Yale Psychiatry Grand Rounds: May 13, 2022

May 13, 2022

Information

Yale Global Mental Health Residents Grand Rounds

Sirikanya Chiraroekmongkon, MD, Resident Physician, Yale School of Medicine

Paul Eigenberger, MD, Resident Physician, Yale School of Medicine

Yvonne Uyanwune, MD, MPH, Psychiatry Resident, Yale School of Medicine

Enock Teefe, MD, Psychiatry Resident, Yale School of Medicine

ID7834

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00:00And your sellers. I also go by Sonia
00:02I'm the resident leader of the yield
00:05global mental health program and also
00:07a second year psychiatry resident.
00:09I'm very excited and honored to be
00:11presenting for you all today about the
00:14yield global mental health program.
00:15So there are four of US residents presenting
00:19total that's myself Doctor Paul Eggenberger,
00:22Dr Yvonne Oyabun and then Doctor Enoch Tefe.
00:27So that's the the four of us.
00:29And then I'm going to start
00:30sharing my screen. OK. Or Trisha?
00:33And are we good to begin?
00:35Yeah? Doctor Crystal,
00:36did you want to say something first?
00:39Yes, this is really exciting day. I really
00:43looking forward to the four presentations
00:46and I do not want
00:48to hold people up. So please please begin
00:53looking forward to the presentations.
00:57Great, thank you. I'll share my screen.
01:04All right, so this is the yield global
01:06mental health resident grand rounds.
01:08We have no disclosures or conflicts
01:10of interest and then an outline of
01:12what we're going to go over today.
01:13So the 1st 1015 minutes we're going
01:15to talk about the basic concepts and
01:18foundation of global mental health and
01:20HealthEquity and some innovative programs.
01:22Then we're going to go into an
01:24update about the young global Mental
01:25health program and then the four of
01:27US residents will take the last 40
01:29minutes to present about our projects.
01:32So global mental health and HealthEquity.
01:37So global mental health.
01:38The definition is an area for study,
01:40research and practice that places
01:42a priority on improving mental
01:44health and achieving equity in
01:46health for all people worldwide.
01:48So I want to emphasize 2 points.
01:50One is about achieving equity
01:52and then the other point is also
01:55about all people worldwide.
01:56I think when we start thinking
01:58about global mental health,
01:59our reflex is to think oh this is
02:01a broad when really it could be
02:03very much done in the United States
02:05and there's so much local need.
02:06And regional need,
02:07and there's so much work that can be done.
02:10And even in our residence presentations
02:12today, you'll hear about Paul,
02:14who will be presenting about rural
02:15mental healthcare in the United
02:17States and then the second point,
02:19I wanted to make is that there is an
02:21extreme mental health care and equity
02:23that exists between rich and poor countries.
02:25So specifically in low and
02:27middle income countries.
02:29They consist of more than 80%
02:31of the world's population,
02:33but unfortunately have less than
02:3520% of the world's mental health.
02:37Resources and then that comes
02:39out to some statistics.
02:41Which is that more than 75% of
02:43those with a diagnosed mental
02:45health condition receive no care,
02:47so this is after someone has been diagnosed.
02:51And then some comparisons between
02:53high income countries and lower
02:55middle income countries in terms
02:56of the mental health workforce.
02:58This slide is specific to number of
03:01psychiatrists so that global average
03:02is about four psychiatrists per
03:05100,000 people in the United States.
03:07We are fortunate to have a little
03:09bit more than that.
03:09So around 16 psychiatrists per
03:12100,000 people in Canada and the UK.
03:14The numbers are similar.
03:16In New Zealand, Switzerland,
03:17Norway and other Nordic countries,
03:19those numbers are in the 40s or in the 20s,
03:22so quite high.
03:22But when you compare that to
03:24low and middle income countries,
03:26so like the most populous
03:28developing countries.
03:29In Asia and in Africa,
03:30so that would be India,
03:31Pakistan,
03:32Nigeria and Ethiopia.
03:33Those numbers are less than one
03:36psychiatrist per 100,000 individuals
03:38and then some countries only have
03:40one or two psychiatrists for the
03:43whole country for population of
03:45over a million and that those
03:47countries are Chad Erythrea Liberia,
03:49where Wanda Afghanistan and Togo.
03:53And then this is a pictorial
03:56representation of that.
03:57And then I wanted to zoom in a little
03:59bit about the different healthcare providers.
04:01So I picked Ethiopian, the United States.
04:04So Ethiopia, there are 40 sachitra lists,
04:07461 psychiatric nurses,
04:0914 psychologists, 3 social workers,
04:12and no occupational therapists.
04:13And this is for 85 million Ethiopians,
04:16so the numbers are quite scarce.
04:19And then the United States.
04:21Those numbers seem a little bit better.
04:23So 41,000 psychiatrists.
04:2516,000 psychiatric.
04:27Versus over 100,000 psychologists
04:29and social workers,
04:30and 20,000 occupational therapists.
04:32And this is our population over
04:35of over 300,000,000 Americans.
04:37So I think when we look at these numbers,
04:41I think we could be lured into
04:42this false sense
04:43of security that the United States
04:45must have better outcome than low and
04:48middle income countries when reality
04:49that's not always the case and we
04:52actually have very similar numbers when
04:55we're thinking about access to care
04:57and also the quality of the care that
05:00individuals do receive and the outcome.
05:03So this slide is to to really
05:05depict that point.
05:06This is the United States when.
05:08Compared to other high income countries,
05:11the United States is the most likely to
05:13have access or affordability issues.
05:16We also have one of the highest rates with
05:18mental health diagnosis or individuals
05:21experiencing individual emotional distress.
05:23We also unfortunately have one of
05:25the highest rates of suicide and
05:27also drug related death rates,
05:29and that the rate of suicide has been
05:32increasing every year since 2000 and then.
05:36This is a statistics that I I think
05:40that really gets to my heart,
05:41which is that over 1/3 of individuals who
05:43are in prisons or who are experiencing
05:46homelessness have a mental illness.
05:48And these numbers are are sorry.
05:50These pictures are actually from
05:52the New Haven.
05:53This is from the New Haven Greens.
05:54This is also from the New Haven Greens
05:56and then this is from Skid Row in LA.
06:02And all of this is to say that there is an
06:05ongoing mental health crisis worldwide,
06:07and the term has been coined.
06:08The failure of humanity.
06:09I wanted to talk about some of
06:12the systemic structures or lack of
06:14structures that are in place that
06:16contribute to these failure of humanity.
06:18So the first one is this term
06:20called the treatment gap.
06:21The treatment gap is how much
06:23the government is spending,
06:24how much the government spends on mental
06:27health versus the burden of the illness.
06:30So that's usually measured in years of
06:32disability when it comes to mental health.
06:35So in some countries in some low
06:37income countries, the government
06:38can spend as little as .5 to one.
06:41Percent of their annual budget and
06:43then the years of disability live
06:44can be as high as 25% or 30%,
06:47which comes out to a treatment
06:50gap as high as 98%,
06:52which then translates to less
06:54than one in 10 individuals.
06:56Unfortunately,
06:57get any mental health care that
06:59they deserve or that they need.
