psychological problems individuals face with undesired self-image. The theory has been applied to psychological problems faced by college students compromising their career choice, understanding clinically depressed students, eating disorders, mental health and depression in chronically ill women and even developing self-confidence in athletes. Self-Discrepancy Theory inherently provides a means to systematically lessen negative affect associated with self-discrepancies by reducing the discrepancies between the self domains in conflict of one another. Not only has it been applied to psychological health, but also to other research and understanding to human emotions such as shame and guilt. The self-guided pressure society and ourselves induce throw an individual into turmoil. The theory finds many of its uses geared toward mental health, anxiety, and depression. Understanding what emotions are being aroused and the reasoning is important to reinstate psychological health.

Procrastination

Studies have correlated the theory and procrastination. Specifically, discrepancies in the actual/ought domain from the own perspective, are the strongest predictor of procrastination. Avoidance is the common theme. The actual/ought self-regulatory system responds through avoidance. Procrastinators also have an avoidance relationship with their goals.

Depression

Depression is associated with conflict between a person’s perceived actual self, and some standard, goal or aspiration. An actual/ought discrepancy triggers agitated depression (characterised by feelings of guilt, apprehension, anxiety or fear). An actual/ideal discrepancy triggers dejected depression (characterised by feelings of failure, disappointment, devaluation or shame).

Emotions

Higgins measured how individuals experienced self-discrepancies by having individuals reminisce and remember about “negative events or personal self-guides, including hopes, goals, duties, and obligations, and measure what will help increase the kind of discomfort that the individual experiences. The study found the “absence of an actual/own and ideal/own discrepancy” is associated with the emotions “happy” and “satisfied” and the “absence of an actual/own and ought/other discrepancy” is associated with the emotions “calm” and “secure”.

New Findings

Since its original conception in 1987, there have been a number of studies that have tested the legitimacy of self-discrepancy theory. Some of their findings do in fact contradict certain aspects of the theory, while another finds further evidence of its validly. These studies give insight into the research that has been done regarding self-discrepancy theory since its original conception in 1987.

Conducted in 1998, “Are Shame and Guilt Related to Distinct Self-Discrepancies? A Test of Higgins’s (1987) Hypotheses”, brought into question the correlations between specific discrepancy and emotional discomforts laid out by self-discrepancy theory. Researches believed that there was no way to tie a unique emotional discomfort to one internal discrepancy, but rather that various internal discrepancies result in a variety of discomforts. The study was carried out and the hypothesis was confirmed based on the results. The findings displayed no evidence suggesting a direct tie between specific discomforts and type of internal discrepancy.

“Self-discrepancies: Measurement and Relation to Various Negative Affective States”, also brought into question the core aspect of self-discrepancy theory – The correlation between specific discrepancies and the emotional discomforts that result. This study went one step further, also testing the validity of two methods used to observe internal discrepancies; “The Selves Questionnaire” or “SQ” along with the “Adjective Rating List” or “ARL”. The study found a strong relationship in results from both methods, speaking to their validly. The results, though, did bring into question the original research done by Higgins, as there were no ties found between specific internal discrepancies and unique emotional discomforts. One of the researchers in this study wrote “Overall, these findings raise significant concerns about the relevance of self-discrepancies as measured by the SQ and ARL and fail to support the main contentions of self-discrepancy theory”.

“Self-discrepancy: Long-term test–retest reliability and test–criterion predictive validity”, published in 2016, tested the long-term validity of self-discrepancy theory. Researchers found evidence to support the long-term validity of the self-discrepancy personality construct along with anxiety and depression having a direct relationship with internal discrepancies.

What is ‘Honne’ and ‘Tatemae’?

Introduction

In Japan, “honne” refers to a person’s true feelings and desires (本音, hon’ne, “true sound”), and “tatemae” refers contrastingly to the behaviour and opinions one displays in public (建前, tatemae, “built in front”, “façade”). This distinction began to be made in the post-war era.

A person’s honne may be contrary to what is expected by society or what is required according to one’s position and circumstances, and they are often kept hidden, except with one’s closest friends. Tatemae is what is expected by society and required according to one’s position and circumstances, and these may or may not match one’s honne. In many cases, tatemae leads to outright telling of lies in order to avoid exposing the true inward feelings.

