Mental Health GAP training in kashmir in collaboration with Royal College of Psychiatry and DHServices Kashmir supported by WHO

 

 

 

 

 

             

 

 

 

            My Vision my dream for the people of my valley

DR Sayed Aqeel Hussain International Project Coordinator for mhGAP Training in Kashmir and Research Collaborater for PRIME (Programme for reducing mhGAP in developing countries) in India

My journey in realising my vision and dream started almost a decade ago when having completed my MBBS from Govt Medical college Srinagar I joined the department of surgery  where I realised that there were enough doctors to deal with the physical aspect of Trauma but not many to deal with the psychological aspect of trauma .I decided to pursue my career in the field where I could contribute to my community and as such moved to Uk to pursue my career in psychiatry in order to realise my dream  of contributing towards my community .Having  completed my training I was looking for an opportunity which came my way while attending  an International psychiatry conference in London where Professor Rachel Jenkins a world renowned professor in  International psychiatry was chairing a workshop about the contribution of Royal College in Iraq over the past few years with regards to training primary care physicians using mhGAP in order to reduce the gap between service need and service delivery.

 

I saw this an opportunity to help the people of my valley where there was severe shortage of trained manpower  to deal with the mental health issues like anxiety,depression,drug abuse and other conditions in both children and adults which could be identified ,treated if possible or referred where necessary at the primary care level.

I approached Prof Rachel Jenkins with a request to help coordinate a similar project in Kashmir which was suffering from political turmoil for the past twenty years and where mental health problems are on the rise .I submitted a country profile of Kashmir which gave her an insight into ground reality of problems in Kashmir and she agreed to help me coordinate a project in Kashmir,in order to reduce the gap between service need and service delivery.

 

In order to realise my dream I decided to come back to Kashmir and joined as a Consultant Psychiatrist in Govt Psychiatric disease hospital Srinagar in order to see and understand the Scale of mental health problems at ground level and I realised the extent of gap between service need and service delivery.Being a member of Royal college of psychiatry and also of international and voluntary special interest  group of the Royal College of psychiatry I approached the Royal college of psychiatry London who appreciated my vision of reducing the mental health gap between service need and service delivery.I met the President of Royal College of Psychiatry and gave a presentation about the mental helath problems in Kashmir as well as the infrastructure available to deal with the mental helath problems in Kashmir.

 

It is worth mentioning that primary care sector in Kashmir is headed by Director Health Services Kashmir Dr Saleem u rRehman who supported this entire project unconditionally which was highly appreciated by the college of psychiatry and the team of delegates who came to deliver mental health gap training in Kashmir.

During the meeting the President agreed to support the mental helath gap training in Kashmir through members of international and voluntary special interest group as well provide ongoing support and advice with regards to improving mental health services in Kashmir which was highly appreciated by the Director of health services  Dr Saleem ur Rehman .

 

On returning from London I discussed the plan with my friend and colleague Dr Mohd Muzaffar Khan who has been instrumental in establishing Drug deaddiction centre in Kashmir with the support of mr SM Sahai the then IGP of Kashmir and is currently Director of police deaddiction services in Kashmir.

In the first meeting held to discuss the implementation of the project which was attended by Mr SM Sahia the then IGP Kashmir ,drSaleem ur Rehman Director health services Kashmir, Dr Muzaffar khan consultant psychologist and myself I presented the minutes of the meeting with the President of the Royal college  to Director health services Kashmir Dr Saleem ur Rehman and the then IGP Kashmir Mr S M sahai who appreciated the efforts and assured of all possible support on his behalf.

 

Mr sahai  shared his vision of improving health services in mental helath field especially in the field of drug and alcohol which has been realised by successfully establishing drug addiction centre as well as ways to reduce the delinquency in juvenile population which was appreciated and commended in the team meeting.

Having received the backing and support of Mr SM Sahai, Mr Saleem ur Rehman and Dr Muzaffar Khan I went to London to finalise the plan for which i received complete support from the Royal college of psychiatry especially Professor Sue Bailey president of the Royal College of psychiatry.