07:01And then the second point is about
07:03the law and legal protection.
07:05That's something I want to
07:08demonstrate with in Nigeria.
07:09They have lunacy ordinance that was
07:12established in 1916 that is their
07:15last mental health law in 1916,
07:17so quite outdated and it essentially
07:20grants medical practitioners and
07:22magistrates the power to involuntarily
07:24detain individual who is quote a
07:27lunatic and a lunatic is described as
07:29quote an idiot or person of unsound mind.
07:32So unfortunately this law.
07:34It doesn't mean that.
07:36Whoever is being detained is
07:38going to get treatment,
07:40but only that whoever is detained
07:42is out of societies purview.
07:45And the Third Point is about
07:47mental health infrastructure.
07:48This is the number of mental health
07:49workers I shared with you earlier,
07:51but also the number of psychiatric beds,
07:54child adolescent beds and also to
07:56keep in mind that these numbers
07:58are usually much higher in the
08:00capital cities or in urban areas,
08:03whereas rural areas can have over
08:0570% of the country's population.
08:06But yet have little to no access
08:09to mental health care.
08:11The 4th point is about the
08:12global human rights violation,
08:14that is,
08:15that has been documented and ongoing.
08:17So these pictures are actually
08:20pictures from prisons in Kentucky,
08:22and these individuals have mental illnesses
08:25and have been chained and locked up.
08:28And then these three pictures
08:29are on from abroad and you could
08:32see a child being chained to a
08:34bed that's made out of wood.
08:37The last point is about stigma
08:39and discrimination and I think
08:41stigma and discrimination are these
08:43two seemingly very little words,
08:45but they have such.
08:48Important consequences for all of our
08:50patients and actually research also
08:52shows that mental health workers are
08:54one of the most prevalent propagators
08:56of stigma and discrimination for
08:58individuals with mental illnesses.
09:00And then, on a systemic level,
09:03this could be something like the government.
09:05How much you're spending money
09:07on improving and increasing
09:09mental health literacy.
09:11And then I wanted to read
09:12this short paragraph from a research paper.
09:17That I read it says,
09:20suppose we begin not with the top
09:22down policy and program initiatives,
09:24but rather with the on the ground
09:26ordinary moral experience of people
09:28in the world they inhabit locally.
09:30So this example is from
09:31a rural village in China,
09:33but I think it very much applies
09:35to the United States.
09:37Research documents that people
09:38disguise and high family members with
09:41mental illness until they are no
09:43longer capable of denying psychosis
09:45without professional services,
09:46families usually wear usually
09:48bear the huge burden of caregiving
09:51alone the folk healers they can
09:53turn to have little to offer that
09:55has been shown to be helpful.
09:57Finally,
09:57family members run out of energy
10:00patients and funds at that point,
10:03and especially after a period of
10:05institutionalization protection
10:07becomes rejection.
10:08The affected person becomes a
10:10non person in the responses of
10:12family members and outsiders,
10:14including mental healthcare workers
10:16no longer regarded as fully human.
10:18He or she or day becomes a target for abuse,
10:21discrimination and ultimately rejection.
10:23The individual is no longer valued
10:26as an effective node and the network
10:28of connections that form social life.
10:31Social inefficacy means non participation
10:34in social reciprocity including
10:36gift exchange. The fundamental.
10:38Cultural process of living an ordinary life.
10:41It also means non participation
10:43in marriage and work and education
10:46and celebrations, festivals,
10:48morning rituals and an ordinary
10:50experiences in markets,
10:52stores and other everyday activity.
10:55Is to be treated as if one does not exist?
11:03So then the question becomes,
11:06what can we do about this and what
11:08has been done about this and in
11:10the field global mental health?
11:12What has been done about this?
11:13Is really this important concept
11:15of five directional learning that
11:18in the United States we have so
11:20much to learn from the global South
11:22as well that we can go into these
11:25communities and be humble and really
11:28listening to what is being done?
11:30And coming back to to sort of.
11:33Implement that into our own community,
11:35so one of the big concepts has
11:37come out of the global South.
11:38Is this concept of community
11:40based rehabilitation and care?
11:41It's a strength based strength based
11:43approach and it's been shown to be more
11:46effective than standard outpatient
11:48treatment as lower baseline disability
11:50score increased family engagement
11:52and increased medication adherence,
11:53and I think all of this is to say
11:56it's because it reduces the social
11:59exclusions that unfortunately happens
12:01to all of our mental health patients.
12:04And how can this be implemented
12:06in the United States?
12:07So these are things like community
12:09based programs would increase cultural
12:11competency and specialty groups,
12:12so that thinking about the
12:14insurance or languages.
12:15So for example,
12:16the Hispanic clinic at the at CMHC.
12:19There's also Doctor Jordan who has a
12:23church based mental health engagement.
12:25There's also something like street
12:28psychiatry with Doctor Emma Lowe.
12:30And then I wanted to talk about
12:32examples that have been done in
12:34different communities around the world.
12:36So this one is the friendship bench,
12:38and these three examples I'm
12:39about to share with you.
12:40We've also had the honor of the individuals,
12:43the founders of the program presenting
12:46during our seminar series this year,
12:48so this one is by Doctor Dixon Chibanda,
12:50based in Zimbabwe.
12:52It's the friendship bench,
12:53and it's an incredible concept really,
12:56of teaching grandmothers about CBT.
13:00And the grandmother is just sit on a
13:02bench right outside of the Community
13:04Health Center and then anyone can sit
13:06on the bench with the grandmother.
13:08And really,
13:08you know,
13:09just talk to them and it's a task
13:12sharing approach and the the research
13:15shows that 14% of patients in the
13:17friendship bench experienced symptoms
13:18of depression after six months.
13:20When that's compared with 50% in
13:22the control group and then those
13:24numbers are 12% of patients with
13:27symptoms of anxiety as compared
13:29to 48% in standard of care.
13:31And then 2% with suicidal thoughts
13:33when in friendship bench as
13:35compared to 12% in standard of care.
13:37And I thought it was also really
13:39interesting during Doctor Chibanda's
13:41presentation that they tried to do this
13:44with grandfathers instead of grandmothers.
13:45And these numbers weren't as good.
13:50The second program is called Dream a world.
13:52So Jamaica is actually the third has.
13:55One has the third highest rate of
13:57homicide in the world and when they
13:59look into the statistics of that,
14:01it's actually delineated by the
14:03school district in Kingston,
14:05which is the capital of Jamaica.
14:07And so they decided to target high risk
14:10primary school and high risk children
14:12through cultural and multimodal therapy.
14:14And this is through group therapy,
14:16social skills training and creative arts,
14:18and they train both the
14:20children and the teachers.
14:21And the results in their
14:23pilot program at all town.
14:26All men Town Primary School actually
14:28moved up from being one of the worst
14:30primary school in the country to one of
14:32the best primary school in the country.
14:35And this program is called,
14:36you belong.
14:37It's based in Uganda and it's program
14:39that targets the transition between
14:42someone leaving the institution to
14:44coming home into the community and
14:47their core value really centers the
14:49family as a basic unit of care rather
14:52than the individual and family as
14:54an active agent towards recovery.
