Case study - SOMALILAND
Dr Mandip Jheeta, ST5, General Adult
SIAS (Solihull Integrated, Addiction
The Bridge, Chelmsley Wood, Solihull
In the Autumn of 2013 I visited Somaliland, a
self-declared independent state located on the northern edge of the
horn of Africa. It is a post-conflict area, after the civil war
ended in 1991, with a significantly underdeveloped healthcare
system. Mental health is a particularly neglected area. I spent two
weeks teaching psychiatry as part of the King’s THET Somaliland
Partnership (KTSP) charitable project. The project works alongside
local partners to ensure that medical and nursing students have
access to an international education that is both culturally
sensitive and relevant to Somaliland.
Alongside Lauren Gavaghan, another UK-based
psychiatry trainee, and a team of Somali co-tutors and staff, we
taught and examined 68 university students how to recognise and
manage common mental health problems. In additon to learning a lot
myself and skills I could apply in my own practice, it was
immensely gratifying to see the students, some of whom had their
own apprehensions and misunderstanings of mental illness, transform
into a group enthusiastic about and comfortable with people with
The training was based on the WHO Mental
Health Gap Action Programme (mhGAP) manual, which is designed to
train non-specialists how to recognise and manage most mental
health problems, especially where there is no psychiatrist.
Case Study – CHAD
Dr Noel McCune
Retired Consultant Child Psychiatrist, Newry, Co Down.
In the Autumn of 2014 I visited Chad, a
country in which there is only one psychiatrist for a population of
11 million. I had received a request from Dr Ann Fursdon of Africa
Inland Mission for a psychiatrist to come and teach primary care
nurses about mental health disorders. She felt there was a lack of
understanding of how to treat them and that the WHO mhGAP programme
would be appropriate as a means to train up nurses.
The teaching lasted five days, during which
time I found the greatest interest to be in the treatment of
psychotic and bipolar disorders as well as alcoholism. Over the
next three weeks the teaching was followed up by visits to health
centres with the goal of supervising nine of the nurses putting
their training into practice.
During my time in Chad I saw a range of mental
disorders and indeed 'treatments'. The nurses gained good
experience providing psycho-education. Hopefully the
training will have helped ensure that people who have often been
physically restrained will receive a proper diagnosis and
treatment, and that the nurses will be more able to talk directly
to patients where previously they would have let other people
speak on their behalf.
Case study – IRAQ
Dr Peter Hughes is
a consultant psychiatrist based at Springfield University
Peter is the RCPsych Blog Editor and Chair of VIPSIG
Contact details: Peter.Hughes@swlstg-tr.nhs.uk
In early 2015 I was given the opportunity to go to Iraq on a
training mission to support mental health care provision in the
refugee and internally displaced person’s camps that have sprung up
as a result of the Syrian and Northern Iraqi crises. It was a
complex mission involving different UN organisations and health
departments in and around the region.
The arrival of Daesh has completely
transformed the humanitarian landscape, and the need for mental
health care in a region with very few psychiatrists is acute.
Capacity is stretched and provision is insufficient for the large
amount of cases of depression, anxiety and stress to be found in
Psychotropic medicine is limited, and only
trained doctors are allowed to prescribe psychotropic drugs; this
includes antidepressants. Some of the issues I encountered included
young men feeling isolated and listless and women of all ages
experiencing sexual violence. I also found that many children were
having nightmares after witnessing family members being killed and
as a result displayed aggressive tendencies.
What I found particularly striking was the
different concept of mental illness, reflected in its treatment.
Religious observance, familial closeness and even a toy workshop
where mothers could make toys for their children by way of
therapeutic activity were seen as ways of treating mental illness.
In these types of humanitarian circumstances, listening to people’s
grief and pain is as important as CBT. Even something as simple as
requesting a washing machine to help alleviate the stress of
mothers dealing with children who wet the bed out of their own
stress was employed as a tactic.
Despite the emotional strain, it was a good
experience and so too was the feeling that I had been able to help
train people in some new skills in mental health and psychosocial
Case study - MYANMAR
Dr Bradley Hillier
Specialist Registrar in Forensic
Psychiatry in South London.
In 2015, I travelled with six other UK psychiatrists to
Myanmar (formerly Burma), a country whose modern history has been
characterized by persistent human rights violations, ethnic
conflicts and widespread poverty.
In conjunction with the UK-based charity “Mind to Mind” set up by
Myanmar native Dr New Thein, we were to train primary care doctors
in how to use mhGAP. Our “trainees” were 60 GPs working as private
practitioners in the community. In addition to mhGAP training we
also decided to incorporate some easily accessible psychosocial and
practical approaches which we thought would be of great immediate
use within the context of busy GP clinics where time pressure is
high, and where patients may be under financial difficulties. We
even had the opportunity to teach and practice through role play
simple family interventions and psychological first aid.
As a primarily Buddhist country, meditation and mindfulness are
well established culturally integrated practices. It was possible
to readily translate and demonstrate how these could be used as
relaxation techniques for distressed, anxious or depressed
patients, and this was a source of some extremely interesting
discussion about their use in Western countries. I found myself
increasingly wondering whether it is possible for us as Westerners
to learn in our approach to mental health care as opposed to
naturally adopting the role of teacher.