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Calhoun, Roxas Receive Award from Yale Psychiatry's Bertram H. Roberts Memorial Fund to Complete Global Mental Health Research

April 24, 2020
by Jordan Sisson

Two Yale Psychiatry residents recently received an award from the Department of Psychiatry to complete research related to global mental health and social psychiatry.

Amanda J. Calhoun, MD, MPH, resident in the Albert J. Solnit Integrated Adult/Child Psychiatry program, and second-year resident Nichole Roxas, MD, MPH, are the recipients of the award from the Bertram H. Roberts Memorial Fund.

The fund provides support for medical students and residents to complete projects in the field of social psychiatry. Roberts, who died in 1955, was well known for his contributions to the field of social psychiatry, which focuses on the interpersonal and cross-cultural context of mental illness and treatment modalities.

With the award, Calhoun traveled to Lagos, Nigeria to conduct a qualitative needs assessment seeking to understand the gaps in child and adolescent mental healthcare access in Nigeria, from the viewpoint of multiple community stakeholders. Calhoun interviewed teachers, physicians, children, and even clergy to understand their perspective on mental illness in children and adolescents, and identify areas of need.

“Like here in the U.S., not everyone [in Nigeria] is even convinced that young children can suffer from mental illness at all, so it was very interesting to open a dialogue about it,” she said.

Calhoun said her plan is for the project to pave the way for a larger pilot interventional study, in which she will partner with teachers and clergy to deliver mental health care to children and adolescents struggling with mental illnesses.

“Being the principal investigator of this project was an amazing experience in and of itself because I got the opportunity to experience all the work that goes into coordinating a cross-cultural, global study,” she said. “It was also so motivating for me to work with brilliant physician mentors who all looked like me. It was so therapeutic for me to be in an African country where I was no longer the minority. I felt like a weight was lifted from my shoulders. I could just be a person, and not have to constantly prove my intelligence or value.”

Calhoun credited her mentors Theddeus Iheanacho, MBBS, DTM&H, Associate Professor of Psychiatry, and Juliet Iwelunmor, Ph.D., Associate Professor at the Saint Louis University School of Public Health and Social Justice, with making her research possible.

“I became interested in global mental health because I know that globally, mental health is underserved, and that physical health is often prioritized over mental health,” Calhoun said. “In children and adolescents especially, mental health often goes unacknowledged and undiagnosed. My aim is to conduct global mental health work that is driven by the community, engages the community and harnesses its strengths and expertise, and that is culturally relevant.”

Roxas aims to develop a standardized manual for The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) Project to facilitate its adoption, by interviewing stakeholders in Imo State, Nigeria, in September 2019. She is also reviewing and analyzing previous interviews and focus group data collected to inform the project sustainability and replication in other sites, and reviewing the current standard operating procedure to identify areas that need to be modified or updated. She also seeks to compile and analyze clinical outcomes data collected since the project began via retrospective chart review.

The HAPPINESS Project is focused on increasing access to evidence-based treatments for mental, neurological and substance use disorders in Nigeria by adapting the World Health Organization (WHO)’s Mental Health Gap Action Programme (mhGAP) Intervention Guide in primary care settings. It is a collaborative project supported by the Yale Global Mental Health Program, the local academic institution Imo State University Teach Hospital, the local government agencies including Imo State Primary Care Development Agency, Imo State Ministry of Health, and non-profits CBM International and ROW Foundation. The HAPPINESS Project provides training, ongoing clinical support and refresher trainings for primary care teams in participating local government areas.

“My interest in global mental health is deeply tied to my journey as a Filipina-American navigating questions of identity, like, ‘Where is home?’ and ‘How do I honor one of my core values — ‘utang na loob,’ which is Tagalog for ‘debt of the heart’?” Roxas said. “Overall, I seek to learn how to share my privilege and knowledge in a positive way that promotes health equity.”

Roxas said it has been an honor for her to work with her fellow trainees, including MPH Health Policy candidate Casey Chu, and several global mental health mentors, including the HAPPINESS Project co-founder psychiatrists Iheanacho; Chinyere Aguocha, MBBS, FMCPsych, the only full-time clinical psychiatrist in Imo State and clinical supervisor for The HAPPINESS Project; Charles Dike, FRCPsych, MBChB, Assistant Professor of Psychiatry; and her Associate Program Director Ayana Jordan, MD, PhD, Assistant Professor of Psychiatry.

“This community’s positive role modeling of their weaving of personal and professional work towards a more just world has been so inspiring and energy-giving,” Roxas said.

Submitted by Jordan Sisson on April 23, 2020