Announcing: Mental Health Care Leadership Champions - A Three-Program Certificate of Specialization
The unmet needs for care for mental health problems have always been large; they have only increased during the current pandemic. Mental Health Care Leadership Champions will help narrow this gap by training and mentoring forward-thinking leaders. For more information visit: Mental Health Care Leadership Champions Program
EMPOWERING LEADERS FOR IMPROVED HEALTH OUTCOMES
The Certificate of Specialization comprises three programs, taught by faculty from the Harvard School of The Certificate of Specialization comprises three programs, taught by faculty from the Harvard School of Public Health, the GlobalMentalHealth@Harvard Initiative and an international pool of experts, embracing both empirical evidence and real-world lessons. Through this training and mentoring program, professionals from around the world will empower themselves to scale-up evidence-based and innovative programs to address the mental health needs of their communities with knowledge, skills, and peer support.
Those who complete both Foundations of Mental Health Care and Scaling Up Mental Health Care programs are invited to join a third program: a peer-learning collaborative to support and learn from one another as they embark on their journey of being champions for mental health.
Learn From the Experts
Foundations of Mental Health Care will be led by renowned faculty who have held both public health research and real-world leadership roles. Core instructors include Shekhar Saxena, former Director of the Department of Mental Health and Substance Abuse at the World Health Organization, Vikram Patel, co-leader of GlobalMentalHealth@Harvard, and Giuseppe Raviola, Director of Mental Health for Partners In Health (PIH), and the Director of the Program in Global Mental Health and Social Change (PGMHSC) at Harvard Medical School.
Written by: Ankita Shah, Program Coordinator, Sangath Bhopal Hub
Edited by: Juliana Restivo, Program Coordinator, Harvard Medical School
“Our experience today reinforced that ASHAs (Accredited Social Health Activists) have the potential to revolutionize mental healthcare. Their interpersonal skills were heart-warming and their strong ties to the community form the needed foundation to deliver accessible, patient-centered care. These lessons are relevant across India but also the rest of the world including North America”Daisy Singla, Ph.D., C.Psych, Clinician Scientist, Center of Addiction and Mental Health, University of Toronto, Lunenfeld Tanenbaum Research Institute
Depression is the leading mental health cause of the global burden of disease[i] and estimated global costs of untreated depression are up to 16 trillion US dollars.[ii] Brief psychological treatments are among the most effective and cost-effective interventions in medicine[iii] and recommended as the first line of care[iv] to address this global burden. The major supply-side barrier of inadequate numbers and inequitable distribution of mental health specialists has been addressed by global mental health practitioners by task-sharing of these treatments to NSPs—including community health workers, lay therapists, peers, nurses, and teachers. There is now a robust evidence base demonstrating that NSP can effectively deliver brief psychological treatments for depression and other common mental health problems in a wide range of contexts.[v],[vi] Dr. Anant Bhan, Site PI for Sangath Bhopal Hub, shared why it is so important to engage with NSPs in this work, particularly in India, “ASHAs are the backbone of the community healthcare India, and by extension, our work. It is indeed an honour to be able to work with these community health change agents with such levels of dedication, commitment and hard work. We believe that the involvement of frontline health workers such as ASHAS is crucial for integrating mental health into primary health care provision.”
Despite the availability of NSPs-delivered, effective and cost-effective psychological treatments, the treatment gap for mental disorders remains a big challenge to be addressed. From the service-delivery perspective, clinical supervision of NSP-delivered psychological treatments positively impact the therapist in training, therapy quality and patient outcomes and thus it essential to ensure the quality of the treatment delivered. Previous approaches to clinical supervision have focused on mental health expert-led, applying ungeneralizable metrics to supervise delivery. This is particularly relevant in India as our country has limited, adequately trained specialists in psychological treatments who are available to provide expert supervision.
This study, funded by Grand Challenges Canada, and led by Principal Investigator of the study is Dr. Daisy R Singla, Clinician Scientist, University of Toronto, Sinai Health System, Lunenfeld Tanenbaum Research Institute, seeks to address the barriers by scaling up measurement-based peer supervision, and innovation the study investigators have designed, piloted and evaluated over the past decade, using the digital platforms for supporting NSP-delivered care in global health. This peer-supervision study is a component of the overall EMPOWER project. EMPOWER is a priority work-stream of the GMH@Harvard Initiative with the goal of increasing health system capacity for the prevention and care of mental health problems across the life course, globally. Using digital training, supervision, and quality assurance tools for specific evidence-based psychosocial interventions EMPOWER will train, and supervise, frontline health workers to deliver these interventions with assured quality. Learn more about EMPOWER’s mission and programs at EMPOWER.care. “The field of global mental health has reached an inflection point where we have sufficient evidence about ‘what works’ but do not understand ‘how to make it work’.” reflects Dr. Abhijit Nadkarni, Site PI for Sangath Goa Hub, “Studies such as the GCC EMPOWER peer-supervision project allow us to answer this critical question which will help the scaling up evidence based psychosocial interventions so that they are accessible to those who need them the most”
This supervision component of the EMPOWER project seeks to address the barriers posed by the orthodox approach to supervision, a key pedagogical and quality assurance tool in treatment delivery which is known to positively impact the therapist in training,[vii],[viii],[ix] therapy quality [x] and patient outcomes.[xi],[xii] The Harvard Medical School Co-Investigators for the project are Professor Vikram Patel and Dr. John Naslund. The Investigators are collaborating with research teams at Dimagi and Sangath to adapt Dimagi’s well known CommCare digital platform for supporting NSP delivered care in global health.