The honne-tatemae divide is considered by some to be of paramount importance in Japanese culture.

Refer to Smile Mask Syndrome.

Causes

In Japanese culture, public failure and the disapproval of others are seen as particular sources of shame and reduced social standing, so it is common to avoid direct confrontation or disagreement in most social contexts. Traditionally, social norms dictate that one should attempt to minimise discord; failure to do so might be seen as insulting or aggressive. For this reason, the Japanese tend to go to great lengths to avoid conflict, especially within the context of large groups. By upholding this social norm, one is socially protected from such transgressions by others.

The conflict between honne and giri (social obligations) is one of the main topics of Japanese drama throughout the ages. For example, the protagonist would have to choose between carrying out his obligations to his family/feudal lord or pursuing a clandestine love affair.

The same concept in Chinese culture is called “inside face” and “outside face”, and these two aspects also frequently come into conflict.

Effects

Contemporary phenomena such as hikikomori seclusion and parasite singles are seen as examples of late Japanese culture’s growing problem of the new generation growing up unable to deal with the complexities of honne-tatemae and pressure of an increasingly consumerist society.

Though tatemae and honne are not a uniquely Japanese phenomenon, some Japanese feel that it is unique to Japan; especially among those Japanese who feel their culture is unique in having the concepts of “private mind” and “public mind”. Although there might not be direct single word translations for honne and tatemae in some languages, they do have two-word descriptions; for example in English, “private mind” and “public mind”.

Some researchers suggest that the need for explicit words for tatemae and honne in Japanese culture is evidence that the concept is relatively new to Japan, whereas the unspoken understanding in many other cultures indicates a deeper internalisation of the concepts. In any case, all cultures have conventions that help to determine appropriate communication and behaviour in various social contexts which are implicitly understood without an explicit name for the social mores on which the conventions are based.

A similar discord of Japanese true own feeling and the pretension before public is observed in yase-gaman, a phrase whose meaning literally translates as “starving to [one’s] skeleton”, referring to being content or pretending to be so. Nowadays, the phrase is used for two different meanings, expressing the samurai virtue of self-discipline, silent moral heroism, or ridiculing stubbornness, face-savingness.

An Overview of Global Mental Health

Introduction

Global mental health is the international perspective on different aspects of mental health.

It is ‘the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide’. There is a growing body of criticism of the global mental health movement, and has been widely criticised as a neo-colonial or “missionary” project and as primarily a front for pharmaceutical companies seeking new clients for psychiatric drugs.

In theory, taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of mental health care systems, human resources in mental health, and human rights issues among others.

The overall aim of the field of global mental health is to strengthen mental health all over the world by providing information about the mental health situation in all countries, and identifying mental health care needs in order to develop cost-effective interventions to meet those specific needs.

The Global Burden of Disease

Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD). This is a global measure of so-called disability-adjusted life years (DALY’s) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY’s – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.

Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability related to health conditions.

Mental Health by (Select) Country

Africa

Mental illnesses and mental health disorders are widespread concerns among underdeveloped African countries, yet these issues are largely neglected, as mental health care in Africa is given statistically less attention than it is in other, westernised nations. Rising death tolls due to mental illness demonstrate the imperative need for improved mental health care policies and advances in treatment for Africans suffering from psychological disorders.

Underdeveloped African countries are so visibly troubled by physical illnesses, disease, malnutrition, and contamination that the dilemma of lacking mental health care has not been prioritised, makes it challenging to have a recognised impact on the African population. In 1988 and 1990, two original resolutions were implemented by the World Health Organisation’s (WHO) Member States in Africa. AFR/RC39/R1 and AFR/RC40/R9 attempted to improve the status of mental health care in specific African regions to combat its growing effects on the African people. However, it was found that these new policies had little impact on the status of mental health in Africa, ultimately resulting in an incline in psychological disorders instead of the desired decline, and causing this to seem like an impossible problem to manage.

