Yale Psychiatry Grand Rounds: May 13, 2022

Transcript

• 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.