14:56So it's not using families to
14:57fill in care services,
14:58but it's really to view family as a basic
15:01level of relationships for human needs.
15:04For mutual love, care,
15:06security and belonging and they also have
15:10a huge emphasis on community as well.
15:13So that is the foundation of
15:15basics of global mental health,
15:17and I'm going to talk a little bit about
15:20the Yale Global Mental Health Program.
15:23First,
15:23I wanted to really acknowledge the
15:26people who founded and built these.
15:28This program in the last 10 years.
15:30It's doctor robot doctor Merrifield
15:32and Doctor Jordan and so many faculty
15:35members and former resident leaders
15:37and residents and faculty and staff
15:39as well who've been just amazing and
15:42incredible and so building this program.
15:44We also was very fortunate to
15:46receive the Kemper Award this year.
15:49And this is our current leadership team.
15:51This is doctor Michelle Silva.
15:53She is our continuity person.
15:56She's amazing and she's also a
15:58psychologist by training and the
16:00director of Connecticut Latino
16:02Behavioral Health system.
16:04This is Doctor Alto leg.
16:05He is a wealth of knowledge,
16:07especially when it comes to Muslim
16:09mental health.
16:10He is a double board certified
16:12psychiatrist and neurologist and also
16:13the President and Co founder of the
16:15Institute of Muslim Mental Health
16:17and then this is doctor Ihenacho.
16:19Just my amazing and wonderful mentor,
16:21he is currently the chairman
16:23at Trinity Health Hospital.
16:25Also the faculty leader of the Yale
16:27Global Mental Health Program and the
16:29leader of The Happiness Project in Nigeria.
16:32This is Sylvia.
16:32She is our student leader from the
16:34School of Public Health and then
16:36this is Doctor Paul Eggenberger.
16:38He's my Co resident and also the Co
16:40leader of the global Mental health program.
16:46So with the Yale Global Mental
16:48Health Program, we have two arms.
16:49One is the resident distinction
16:51pathway and then the other
16:52one is the seminar series.
16:56With the resident distinction pathway,
16:59that's you know 1/2 of our program.
17:02There's three requirements for
17:03residents to enter this program.
17:05The three requirements are the
17:07academic project site tactic,
17:09and then Capstone Scholarship.
17:10It's a one year commitment,
17:12and then at the end of
17:14participation in this program,
17:15we get a formal certification
17:18to show that we've completed
17:20this program during graduation.
17:23So for the academic project portion
17:26it's there's you know process and
17:29selection that is involved when
17:31we are applying to the program,
17:34residents can choose to have
17:35their own projects and you know
17:37bring their own mentors.
17:38They're really connected with,
17:39or they could choose from one of the
17:41many mentors that we have within the
17:43Yellow Department of Psychiatry Community.
17:45And we also meet quarterly for support
17:47and for feedback of one another.
17:49And also get a group gift card so
17:52some opportunities are available
17:54in the local program.
17:56There is St psychiatry with Doctor Emma low.
17:59There's refugee,
18:00care with Doctor Adam Malai,
18:02there's Hispanic clinic with Doctor Silva.
18:04There's the VA homeless program with
18:06Doctor Nacho and then the Muslim,
18:09the mental health and Muslim
18:11population with Doctor Altwin.
18:12And also to emphasize again,
18:15that global mental health
18:17doesn't necessarily mean abroad.
18:19But we are also very responsive
18:21to our local community and the
18:23local needs of our community.
18:25And some international programs
18:27that residents can connect to.
18:28So this is psychosis research.
18:31This is based in India with
18:33Doctor Radhakrishnan.
18:34The Happiness Project based in
18:36Nigeria with Doctor Ihenacho.
18:38There's substance use related HIV problems.
18:41This is based in Southeast Asia with
18:43Doctor Sawatzki and then of course the
18:46Yellow China program with doctor approval.
18:48So these two lists are not
18:50comprehensive lists by any means of
18:52the opportunities that are available.
18:55And the department.
18:56These are just very preliminary
18:58lists of faculty members that
19:01we have connected with.
19:03So the other requirement of the
19:05resident being a part of this
19:07pathway is the Capstone Scholarship.
19:09Of course,
19:09we're presenting during grand
19:11rounds this year and then there are
19:13opportunities for dissemination and then
19:14the last requirement is our didactics.
19:17We're fortunate to have some things already
19:19embedded in the residency didactics.
19:21We also have global mental health
19:23competencies that's posted on
19:25the on our global Yale Global
19:27Mental Health website that's been
19:29developed by the previous resident
19:31leader and faculty members.
19:33We also have monthly seminar
19:34series that we have to attend.
19:38So pivoting a little bit to
19:40talk about the seminar series.
19:41So that's our other arm of the
19:43Yale Global Mental Health Program,
19:45the established structure that's
19:47been in place is that there
19:49are different themes yearly,
19:51and it's an in person gathering
19:52of this is pre COVID of course
19:54of five to 20 individuals,
19:56and most of the speakers are within
19:57the Yale community itself and the
19:59attendees are usually psychiatry
20:01residents or students from the school.
20:02Public health met students and the
20:06leadership. So with this year.
20:08With COVID happening,
20:09we wanted to capitalize on that
20:11and really capitalize on the
20:13virtual connection and the zoom
20:15that's available during COVID.
20:16So we were very intentional about
20:21inviting speakers who are based
20:24in their home communities and who
20:26are developing amazing programs
20:28in their home communities.
20:30We also wanted to emphasize HealthEquity,
20:33so that means being very intentional
20:35about which speaker we choose in
20:37terms of their identity and which.
20:39Region of the world.
20:41It is so even with us being very
20:45intentional about, you know,
20:47choosing individuals from abroad.
20:49We unfortunately did not have any
20:51speaker from Asia and we also had
20:55much less female speakers this year.
20:57So just keeping in mind that even
20:59when we're trying to be very
21:02intentional and conscious about
21:03who we're inviting as speakers,
21:05we're still falling a little bit short.
21:08And then the other difference.
21:10This year is that we have opened
21:12this because of zoom to the general
21:14public and we have had additional
21:17attendees from the the speakers
21:19in the countries themselves,
21:20which has been a very wonderful process
21:24as well. So this is some pictures.
21:27This is of the asido on the shame
21:31presentation by Doctor Abdul Malik.
21:34This is based in Nigeria.
21:36He's talking about the Sital
21:38program and then we've had the
21:40dream of world that I talked about
21:42friendship bench that you belong.
21:43We also had chats saved which is based in
21:46Australia and it's about young persons.
21:50How to communicate online for
21:52young persons regarding mental
21:54health and regarding suicide.
21:56We also had our very own doctor
21:58Autolib presenting about Muslim mental
22:00health and we also had our last
22:04session was about tuberculosis and
22:06mental health and actually this was
22:08done in Spanish and had a translator
22:11over zoom and there were still still
22:14a little bit of finicky things.
22:16We're figuring out,
22:16but I think we also wanted to
22:18make sure that language was.
22:19That barrier to us bringing us
22:23speakers into the Community.
22:25I'm learning from them.
22:29So this is the Muslim mental health
22:31conference that we have had the
22:33honor to Co sponsor this year.