In Africa, many socio-cultural and biological factors have led to heightened psychological struggles, while also masking their immediate level of importance to the African eye. Increasing rates of unemployment, violence, crime, rape, and disease are often linked to substance abuse, which can cause mental illness rates to inflate. Additionally, physical disease like HIV/AIDS, the Ebola epidemic, and malaria often have lasting psychological effects on victims that go unrecognised in African communities because of their inherent cultural beliefs. Traditional African beliefs have led to the perception of mental illness as being caused by supernatural forces, preventing helpful or rational responses to abnormal behaviour. For example, Ebola received loads of media attention when it became rampant in Africa and eventually spread to the US, however, researchers never really paid attention to its psychological effects on the African brain. Extreme anxiety, struggles with grief, feelings of rejection and incompetence, depression leading to suicide, PTSD, and much more are only some of the noted effects of diseases like Ebola. These epidemics come and go, but their lasting effects on mental health are remaining for years to come, and even ending lives because of the lack of action. There has been some effort to financially fund psychiatric support in countries like Liberia, due to its dramatic mental health crisis after warfare, but not much was benefited. Aside from financial reasons, it is so difficult to enforce mental health interventions and manage mental health in general in underdeveloped countries simply because the individuals living there do not necessarily believe in western psychiatry. It is also important to note that the socio-cultural model of psychology and abnormal behaviour is dependent on factors surrounding cultural differences. This causes mental health abnormalities to remain more hidden due to the culture’s natural behaviour, compared to westernised behaviour and cultural norms.

This relationship between mental and physical illness is an ongoing cycle that has yet to be broken. While many organisations are attempting to solve problems about physical health in Africa, as these problems are clearly visible and recognisable, there is little action taken to confront the underlying mental effects that are left on the victims. It is recognised that many of the mentally ill in Africa search for help from spiritual or religious leaders, however this is widely because many African countries are significantly lacking in mental health professionals in comparison to the rest of the world. In Ethiopia alone, there are “only 10 psychiatrists for the population of 61 million people,” studies have shown. While numbers have definitely changed since this research was done, the lack of psychological professionals throughout African continues with a current average of 1.4 mental health workers per 100,000 people compared to the global statistic of 9.0 professionals per 100,00 people. Additionally, statistics show that the “global annual rate of visits to mental health outpatient facilities is 1,051 per 100,000 population,” while “in Africa the rate is 14 per 100,000” visits. About half of Africa’s countries have some sort of mental health policy, however, these policies are highly disregarded, as Africa’s government spends “less than 1% of the total health budget on mental health”. Specifically in Sierra Leone, about 98.8% of people suffering from mental disorders remain untreated, even after the building of a well below average psychiatric hospital, further demonstrating the need for intervention.

Not only has there been little hands-on action taken to combat mental health issues in Africa, but there has also been little research done on the topic to spread its awareness and prevent deaths. The Lancet Global Health acknowledges that there are well over 1,000 published articles covering physical health in Africa, but there are still less than 50 discussing mental health. And this pressing dilemma of prioritizing physical health vs. mental health is only worsening as the continent’s population is substantially growing with research showing that “Between 2000 and 2015 the continent’s population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%”. The number of deaths caused by mental instability is truly competing with those caused by physical diseases: “In 2015, 17.9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18.5 million years lost to disability,”. Mental health and physical health care, while they may seem separate, are very much connected, as these two factors determine life or death for humans. As new challenges surface and old challenges still have not been prioritised, Africa’s mental health care policies need significant improvement in order to provide its people with the appropriate health care they deserve, hopefully preventing this problem from expanding.

Australia

A survey conducted by Australian Bureau of Statistics in 2008 regarding adults with manageable to severe neurosis reveals almost half of the population had a mental disorder at some point of their life and one in five people had a sustained disorder in the preceding 12 months. In neurotic disorders, 14% of the population experienced anxiety and comorbidity disorders were next to common mental disorder with vulnerability to substance abuse and relapses. There were distinct gender differences in disposition to mental health illness. Women were found to have high rate of mental health disorders, and Men had higher propensity of risk for substance abuse. The Survey of Mental Health and Well-Being (SMHWB survey) showed families that had low socioeconomic status and high dysfunctional patterns had a greater proportional risk for mental health disorders. A 2010 survey regarding adults with psychosis revealed 5 persons per 1000 in the population seeks professional mental health services for psychotic disorders and the most common psychotic disorder was schizophrenia.