In collaboration with projects based out of two Sangath hubs in Bhopal and Goa, the study will be conducted in primary care facilities in the Sehore district of Madhya Pradesh (14 facilities in rural settings), and the state of Goa (urban/peri-urban with 24 facilities). The NSPs will be trained to deliver a brief psychological treatment for depression called the Health Activity Program (HAP). In December 2021 the teams met in Hoshangabad district in Madhya Pradesh, India to test a beta version of Dimagi’s CommCare app for peer-supervision. There were 10 NSPs in total who attended the CommCare platform training consisting of five Accredited Social Health Activist (ASHA) supervisors and five ASHAs. “It was so inspiring, and humbling, to witness ASHAs, the formidable cadre of India’s public health workforce, demonstrate such commitment, motivation and comfort in learning to engage with cutting-edge technologies to support their new roles as mental health care providers”. Professor Vikram Patel shared about his time meeting with the ASHAs during the pilot testing. The NSPs travelled from 9 to 60 kilometres to participate in the training. This set of NSPs has a diverse variety of qualifications, ranging from high school to post-graduate studies, with eight NSPs having completed either secondary or post-secondary education. The rest held a bachelor’s degree (BA). The NSPs ages ranged from 30 to 50 years old. This particular group of NSPs owned a smartphone and were well-versed in the procedure.
Study team members who also attended the pilot testing and met with ASHA’s included:
- Deepak Tugnawat, Director of projects in Sangath Bhopal
- Nitish Dube, Associate Director, Dimagi
- Ankita Shah, Project Coordinator, Sangath Bhopal
- Azaz Khan, Project Intervention Coordinator, Sangath Bhopal
- Deepali Vishwakarma, Project HAP supervisor, Sangath Bhopal
- Phool Singh, Project HAP supervisor, Sangath Bhopal
- Radhika Tak, Project HAP supervisor, Sangath Bhopal
- Akshat Purohit, Project HAP supervisor, Sangath Bhopal
[i] Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10(11): e1001547.
[ii] Patel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development. The Lancet 2018; 392(10157): 1553-98.
[iii] Organization WH. Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological and substance use disorders, 2015: World Health Organization; 2015.
[iv] World Health Organization. Mental Health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG): Clinical Management of Mental, Neurological, and Substance Use Conditions in Humanitarian Emergencies. Geneva: WHO, 2015.
[v] Singla DR, Kohrt B, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low-and middle-income countries. Annual Review of Clinical Psychology 2017; 13(1).
[vi] Van Ginneken N, Tharyan P, Lewin S, et al. Non‐specialist health worker interventions for the care of mental, neurological and substance‐abuse disorders in low‐and middle‐income countries. The Cochrane Library 2013.
[vii] Saxon D, Firth N, Barkham M. The relationship between therapist effects and therapy delivery factors: Therapy modality, dosage, and non-completion. Administration and Policy in Mental Health and Mental Health Services Research 2016: 1-11.
[viii] Fairburn CG, Allen E, Bailey-Straebler S, O’Connor ME, Cooper Z. Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists. J Med Internet Res 2017; 19(6): e214.
[ix] Kühne F, Maas J, Wiesenthal S, Weck F. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC psychology 2019; 7(1): 54.
[x] Weck F, Jakob M, Neng JM, Höfling V, Grikscheit F, Bohus M. The effects of bug‐in‐the‐ eye supervision on therapeutic alliance and therapist competence in cognitive‐behavioural therapy: A randomized controlled trial. Clinical psychology & psychotherapy 2016; 23(5): 386-96.
[xi] Saxon D, Barkham M, Foster A, Parry G. The contribution of therapist effects to patient dropout and deterioration in the psychological therapies. Clinical psychology & psychotherapy 2017; 24(3): 575-88.
[xii] Singla DR, Hollon SD, Velleman R, et al. Temporal pathways of change in two randomized controlled trials for depression and harmful drinking in Goa, India. Psychological Medicine 2019: 1-9.
Written by GMH@Harvard Ambassador Board Members: Bill Kriebel, Sarah Coleman, Anna Bartuska, and Amruta Houde
All artwork by Bill Kriebel
October, World Mental Health Month, begins at the end of this week! Saturday October 10th is World Mental Health Day and the theme this year is Move For Mental Health: Let’s Invest. The World Health Organization, for the first time ever will be hosting a global online advocacy and fundraising event on Mental Health.