22:35This is the 14th year that this
22:38conference has happened and is hybrid
22:40and actually it was based here at Yale
22:43and we had over 420 registered attendees
22:46with over 15 countries represented.
22:48It was highly interdisciplinary.
22:50There was four tracks that were
22:52present and the themes of the tracks
22:54were one is the impact of COVID on
22:57mental health workforce another?
22:58Is interpersonal violence and then
23:00the third one is representation.
23:02Presentation of psychopathology
23:03across cultures.
23:05And the last one is the role of religion,
23:07culture and spirituality,
23:08both as a barrier and the
23:10facilitator to mental healthcare.
23:12So a very successful conference
23:14that was hybrid in nature.
23:17Some future direction about the
23:18Oklahoma mental health program.
23:20We're hoping to evaluate a lot of things,
23:23so the first two is to evaluate
23:25the resident experience.
23:25So the four of US residents through this
23:28distinction pathway and the 2nd is to
23:31evaluate the guest speakers experience,
23:33and then the attendees experience.
23:35We also want to develop and maintain a
23:39leadership guidebook for continuity purposes,
23:42and then the fourth point is to strengthen
23:45multidisciplinary collaboration.
23:46I think there's already a
23:47lot of collaboration.
23:48But there's I think can always be more.
23:51Especially there's so much wealth and
23:53resources in the Yale Department psychiatry.
23:56But even outside of the department,
23:57so the Yale Internal Medicine program,
24:00or just the Yale University at large,
24:03we also wanted to increase
24:04our social media presence.
24:06And Divya,
24:06our student leader,
24:07had a great idea about posting
24:11about the seminar series,
24:13some important learning points from
24:14each of these speakers so that there
24:17is a continuous learning process.
24:18As well as increased visibility
24:21about the program.
24:23And some more immediate things
24:25that we're looking forward to.
24:28We wanted to welcome the Yale Psychiatry
24:30class of 2026 and the incoming transfers.
24:34We want to make sure that if there's
24:36any interested residents that are
24:38current or incoming that they are
24:40connecting with us and so that we can
24:42connect them with faculty members
24:43who are in global mental health.
24:46And then fortunately all of our
24:48leadership is staying on board.
24:49So there's going to be continuation
24:52in the next expansion of that
24:54and then Paul and myself were
24:56actually in our Co leadership.
24:58Uh,
24:59resident role.
24:59We're going to have a clear billion where
25:02Paul is going to take the seminar series,
25:04and I would be taking the
25:06resident distinction pathway.
25:07So if you have any suggested speakers
25:10or amazing individuals you would
25:12like to really feature and highlight,
25:14please email Paul and then if you're
25:16interested resident or if you're interested
25:18faculty and working with a resident,
25:19please email me.
25:20I would be happy to receive your email.
25:23We are also gaining an undergraduate student.
25:26And then we're also trying to.
25:29Recruit some student leaders
25:29from the School of Public Health
25:31and then the School of Medicine.
25:34And then our similar series next
25:36year we've been talking about
25:38maybe going into the hybrid,
25:40keeping some of the zoom function,
25:41especially with inviting speakers from
25:43different countries around the world.
25:45We also want to make sure there are
25:47opportunities for dissemination,
25:48especially with the seminar series.
25:51So I think that is pretty much
25:54done with the introduction portion,
25:57and now we're going to pivot to
25:59the resident academic projects,
26:01and I'm very honored to present
26:04to you Doctor Uyuni.
26:09Thank you so much, doctor Sellers.
26:11Hello everyone, I'm Yvonne ELA a
26:13third year psychiatry resident and
26:15will be sharing some of the work I
26:17did towards developing an online
26:19directory for the Happiness Project.
26:24Please.
26:27This is a brief outline of the presentation.
26:29We'll begin with a brief overview
26:30of the Happiness project followed by
26:33background slash, literature review,
26:35and some content of this current project
26:37of creating an online directory.
26:42I would like to begin by
26:44acknowledging my mentor,
26:45Doctor Ted Ihenacho for this project.
26:48I also want to uplift multiple other
26:50contributors to the Happiness project,
26:52both locally and globally,
26:54including current yellow faculty,
26:56residents, and recent alumni
26:58such as Doctor Charles,
26:59DK Doctor Nicole, Roxas,
27:01Dr Francis, Adachi,
27:03Doctor Daniel de Francisco and many more.
27:09The Happiness project stands for health
27:12action for psychiatric problems in Nigeria,
27:14including epilepsy and substances.
27:16I was drawn to collaborating on this
27:18project that I was born in Nigeria
27:20and feel connected to contribute to
27:22improving its mental health resources.
27:27Happy, Nice project is a
27:29collaboration between Yale University,
27:31Hemo State University and email state
27:33Primary Health care development agency.
27:35During Yale President Peter
27:37Salovey's visit to Lagos,
27:39he met with officials to finalize
27:41plans to expand the Happiness project.
27:43The Happiness Project trained healthcare
27:45workers such as primary care physicians,
27:48nurses, community, community,
27:49mental health workers in rural.
27:52Communities to screen for,
27:54assess and manage mental health
27:56disorders in their communities.
28:00In Nigeria 20 to 30% of the population
28:03suffer from mental health disorders.
28:05However, with less than 300
28:07psychiatrists for an estimated
28:09population of 200 million people,
28:11only 10% of adults with any mental
28:14health disorder receive any
28:16care irrespective of severity.
28:19This is where the happiness
28:21project comes into play.
28:22It adopts the WHO's mental health
28:24gap Action plan Intervention Guide,
28:26which is in line with Nigeria's
28:29policy of integrating mental
28:31health into primary care.
28:33This collaborative approach is 1
28:35model of reducing the treatment gap
28:37for mental health disorders in low
28:39middle income countries like Nigeria
28:41with very few psychiatric specialists.
28:45The next few slides illustrate a brief
28:48overview of the HMH Gap Intervention Guide,
28:51which includes training to screen
28:53for depression, psychosis, epilepsy.
28:57Child and adolescent mental health,
29:00dementia, substance use and self harm.
29:05Since it's inception in 2018,
29:08The Happiness Project has trained
29:11over 600 primary care workers and
29:14across all 27 local government
29:16areas and email state Nigeria.
29:18These trained community primary
29:20healthcare workers conduct
29:22routine clinic screenings.
29:24In Person, committee awareness
29:25activities and also get word
29:27of mouth recommendations.
29:31Even with the trained clinicians,
29:33we recognize that barriers still
29:35exist in connecting people with them.
29:37Online directories for mental health
29:39specialists facilitate pathways to get
29:41access to services within their region.
29:43Such directories are more readily
29:46available in high income countries
29:48compared to lower middle income countries.
29:50In countries such as Kenya,
29:53Egypt, South Africa and Ghana,
29:55there is growing movement towards
29:57building robust online directories
29:59of mental health providers,
30:01and I've shown a few of these
30:02initiatives on this slide.
30:06In Nigeria specifically,
30:07there's little to no specific
30:09directories of mental health providers.
30:11The few that do exist serve more affluent
30:14regions of the country such as Lagos,
30:16the Commercial Center,
30:17and Abuja the capital city.