Bangladesh

Mental health disorder is considered a major public health concern and it constitutes about 13% of the Global Burden of disease and severe mental health disease may reduce each individual’s life expectancy by about 20%. Low and middle-income countries have a higher burden of mental health disorder as it is not considered as a health problem as other chronic diseases. Being a low-income country, in Bangladesh, mental health issues are highly stigmatised.

A community-based study in the rural area of Bangladesh in 2000-2001 estimated that the burden of mental morbidity was 16.5% among rural people and most were suffering from mainly depression and anxiety and which was one-half and one-third of total cases respectively. Furthermore, the prevalence of mental disorders was higher in women in large families aged 45 years.

Care for Mental Health in Bangladesh

A study conducted in 2008 stated that only 16% of patients came directly to the Mental Health Practitioner with a mean delay of 10.5 months of the onset of mental illness, which made them more vulnerable in many ways. 22% of patients went for the religious or traditional healer and 12% consulted a rural medical practitioner with the least delay of 2-2.5 weeks.

Canada

According to statistics released by the Centre of Addiction and Mental Health (CAMH) one in five people in Canada experience a mental health or addiction problem. Young people of ages 15 to 25 are particularly found to be vulnerable. Major depression is found to affect 8% and anxiety disorder 12% of the population. Women are 1.5 times more likely to suffer from mood and anxiety disorders. WHO points out that there are distinct gender differences in patterns of mental health and illness. The lack of power and control over their socioeconomic status, gender based violence; low social position and responsibility for the care of others render women vulnerable to mental health risks.[citation needed] Since more women than men seek help regarding a mental health problem, this has led to not only gender stereotyping but also reinforcing social stigma. WHO has found that this stereotyping has led doctors to diagnose depression more often in women than in men even when they display identical symptoms. Often communication between health care providers and women is authoritarian leading to either the under-treatment or over-treatment of these women.

Women’s College Hospital has a programme called the “Women’s Mental Health Programme” where doctors and nurses help treat and educate women regarding mental health collaboratively, individually, and online by answering questions from the public.

Another Canadian organisation serving mental health needs is CAMH. CAMH is one of Canada’s largest and most well-known health and addiction facilities, and it has received international recognitions from the Pan American Health Organisation and WHO Collaborating Centre. They do research in areas of addiction and mental health in both men and women. In order to help both men and women, CAMH provides “clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.” CAMH is different from Women’s College Hospital due to its widely known rehab centre for women who have minor addiction issues, to severe ones. This organisation provides care for mental health issues by assessments, interventions, residential programmes, treatments, and doctor and family support.

Middle East

Israel

In Israel, a Mental Health Insurance Reform took effect in July 2015, transferring responsibility for the provision of mental health services from the Ministry of Health to the four national health plans. Physical and mental health care were united under one roof; previously they had functioned separately in terms of finance, location, and provider. Under the reform, the health plans developed new services or expanded existing ones to address mental health problems.

United States

According to the WHO, in 2004, was depression is the leading cause of disability in the United States for individuals ages 15 to 44. Absence from work in the US due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centres for Disease Control and Prevention). In 2004, suicide was the 11th leading cause of death in the United States (Centres for Disease Control and Prevention), third among individuals ages 15-24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high. By way of comparison, a study conducted in Australia during 2006 to 2007 reported that one-third (34.9%) of patients diagnosed with a mental health disorder had presented to medical health services for treatment. The US has a shortage of mental healthcare workers, contributing to the unmet need for treatment. By 2025, the US will need an additional 15,400 psychiatrists and 57,490 psychologists to meet the demand for treatment.

Treatment Gap

It is estimated that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Although many effective interventions for the treatment of mental disorders are known, and awareness of the need for treatment of people with mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called “treatment gap” is estimated to reach between 76-85% for low- and middle-income countries, and 35-50% for high-income countries.