We have aligned our three-part series to coincide with this important theme.In our first article of the series we discussed with Elisha London, Founder and CEO of United for Global Mental Health, about what it means to invest in mental health and how we can take action to improve global mental health. In this article, we share ways that you can invest in your own mental health, especially through mindfulness and expressive arts. Our third article of the series will be released after World Mental Health Day and explore financial investment in global mental health.
It’s time to invest in your own mental health
Let’s get real. COVID 19 is stressful and impacts how we feel, what we say to ourselves, and what we do. Our lead author went through a lot of stress leading 13 teams in nine countries and turned to mindfulness and expressive arts to stay mentally healthy. Now he shares these experiences as a Certified Peer Specialist and through this article seeks to share these strategies with others. In this article, we offer ways and resources to help you stay emotionally and mentally healthy during these challenging times. The following list of strategies is not mean to be comprehensive, but instead help you begin to invest in your own mental health. You may wish to start with these articles to set the stage.
Invest in relaxing
Pretend like we are meeting in a big living room with a nice warm fireplace
Be comfortable and mindful
Meditate: Rest with your body and breath
Why? You are investing in reducing stress, staying calm, and improving your immune system
Invest in gratitude every day
Find greatness in being at home
Living is a miracle!
Savor your cuisine, it nurtures you
Why? You are investing in staying positive no matter what
Invest in being deeply aware of what is
If you can go outside, let nature speak to you
If you are spiritual, take time to cultivate spirituality
Now is the only time you actually live
Why? Investing in connecting with your inner and outer world will raise awareness of how you really are.
Invest in your body and your health
Walk, Exercise, Yoga, Run, Hike, Swim, Breath
Eat well, regularly and diversely
Consistently maintain your hygiene
Why? Investing in your body is essential as science shows exercise can reduce symptoms of anxiety and depression
Link: Invest in your health
Invest in creating and expressing yourself
Dance, Sing, Play music
Draw, Paint, Watercolor
Why? Investing in playful heart energy and being present to boost your health and stay happy
Invest in challenging and strengthening your mind
Take classes, read, play games, etc
The importance is to keep your mind strong
Why? Investing in a strong mind keeps you young, active and healthy
Invest in building community!
This may be tricky with COVID. Definitions of community can change to fit the times.
Call family and friends, Zoom
Make sure your friends and family have the social support they need, especially if they are in quarantine or part of a vulnerable population
Check in on people you care about who are on the front lines such as clinicians, teachers, public health workers, etc
Join the global movement of COVID-19 response such as at Partners In Health and share success stories to lift each other up
Why? Investing in community keeps you connected with others which can become essential
Invest in your wellness recovery action plan
Who are the people that you will call in a mental health emergency?
Who will take you to the hospital?
Which doctors, medications, and allergies do the emergency room staff need to know
Which medical information do you need to have on hand?
Why? Investing in emergency preparation while you are mentally strong, is essential if you may need help
Link: WRAP plan
Invest in keeping your bills paid and finances well managed
Simplify and keep a consistent process
Save money now in case you need money for healthcare emergencies or lost work
Why? Investing in your finances now will greatly reduce mental health concerns when sick
The following provides a good workbook for finances and the above topics
Link: 8 Dimensions of Wellness
What if all of this is too much? Invest in getting help!
You may have a treatable mental health concern
Speak with a therapist or doctor
You could look up your concerns on the web, but this has dangers if you have a true concern
Why? Investing in one-on-one communication with a professional can isolate a specific concern that needs your attention
What if you know you have an illness? Invest in making connections!
Ok, this is not for everyone and is harder with Covid
Still, make the effort
Join a recovery community
Why? Investing in connecting with other people can be essential to healing, or at least beneficial
What if your illness is much more serious? Invest more!
If you have a serious condition and have tried many alternatives, you may need more
There are many residential programs throughout the US
Why? Investing in a residential program can help you treat your health holistically
Invest in learning about mental health concerns
Why? Investing in learning about mental health can help you and others take the best actions
Healthy and ready to help others?
Invest in the greater good of the world
We are in a time of multiple crises- public health, racial, economic, police brutality: all affecting our mental health and compounded by potential COVID-19 mental health related challenges
Why? This improves everyone’s mental health collectively, while helping ourselves
Don’t forget to invest in yourself and in your communities on World Mental Health Day, Saturday October 10!
Are you ready to #MoveForMentalHealth? Visit United for Global Mental Health and join the virtual #WMHD activities! Stay tuned for our third and final article Investing in Mental Health later this month!
Anna D. Bartuska, Program Coordinator, Community Psychiatry PRIDE, Massachusetts General Hospital
Sarah Coleman, Cross-Site Mental Health Officer, Partners In Health
Amruta Houde, Mental Health Program Associate, Partners in Health
William Kriebel, Master’s of Liberal Arts Student at the Harvard Extension School, studying Management. Certified Peer Specialist, Boston Medical Center