30:20Through this proposal we developed
30:21and published an online directory
30:23of happiness project trained mental
30:25health providers and email states.
30:29This map of Imo State
30:32Nigeria shows that it has,
30:33you know 27 local government areas.
30:36The state has an estimated
30:38population of about 5,000,000
30:39people and is located in South
30:41the southeast region of Nigeria,
30:43which does not have any region
30:45specific mental health directory.
30:49Mobile phones and Internet
30:51usage coverage in Nigeria.
30:52Like all developing countries,
30:54has rapidly increased in
30:55increase in recent years,
30:57providing an opportunity to
30:59leverage mobile technology to
31:01improve global mental health.
31:03About 85% of Nigerians use a mobile phone,
31:06although majority of mobile
31:08phone users are using phones
31:10that offer basic functions like
31:12voice calling and text messaging.
31:14Smartphone penetration is projected
31:16to grow about 60% by 2025.
31:20With all of this
31:21in mind, we created an online directory so
31:23that potential patients can find trained
31:26clinicians and email state Nigeria.
31:27It provides a useful tool for assessing
31:30mental health care and can serve as a
31:33model for developing similar directories
31:35and other states in the country.
31:37It can also strengthen the referral process
31:40between Community agencies and specialist
31:43mental health providers in tertiary centers.
31:47So we applied for an IP addendum as
31:49well as grant funding for this project.
31:52We created a Qualtrics survey to
31:54gather data of all trained clinicians
31:57via the Happiness project.
32:00These included their names,
32:01phone numbers, their physical locations,
32:03hours of operation,
32:05and also any local hospital
32:07affiliations and many more.
32:11We successfully launched a directory
32:13last year as shown on this slide.
32:19On this next slide,
32:20Imo State is highlighted in green as
32:22it's the current state of happiness
32:24trained clinicians prospective clients
32:26can click on the map and be directed
32:28to a search bar to find clinicians
32:31based on their local government area.
32:33One of the long term goals would be
32:35to make the entire map of Nigeria
32:37Green and have happiness trained
32:39clinicians across the country.
32:43So this shows the search search
32:46bar when people click on the email
32:49state map and you can look for
32:51any potential clinicians based
32:53on your local government era,
32:55which is sort of proximate to
32:58like a zip code over here.
33:04So overall, we've been able
33:06to meet our first target goal,
33:08which included creating this
33:09comprehensive online directory and
33:11service locator of Community mental
33:13health providers and Imo State Nigeria.
33:16We hope to include updated
33:17information of relevant agencies.
33:19Organizations like the
33:20State Ministry of Health,
33:22Acute Care clinic,
33:24psychiatric hospitals,
33:25other professional organizations
33:27and non governmental organizations.
33:29Doctor Hanna Tran colleagues are
33:31also currently collaborating
33:32with an already established.
33:34Local mobile health application.
33:36That does not have mental health
33:39specialists to include the directory
33:41of happiness trained clinicians.
33:43Ideally,
33:43the mobile application will also
33:45have embedded screening tools for
33:47common mental health disorders.
33:50Thank you.
33:57All right? I'll
34:00go to the next slide.
34:03Alright, so my name's Paul Hegenberger.
34:06I am a second year statue resident in
34:09the Collier along with doctor Sellers
34:11in the global mental health track.
34:13And I'll be talking a little bit
34:16about my project, which is a real
34:20psychiatry curriculum project.
34:21It's doctor Sellers mentioned how we
34:24provide mental health care to to rural
34:27populations is a domestic and a global issue,
34:30and it's a really important part of
34:33improving equitable mental health
34:35care across the across the world.
34:39Next
34:42so I'd like to start out by telling
34:44everybody a little bit about myself
34:47and my motivation for this project.
34:49So during medical school at
34:51the University of Colorado,
34:52I spent part of my 4th year doing
34:55a roll rotation out on the western
34:58slope of the Rocky Mountains
35:00in a town called Montrose.
35:01These are some of the photos I
35:03took during that experience.
35:04I was lucky enough to go out
35:07there with my whole family.
35:09And something I was struck by
35:11and something that stuck with me
35:13during that time beyond the natural
35:15beauty of the mountains was that
35:17there was a dire need for mental
35:20health care in the community.
35:21I heard it over and over and
35:23over again from patients and from
35:25positions that there was not.
35:26There were not enough psychiatrists
35:28in that they're really hurting.
35:31Next slide, please.
35:34And as you know, using Montrose as
35:37a case study for rural psychiatry,
35:40you know highlighted it during the map.
35:42It's a little red pin out there on the
35:45western side of the Rockies has about
35:4720,000 people and has a catchment
35:49area that I tried to highlight there.
35:51I don't know what the square mileage is,
35:52but it's quite large and it has
35:56one practicing psychiatrist who's
35:58not accepting any new patients.
36:01And it has a small community
36:02mental Health Center.
36:03That provides care primarily for the
36:05seriously mental ill who have Medicaid
36:07and it's all done via Tele health.
36:09There's no local providers.
36:12And just, you know we talk a lot
36:14about real mental health disparities.
36:16And I just wanted to to bring
36:18it home with the statistics.
36:20So as far as the age adjusted years
36:22of life loss per 100,000 in the
36:24state of Colorado by suicide and you
36:26can see at the bottom of the slide,
36:28Montrose County is almost double
36:30that of Denver County when normed.
36:32For for the population.
36:38So to to center this around the problem.
36:40You know we have worse mental
36:42health outcomes in terms of suicide
36:44untreated substance use disorder,
36:46untreated mood disorders in
36:48rural communities versus urban,
36:49but the rates of these mental health
36:53disorders seem to be pretty similar.
36:55Thought that the disparities are driven
36:57largely by issues of access and you know,
37:00one of these issues is that it's
37:02difficult to recruit and retain
37:04psychiatrist in rural areas. Next time.
37:08Bringing it here to Connecticut.
37:10Now that I'm here to seal resident,
37:11I've been, you know,
37:12learning as much as I can about you,
37:15know the problems that affect us here
37:17and in the state of Connecticut.
37:19There's about 326,000 people
37:22who live in rural communities.
37:23It's about 10% of the population that are
37:2682 health professional shortage areas,
37:2917 of which are for behavioral health.
37:32Next slide.
37:34And as far as the state,
37:36that portion of the state that's most
37:38affected by the rural health disparities,
37:40it seems to be the eastern
37:42part according to the.
37:44Yes,
37:44statistics here you can see there's
37:46a disproportionate burden of
37:48mental health and substance use.
37:49Clients there in the eastern
37:51eastern portion of Connecticut.
37:56So an intervention that I'm interested in is,
37:59you know, how do we?
38:00How do we improve our ability to care
38:03for real populations and domestically
38:05and globally and and one way,
38:08I think to do that is to improve
38:11the training that we receive and
38:13and caring for these populations.
38:15And so I'm interested in
38:16designing and implementing a real
38:18country curriculum here at Yale,
38:20and I think it aligns well with the
38:22programs goals of reducing mental health.
38:24Charities and improving HealthEquity.
38:30And this is the curriculum
38:31development model that I use.