Despite the acknowledged need, for the most part there have not been substantial changes in mental health care delivery during the past years. Main reasons for this problem are public health priorities, lack of a mental health policy and legislation in many countries, a lack of resources – financial and human resources – as well as inefficient resource allocation.

In 2011, the WHO estimated a shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. The annual wage bill to remove this health workforce shortage was estimated at about US$4.4 billion.

Interventions

Information and evidence about cost-effective interventions to provide better mental health care are available. Although most of the research (80%) has been carried out in high-income countries, there is also strong evidence from low- and middle-income countries that pharmacological and psychosocial interventions are effective ways to treat mental disorders, with the strongest evidence for depression, schizophrenia, bipolar disorder and hazardous alcohol use.

Recommendations to strengthen mental health systems around the world have been first mentioned in the WHO’s World Health Report 2001, which focused on mental health:

  • Provide treatment in primary care.
  • Make psychotropic drugs available.
  • Give care in the community.
  • Educate the public.
  • Involve communities, families and consumers.
  • Establish national policies, programs and legislation.
  • Develop human resources.
  • Link with other sectors.
  • Monitor community mental health.
  • Support more research.

Based on the data of 12 countries, assessed by the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the costs of scaling up mental health services by providing a core treatment package for schizophrenia, bipolar affective disorder, depressive episodes and hazardous alcohol use have been estimated. Structural changes in mental health systems according to the WHO recommendations have been taken into account.

For most countries, this model suggests an initial period of investment of US$0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least ten-fold in low-income countries. In those countries, additional financial resources will be needed, while in middle- and high-income countries the main challenge will be the reallocation of resources within the health system to provide better mental health service.

Prevention

Prevention is beginning to appear in mental health strategies, including the 2004 WHO report “Prevention of Mental Disorders”, the 2008 EU “Pact for Mental Health” and the 2011 US National Prevention Strategy. NIMH or the National Institute of Mental Health has over 400 grants.

Stakeholders

World Health Organization (WHO)

Two of WHO’s core programmes for mental health are WHO MIND (Mental health improvements for Nations Development) and Mental Health Gap Action Programme (mhGAP).

WHO MIND focuses on 5 areas of action to ensure concrete changes in people’s daily lives. These are:

  • Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet).
  • Mental health policy, planning and service development.
  • Mental health human rights and legislation.
  • Mental health as a core part of human development.
  • The QualityRights Project which works to unite and empower people to improve the quality of care and promote human rights in mental health facilities and social care homes.

Mental Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The aim of mhGAP is to build partnerships for collective action and to reinforce the commitment of governments, international organisations and other stakeholders.

The mhGAP Intervention Guide (mhGAP-IG) was launched in October 2010. It is a technical tool for the management of mental, neurological and substance use disorders in non-specialist health settings. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.

Criticism

One of the most prominent critics of the Movement for Global Mental Health has been China Mills, author of the book Decolonising Global Mental Health: The Psychiatrisation of the Majority World. Mills writes that:[7]

This book charts the creeping of psychology and psychiatry across the borders of everyday experience and across geographical borders, as a form of colonialism that comes from within and from outside, swallowed in the form of a pill. It maps an anxious space where socio-economic crises come to be reconfigured as individual crisis – as ‘mental illness’; and how potentially violent interventions come to be seen as ‘essential’ treatment.

Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalisation of the American Psyche. A more constructive approach is offered by Vincenzo Di Nicola whose article on the Global South as an emergent epistemology creates a bridge between critiques of globalisation and the initial gaps and limitations of the Global Mental Health movement.

A recent review presents a simple summary outlining the key characteristics of the global mental health landscape and indicating the diversity existing within the field. This review demonstrates how the area is not confined to the limits of the local-global debate, which has historically defined it.

What is the Six-Factor Model of Psychological Well-Being?

Introduction

The Six-factor Model of Psychological Well-being is a theory developed by Carol Ryff which determines six factors which contribute to an individual’s psychological well-being, contentment, and happiness.

Psychological well-being consists of positive relationships with others, personal mastery, autonomy, a feeling of purpose and meaning in life, and personal growth and development. Psychological well-being is attained by achieving a state of balance affected by both challenging and rewarding life events.

Refer to Euthymia.

Measurement

The Ryff Scale of Measurement is a psychometric inventory consisting of two forms (either 54 or 84 items) in which respondents rate statements on a scale of 1 to 6, where 1 indicates strong disagreement and 6 indicates strong agreement. Ryff’s model is not based on merely feeling happy, but is based on Aristotle’s Nicomachean Ethics, “where the goal of life isn’t feeling good, but is instead about living virtuously”.

The Ryff Scale is based on six factors: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Higher total scores indicate higher psychological well-being. Following are explanations of each criterion, and an example statement from the Ryff Inventory to measure each criterion.

  • Autonomy:
    • High scores indicate that the respondent is independent and regulates their behaviour independent of social pressures.
    • An example statement for this criterion is “I have confidence in my opinions, even if they are contrary to the general consensus”.
  • Environmental Mastery:
    • High scores indicate that the respondent makes effective use of opportunities and has a sense of mastery in managing environmental factors and activities, including managing everyday affairs and creating situations to benefit personal needs.
    • An example statement for this criterion is “In general, I feel I am in charge of the situation in which I live”.
  • Personal Growth:
    • High scores indicate that the respondent continues to develop, is welcoming to new experiences, and recognises improvement in behaviour and self over time.
    • An example statement for this criterion is “I think it is important to have new experiences that challenge how you think about yourself and the world”.
  • Positive Relations with Others:
    • High scores reflect the respondent’s engagement in meaningful relationships with others that include reciprocal empathy, intimacy, and affection.
    • An example statement for this criterion is “People would describe me as a giving person, willing to share my time with others”.
  • Purpose in Life:
    • High scores reflect the respondent’s strong goal orientation and conviction that life holds meaning.
    • An example statement for this criterion is “Some people wander aimlessly through life, but I am not one of them”.
  • Self-Acceptance:
    • High scores reflect the respondent’s positive attitude about his or her self.
    • An example statement for this criterion is “I like most aspects of my personality”

Applications and Research Findings

Contributing Factors

Positive Contributing Factors

Positive psychological well-being may emerge from numerous sources. A happy marriage is contributive, for example, as is a satisfying job or a meaningful relationship with another person. When marriages include forgiveness, optimistic expectations, positive thoughts about one’s spouse, and kindness, a marriage significantly improves psychological well-being. A propensity to unrealistic optimism and over-exaggerated self-evaluations can be useful. These positive illusions are especially important when an individual receives threatening negative feedback, as the illusions allow for adaptation in these circumstances to protect psychological well-being and self-confidence (Taylor & Brown, 1988). Optimism also can help an individual cope with stresses to their well-being.

Negative Contributing Factors

Psychological well-being can also be affected negatively, as is the case with a degrading and unrewarding work environment, unfulfilling obligations and unsatisfying relationships. Social interaction has a strong effect on well-being as negative social outcomes are more strongly related to well-being than are positive social outcomes. Childhood traumatic experiences diminish psychological well-being throughout adult life, and can damage psychological resilience in children, adolescents, and adults. Perceived stigma also diminished psychological well-being, particularly stigma in relation to obesity and other physical ailments or disabilities.

Extrinsic and Intrinsic Psychological Needs

A study conducted in the early 1990s exploring the relationship between well-being and those aspects of positive functioning that were put forth in Ryff’s model indicates that persons who aspired more for financial success relative to affiliation with others or their community scored lower on various measures of well-being.

Individuals that strive for a life defined by affiliation, intimacy, and contributing to one’s community can be described as aspiring to fulfil their intrinsic psychological needs. In contrast, those individuals who aspire for wealth and material, social recognition, fame, image, or attractiveness can be described as aiming to fulfil their extrinsic psychological needs. The strength of an individual’s intrinsic (relative to extrinsic) aspirations as indicated by rankings of importance correlates with an array of psychological outcomes. Positive correlations have been found with indications of psychological well-being: positive affect, vitality, and self-actualisation. Negative correlations have been found with indicators of psychological ill-being: negative affect, depression, and anxiety.