38:33That's something that is fairly standard
38:35and starts with the needs assessment.
38:38Figuring out your learner characteristics
38:40and outlining goals and objectives.
38:42And that's sort of where I am starting
38:44to develop this curriculum from. Next
38:51so as far as the needs assessment goes,
38:53you know the first step
38:55was taking a look at what?
38:57We have here in the curriculum
38:59already and as far as I could find
39:02there there was no program wide
39:03curriculum specific to rural sachitra
39:05or there was really any didactic
39:08content and our rotation sites are
39:10kind of centered here in New Haven,
39:13which is decidedly urban or suburban area.
39:16And there is a current elective opportunity,
39:20which is a telemental health
39:22elective for 3rd year at the VA with
39:24Doctor Kearney is it's 1/2 day.
39:26We're providing a telemental health
39:28services to cbox and primary care clinic.
39:35So the you know second part of the needs
39:39assessment was essentially asking our
39:41our residents what would you guys like.
39:43What do you think you need and what?
39:45How do you rate your knowledge and
39:49abilities and preparedness to practice
39:51in a rural setting and understand some of
39:54the issues that affect rural populations?
39:56And I was also curious.
39:58I think for a future project or what
39:59are some of the barriers that people and
40:01faculty cedar practicing the rural setting?
40:07And I'm happy to share a little
40:09bit of preliminary data.
40:10The survey still out there and the
40:13responses are still going to come in.
40:15But I think there's so far
40:17what I'm seeing is we have.
40:19Knowledge gap specifically in regards to
40:23telepsychiatry models of behavioral health,
40:26integration and primary care settings.
40:29Some of the barriers to getting
40:31psychiatrist in rural areas and
40:33barrier other barriers to mental
40:34health access in rural communities.
40:37Interestingly,
40:37we do a pretty good job with some of
40:41the epidemiologic and disparity issues.
40:44Next and I think as far as preparedness goes,
40:49these questions kind of are getting
40:52at how ready we are to to sort of
40:54do the work in rural communities
40:55like the the data so far show that
40:58there is room for improvement there.
41:00Next and then this is getting
41:03out what you know.
41:04What would be the best you
41:06know curricular interventions.
41:07And I think there's pretty pretty broad
41:11support for more didactic content,
41:13and I think there is support,
41:16though a little more mixed.
41:17And maybe these are selected
41:19opportunities for clinical experiences
41:21and a real psychiatry track.
41:23And I think the the date at the
41:26bottom shows that we can definitely
41:28improve our curriculum within
41:30this residency program.
41:32Regards to a psychiatry.
41:36And then for future directions,
41:39I think another you know as
41:41doctor Sellers mentioned,
41:42there's a bidirectional aspect of this,
41:44so I think another important part is.
41:47Doing a needs assessment in a rural
41:50community within Connecticut to see
41:52how how we can best meet their needs,
41:54as well as our own, you know,
41:55needs for training and that goes
41:57along with identification of rural
42:00community partners and training
42:01sites and then on an RN developing
42:04and detective curriculum that we
42:06could implement in the near future.
42:14Hello everyone, I'm an architect.
42:18My third year psychiatry resident and
42:21today I'll be talking to you about kind
42:24of the beginning stages of a global
42:27mental health education collaboration
42:29that I'm planning on starting with
42:33Mercury University in Kampala,
42:35Uganda with the university next slide.
42:40So the motivation for my
42:42collaboration is that I was born
42:45and raised in Uganda in East Africa.
42:48On the top left there that is.
42:51That is me. At six years old I
42:55was born in a in a village in in
42:57western Uganda in Masaka district,
43:00and that was my I think,
43:02middle school graduation.
43:04I still have very strong
43:06links with the Uganda.
43:07I came to the United States and did
43:11my undergraduate and medical and
43:13psychiatric training here and so
43:16I have this very strong personal
43:19obligation to be able to serve.
43:22With the community that have
43:23formed here in the United States.
43:25And my community back home in
43:27Uganda on the top right there.
43:29That's my mother and my sister
43:32Nicholas family. Next slide.
43:36So in my application to come to
43:40psychiatry resident at residency at Yale,
43:44I talked to Doctor Rob who
43:47had a suggestion that we could
43:49possibly start a collaboration in
43:51education collaboration with them.
43:54The largest and oldest university
43:57in Uganda called Macara University,
44:01and at that suggestion I was
44:03hooked and I wanted to. Got the.
44:08Collaboration or the the building
44:10blocks to to make this collaboration
44:13happen and part of the objectives
44:16of this collaboration would be to
44:18establish a global mental health
44:20curriculum at both institutions.
44:22Maybe within this global mental health
44:26initiative within the residency.
44:28The second objective would be to enhance
44:32training across both universities
44:35in the form of having trainees and
44:38and faculty be able to see how.
44:43Psychiatry is practiced and and taught
44:47across both institutions in high income
44:50setting as well as a low income setting.
44:53And then those objectives,
44:55I think,
44:56will fall nicely into being able to
44:59advance patient care if a lot of that
45:01medical education and the research
45:03that is done with this collaboration
45:05can be directly applied to patient
45:08care on the top right there,
45:10that is the the green that.
45:13Mccurry University,
45:16I think in.
45:18Outside of South Africa,
45:20it is the largest university in South
45:24Sub Saharan Africa and is ranked the
45:27highest in World News and report.
45:29If you believe them.
45:31Next slide.
45:35Fortunately for me.
45:38Yale University has had a long standing
45:42collaboration with the with Macquarie,
45:45so I don't have to start from scratch.
45:50Yale has been collaborating with McClure
45:53University in collaboration called Muyu,
45:55and this is primarily through the
45:59internal Department of Internal Medicine.
46:02This is core directed by associate
46:05professor here in internal medicine.
46:07Doctor Tracy Rayburn, who is.
46:10Bottom middle succeeded there she
46:13could directs this with the professor
46:17over at Macquarie University,
46:19Professor of Medicine at
46:21Macquarie University,
46:22who is in the top right there
46:24in the Purple Doctor Mayanja.
46:27She's this collaboration has been.
46:32Has been there for about.
46:3516 I think 16 to 18 years,
46:39and it's primarily centered around being
46:42able to improve human resource capacity.
46:46Building so primarily training
46:48and education of physicians in
46:51internal medicine and and allow
46:54their associated specialties.
46:56It has built some.
46:57It has been built so much over
46:59the years that currently there is
47:01an office of muyu out in Uganda.
47:04In the material university campus and
47:08in talking to Doctor Tracy Ray Vinash,
47:11she was very much interested in
47:14incorporating psychiatry into
47:16this infrastructure.
47:17Next slide.
47:21So part of the kind of the success
47:24of Muyou has been this idea of a
47:28bidirectional exchange of ideas and.
47:31And and expertise.
47:33So over those fourteen 1416 years
47:37Yale has sent individuals to Macquarie
47:41University or physicians, residents,
47:44medical students, hundreds of them.
47:47And there's also been physicians,
47:51medical students, nurse educators,
47:53and medical librarians that have come
47:56from a care university to train and gain.
48:01Ideas about improving?
48:03Education and and and healthcare
48:06in new and in Uganda.