Relations with Others

A more recent study confirming Ryff’s notion of maintaining positive relations with others as a way of leading a meaningful life involved comparing levels of self-reported life satisfaction and subjective well-being (positive/negative affect). Results suggested that individuals whose actions had underlying eudaimonic tendencies as indicated by their self-reports (e.g. “I seek out situations that challenge my skills and abilities”) were found to possess higher subjective well-being and life satisfaction scores compared to participants who did not. Individuals were grouped according to their chosen paths/strategies to happiness as identified by their answers on an Orientation to Happiness Questionnaire. The questionnaire describes and differentiates individuals on the basis of three orientations to happiness which can be pursued, though some individuals do not pursue any. The “pleasure” orientation describes a path to happiness that is associated with adopting hedonistic life goals to satisfy only one’s extrinsic needs. Engagement and meaning orientations describe a pursuit of happiness that integrates two positive psychology constructs “flow/engagement” and “eudaimonia/meaning”. Both of the latter orientations are also associated with aspiring to meet intrinsic needs for affiliation and community and were amalgamated by Anić and Tončić into a single “eudaimonic” path to happiness that elicited high scores on all measures of well-being and life satisfaction. Importantly, she also produced scales for assessing mental health. This factor structure has been debated, but has generated much research in wellbeing, health, and successful ageing.

Heritability

Individual differences in both overall Eudaimonia, identified loosely with self-control and in the facets of eudaimonia are heritable. Evidence from one study supports 5 independent genetic mechanisms underlying the Ryff facets of this trait, leading to a genetic construct of eudaimonia in terms of general self-control, and four subsidiary biological mechanisms enabling the psychological capabilities of purpose, agency, growth, and positive social relations.

Well-Being Therapy

According to Seligman, positive interventions to attain positive human experience should not be at the expense of disregarding human suffering, weakness, and disorder. A therapy based on Ryff’s six elements was developed by Fava and others in this regards.

What is Euthymia?

Introduction

In psychiatry and psychology, euthymia is a normal, tranquil mental state or mood.

In those with bipolar disorder, euthymia is a stable mental state or mood that is neither manic nor depressive, yet distinguishable from the state of healthy people. Euthymia is also the “baseline” of other cyclical mood disorders like major depressive disorder (MDD), borderline personality disorder (BPD) and narcissistic personality disorder (NPD). This state is the goal of psychiatric and psychological interventions.

Background

The term euthymia is derived from the Greek words “eu”, well, and “thymo”, soul or emotion. The word “thymos” also had four additional meanings: life energy; feelings and passions; desires and inclinations; and thought or intelligence. Euthymia is also derived from a verb, “euthymeo”, that means both “I am happy, in good spirits” and “I make others happy, I reassure and encourage”. This is the basis on which the first formal definition of euthymia was built.

Democritus, who coined the philosophical concept of euthymia, said that euthymia is achieved when “one is satisfied with what is present and available, taking little heed of people who are envied and admired and observing the lives of those who suffer and yet endure”. This was later amended in the translation given by the Roman philosopher Seneca the Younger in which euthymia means a state of internal calm and contentment. Seneca was also the first to link the state of euthymia to a learning process; in order to achieve it, one must be aware of psychological well-being. Seneca’s definition included a cache about detachment from current events. Later, the Greek biographer Plutarch removed this cache with his definition which focused more on learning from adverse events.

In 1958, Marie Jahoda gave a modern clinical definition of mental health in the terms of positive symptoms by outlining the criteria for mental health: “autonomy (regulation of behaviour from within), environmental mastery, satisfactory interactions with other people and the milieu, the individual’s style and degree of growth, development or self-actualization, the attitudes of an individual toward his/her own self”. In her definition she acknowledged the absence of disease as being necessary, but not enough, to constitute positive mental health, or euthymia.

Carol Ryff (1989) was the first to develop a comprehensive scale that could assess euthymia: the six-factor model of psychological well-being. The 84-item scale includes facets of self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. It did not include a notion of resilience, which people in the field started working to add in the 2000s.

Parathymia, on the other hand, is related to pathological laughter (called “Witzelsucht”).