48:08Next slide.
48:11So just to. As I thought about at the
48:17beginning of forming this collaboration,
48:19and it was important to understand
48:22the state of psychiatry in Uganda,
48:25and just to Orient you,
48:28there's about 45 million individuals
48:30in Uganda and as everyone has mentioned
48:34from a global mental health perspective,
48:36a lot of low and middle income
48:38countries don't have a enough
48:40psychiatrists to cover the populations.
48:43Uganda is no different, I believe.
48:45There were number is about
48:47.08 psychiatrists 100,000.
48:50There's only one standing,
48:53one standing psychiatric hospital
48:55that is located in a capital city
48:59and that is Butalbital Hospital
49:01which is on the top right there.
49:04Local hospital does not have
49:06a child and not listen units,
49:08so a lot of the children are treated
49:11in the same settings as adults.
49:13And in the GDP spending of Uganda,
49:1810% of their spending is on healthcare but
49:21less than 1% is on mental health care.
49:23So there's a lot of financial and
49:26resource constraints resource constraints
49:29on being able to to give good mental
49:33healthcare to the population.
49:36But I wanted to use some of the.
49:42To get to give you an idea of some
49:44of the challenges of providing mental
49:47healthcare in a place like Uganda, but.
49:51Quoting from a survey,
49:54a qualitative survey that was done
49:57in multiple countries and published
49:59recently in the BMC Psychiatry Journal
50:02at the top quote kind of gives you
50:06an idea of kind of the resource
50:09challenges that face individuals that
50:11need to access mental health care in Uganda.
50:13This comes from our caregiver in the
50:17mental health system in Uganda and
50:18they said that financial constraint
50:20is another.
50:21For us,
50:22we have to walk long distances and
50:24remember walking with these patients is
50:26not easy as they unpredictable and behavior.
50:29So this is a health worker who is,
50:33I think exemplifying the problem
50:35of the fact that the only standing
50:37hospital is in is in the.
50:41Capital City of Uganda.
50:43However,
50:4380% of the population actually live
50:45in rural areas,
50:46so a lot of them have to really take
50:49buses and and do a lot of walking
50:52to to be able to get to any kind
50:55of General Healthcare facility.
50:56But also a mental health facility.
50:59And then the second quote is
51:02around the issue of how individuals
51:07view mental healthcare.
51:10As as a community in in Uganda,
51:13and this is from a policymaker in Uganda,
51:16and he said,
51:17they say that visiting a health
51:19facility for mental Healthcare is
51:20not very common are people believe
51:22the mental health mental illness
51:24is from witchcraft.
51:25It's demonic,
51:26so they are now more in the church
51:28than the health facilities.
51:29Others go to the witch doctor consultant,
51:31take some local medicines.
51:33The highest percentage of people with
51:35mental illness believe somebody's
51:36out there using demons to torment them.
51:39So there's a challenge there for
51:42being able to give individuals
51:46that need mental health treatment.
51:50Effective treatment with these
51:52beliefs in the community and some
51:55of the practitioners have really advocated
51:58for being able to partner with a lot
52:00of these spiritual leaders to help them
52:03understand how they can in their own way.
52:05Triage. A lot of these individuals
52:09suffering from mental health and
52:10bring them to effective treatments.
52:12And the third one.
52:14There's also a quote from a health
52:16worker in Uganda who said that some in
52:19the community fear people with epilepsy,
52:22they believe.
52:24Usually in in Uganda,
52:26and you know a lot of other low
52:28income countries, epilepsy and
52:30mental illness of Judith together.
52:32So in the community for people with epilepsy,
52:34they believe that it is transmitted by
52:36staying with or being near that person.
52:38People end up running away from the patient.
52:40Feeding, falling down convulsing,
52:42and there's nobody to attend to him,
52:44even the home itself will be stigmatized.
52:46People will say that home has a
52:49disease they call it a bad disease.
52:52So this is the issue of stigma,
52:53which is does not only stem is
52:58not only experienced in low
52:59income countries like Uganda,
53:01but also here in the US.
53:03So a lot of communities,
53:08one of the bigger,
53:09the biggest challenges of being able
53:11to provide good mental Healthcare is
53:13that once individuals within their
53:15families get get mental illness,
53:17they're stigmatized.
53:18But also the family feels stigmatized
53:20and when they admitted to a hospital.
53:22Aquatica,
53:23it's very hard for them to be discharged
53:25because the community does not want
53:27to accept them back next slide.
53:32So in terms of trying to
53:34start this collaboration,
53:36I wanted to get a sense of how
53:38their education solutions can
53:42be implemented in Uganda and
53:44I've been having conversations
53:45with the chair of the department
53:48psychiatry at Macquarie University,
53:50Dr Nowlin Nakatsuka there
53:52on the top left and she.
53:58Reiterated some of the problems
54:00that I just stated above,
54:02but also you know additional issues and
54:05suggested that a collaboration of this
54:08extent from an education perspective
54:11could be valuable in three ways.
54:13One, this idea of integrating
54:15mental health with primary care,
54:18which is a.
54:20One of the initiatives that was
54:23mentioned by by Sonia that is advocated
54:26by Image Gap in Mulago Hospital,
54:29which is the primary teaching hospital
54:31in the and the capital city of Uganda.
54:34The palliative care team,
54:36she said,
54:37is a is one of the teams that
54:39exemplifies this and they're able
54:40to integrate a lot of different
54:42services into their care and have
54:44invited psychiatrist to be able
54:46to be part of that care team.
54:49So she thought that that would be an
54:51exciting way to be able to integrate.
54:54Trainees into into that kind of program.
54:57She also talked about a community education
55:01and reintegration program after discharge,
55:03and this was around trying to address
55:08the issue of stigma in communities.
55:12One of her frustrations was around
55:14the inability to discharge individuals
55:16back to their homes because of the
55:19stigma and so she had developed a
55:22program over the years where once
55:24individuals are discharged they
55:26actually walked to their homes by a
55:29psychiatrist or healthcare worker
55:31who then sits with the family
55:33and explains the treatment plan,
55:35educates them on the mental illness
55:38and tries to help them understand
55:40how they can be a part of.
55:42This person's journey to health.
55:45So she was very much interested
55:47in being able to.
55:48To continue to build that through
55:51an education perspective and then.
55:54We've we've talked at length around the
55:57lack of psychiatrists in these regions.
55:59Part of it is a resource problem,
56:02but part of it is a lack of encouragement
56:04and excitement around psychiatry.
56:06And so I should.
56:08She was very excited to see if having
56:11a collaboration with Yale will be.
56:15Positive for mentoring and encouraging
56:17tradies to consider psychiatry
56:20as a profession going forward.
56:22So these are the faculty mentors
56:26that will be.
56:29Helping establish this collaboration,
56:30I've already told you about
56:32Doctor Nolan Nakatsuka,
56:33who's the chair of the department
56:36at Macquarie University.
56:37You've already had about Doctor Unnatural.
56:39Who's the head of Happiness
56:41Project and also directs this.
56:44The Yellow global mental
56:45health and psychiatry,
56:47as well as Doctor Tracy Rabin,
56:50who is part of the Who's the,
56:52the Co director of the McCain
56:55University of University collaboration
56:57that is already existing.
56:59With the Department of Internal Medicine.
57:02We're currently with the stages
57:04of finishing up the engagement of
57:07stakeholders and the next steps would
57:09be to try and develop a curriculum
57:11as well as secure funding to
57:14establish this collaboration.
57:21Hi everyone, let me go back real fast.
57:24I know we have about 5 minutes left
57:26so I'll be brief in my presentation
57:28so I'm working with Doctor Ryan Nacho
57:30in the Happiness project, based in
57:33Nigeria and developing a postgraduate
57:35diploma in Community Mental Health.
57:37So first I wanted to talk
57:39about my motivation.
57:40This is my beautiful mother.
57:42This is me and my brother in the house
57:44that we grew up in in Bangkok, Thailand.
57:46This is the street that
57:48I lived and grew up in.
57:49This is about the size of the apartment,
57:51but our. Apartments at the end
57:52of the block there and then.
57:54This is my primary school.
57:56These are my beautiful,
57:58wonderful siblings that are
58:00living with my dad in Bangkok,
58:02Thailand right now.
58:03So I think this slide is to really
58:05say to myself and to to everyone that
58:07where I come from is as important
58:09as where I'm going and I always
58:12keep that in mind growing up in,
58:14you know,
58:15poor community and and country and now
58:19being here in an Ivy League institution and.
58:22Me a position.
58:23And I also wanted to give a shout
58:25out and acknowledgement to my mentor,
58:27Doctor Ihenacho.
58:28I know you guys have already
58:29heard a lot about him,
58:30but I he was one of my 3 interviewers
58:33and I remember hearing about the
58:35Happiness project then and I
58:37thought it was a beautiful homage
58:39that he was doing to his home
58:41for his home country in Nigeria.
58:43Even though you know he's still
58:45facing the United States and also
58:47we in the middle of my intern year,
58:49we talked about me becoming the
58:51resident leader for the Yale
58:53Global Mental Health Program.
58:54And I remember talking about
58:56how there were other.
58:57There is usually 4th year students,
59:00fourth year residents who
59:01are the resident leaders.
59:02But he said, well, yeah,
59:03that's one way you could look at it.
59:04Or you could say that you know,
59:06since you'll be in this program for
59:08the next three or four years that
59:10you'll be an expert by the end of it.
59:13So I always I'm grateful to him
59:15for that opportunity,
59:16so a little bit about the postgraduate
59:19diploma and Community Mental Health.
59:20It's it's a collaboration between Ohio
59:22State University and Yale University.
59:24It's a novel model of training.
59:26It's going to be hybrid based in
59:28Imo State and the participants who
59:30are primary care workers in Nigeria
59:33will gather in the conference
59:34room and it's going to be a
59:37longitudinal intensive programs.
59:38That's going to be about 10 months
59:40and then at the end they'll get a
59:41formal certification and recognition.
59:43So this. Graduate postgraduate diploma.
59:46This is the happiness project in
59:48Nigeria and it's because it's
59:50an expansion of that.
59:51And then it's also an expansion
59:52of the MH gap.
59:53So The Who has the mental health Gap
59:56Action program intervention guide
59:57and this program is essentially
59:59the gold standard.
01:00:00That's usually it's the past
01:00:02sharing approach is utilized in
01:00:04over 90 countries.
01:00:05Low and middle income countries
01:00:07around the world and the essence of
01:00:10it is to train primary care workers.
01:00:12So non psychiatric workers about
01:00:14common mental health diagnosis.
01:00:16And treatment and triaging of that.
01:00:19So the priority conditions Evan already
01:00:21went over with you and then just wanted
01:00:23to illustrate this is the psychosis
01:00:25module you can look up the modules there.
01:00:27They're on The Who website.
01:00:29It's very comprehensive and
01:00:30it's very beautifully done,
01:00:32very expertly done.
01:00:33So this is a quick overview of it.
01:00:34You know there's the assessment
01:00:36portion you think about for psychosis
01:00:39assessing for acute manic episode.
01:00:41And then there's management portion.
01:00:43There's both psychosocial interventions
01:00:45and pharmacological interventions.
01:00:46They even list the most
01:00:48common side effects and.
01:00:49Things to mitigate and watch out for
01:00:51and then follow up routines for that.
01:00:55And this is to say that the Happiness
01:00:57project is already implemented is already
01:01:00implementing the MH GAP Intervention
01:01:02guide in Nigeria and Imo State.
01:01:05And it's about two week long training,
01:01:0740 hours and our postgraduate
01:01:09diploma is an expansion of that.
01:01:11So there's an engagement of
01:01:13stakeholders which which doctor
01:01:15Anacho has already established between
01:01:17Imo State and build university,
01:01:19which I think is probably one of the
01:01:22hardest parts, is the engagement.
01:01:24In collaboration of stakeholders.
01:01:27And this is going to be 10 months.
01:01:30We're going to have,
01:01:30and it's going to be a monthly gathering.
01:01:32It's going to be both lectures
01:01:34and supervision,
01:01:34and the lecture portion it's going
01:01:36to be both Nigerian psychiatrists
01:01:38at home and in the in the diaspora.
01:01:40And also I'll be emailing yellow
01:01:44psychiatry faculty members to
01:01:46volunteer to teach about different
01:01:49mental health classifications.
01:01:50So and then the last part
01:01:53is the supervision part.
01:01:55It's going to be Nigerian licensed
01:01:57psychiatrists or psychologists
01:01:57to be providing. That last part.
01:02:00And this is to say that enrollment
01:02:03is open now in animal state.
01:02:05And this is our proposed curriculum,
01:02:07with all the different.
01:02:09Uh,
01:02:11modules.
01:02:12And then our future direction of
01:02:13this is that we're going to have an
01:02:16assessment to students and evaluation
01:02:17of curriculum will continue to
01:02:19strengthen that collaboration with
01:02:20Imo State and then hopefully have an
01:02:23exchange site visit with trainees from
01:02:25both Yale and Imo State University.
01:02:27And then of course,
01:02:28the think about dissemination.
01:02:29Since this is a novel model
01:02:31of intensive training,
01:02:32and it's also hybrid program.
01:02:34And then I just wanted to mention
01:02:36some of the other global mental
01:02:37health projects I've been a part of.
01:02:39So there's this book with Doctor Alta Lib,
01:02:41he's.
01:02:42Published,
01:02:42it's impressed with the American
01:02:45Psychiatric Association.
01:02:46It's on Muslim mental health in
01:02:47different countries and I contributed
01:02:49a chapter with Doctor Pennachio,
01:02:51but Nigeria.
01:02:52I'm also working with Doctor all to
01:02:54live about the assessment of mental
01:02:57healthcare that's being integrated
01:02:58into different neurological clinics
01:03:00and this is a global assessment
01:03:02and this is in partnership with
01:03:04the American Academy of Neurology
01:03:06and it's being featured.
01:03:08It's going to be a feature of
01:03:09theology and clinical practice,
01:03:11so they're they're main clinical journal.
01:03:13And that is the end of our grand rounds.
01:03:16And I'll stop sharing.
01:03:19And open up for questions.