I also met Dr  Shekhar Saxena Director WHO mental health and substance abuse  who is also the head of WHO formulated mhGAP in the world and advises ministries on mental health issues around the world .Dr Saxena reassured of all possible support with regards to implementation of mhGAP in Kashmir .In the meeting with Dr Yuta  in charge mhGAP in Geneva it was agreed that WHO will continue to provide support and advice as the project proceeds and I would serve as a link between the Royal college of psychiatry, WHO and the Directorate of Health Services Kashmir which was endorsed by Dr shekhar Saxena Director WHO  who along with Royal college of psychiatry assured of advice and support with regards to implementation of District Mental Health programme in Kashmir.

• I also met prof Rachel Jenkins Professor Rachel Jenkins ,Emerita Professor of Epidemiology and International Mental Health Policy ,Department of Health Service and Population Research,Director of WHO collaborating centre     who was instrumental in inspiring me to proceed with this project and

• Professor Vikram Patel ,Professor of International Mental Health and Welcome Trust Senior Research Fellow Sangath Centre, Goa India.He serves on the WHOs Expert Advisory Group for mental health,the World Economic Forum Global Agenda council on Mental Health and the Mental Health Policy group of Ministry of Health Government of India who also reassured of all possible support as the project proceeds besides other world renowned professors and experts who continued to provide support and advice as the programme got unfolded and realised at ground level.

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• As the programme unfolded a group of 14 volunteers from international and voluntary special interest group volunteered to be part of the team which was headed by dr Peter Hughes who has worked extensively around the world with regards to implementation of mhGAP especially in Somalia, Iraq, Haiti,Ghana,Uganda,Pakistan and has been awarded the presidents medal by royal college of psychiatry for his outstanding contribution to international psychiatry.

• Director health services Kashmir Dr Saleem ur Rehman provided all possible support especially with regards to accommodation,venue and trainees which included doctors and nurses from all 12 districts of Kashmir which was highly commended by Dr peter Hughes and his team

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• Other stake holders who supported the traing programme included MRs Nighat Shafi a renowned social activist who has worked extensively in rehabilitating women and children effected by conflict and was the receipient of famous Jamana lal Bajaj award in 2012.

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• Action aid india which has been working in Kashmir extensively for past 8 years dealing with psycho social component of mental health and is led by Mr Shoib ifra who is of kashmiri origin and is able to understand the problems at ground level which is necessary for effective implementation of programme at ground level.

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• J and K bank which is known for their philanthropic work and are discharging their responsibilities as corporate organisation towards the community with great zeal and enthusiasm which was demonstrated by their generous contribution towards this project .

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• Other organisations include TCI cements whose contribution was commended upon as well.

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• Finally the organisers were thankful to Jk police who provided transport and security for our guests which helped in the smooth running of the programme.

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• The aim of the training was to reduce the mental health gap between service need and service delivery due to shortage of psychiatrist and trained paramedical staff.the fundamental principle is to take the mental helath care into the community and to train and empower professionals in identifying mental health problems ,treat if possible and refer appropriately.it involves the principle of task shifting which involves empowering professionals like primary care doctors, nurses,socialwokers,teachers,police .research by prof Vikram Patel showed that these professionals can effectively deliver mental health care at grass root level with appropriate training ,monitoring and supervision.In simple language we need to aim at  simpifying the message,unpack the treatment ,deliver where they are,it should be affordable and have available human resources and there should be reallocation of specialists to train and supervise .

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• The training started at regional institute of family welfare Dhobiwan with first  batch including about 100 participants of doctors ,psychologists sand social workers split into three groups .the training was deliverted by Dr Peter Hughes and his team and the trainers included renowned psychiatrists  like Dr Sophie Thomson consultant learning disability and psychotherapist who chaired the session for psychologists.Dr Sajad Yousuf a graduate from Govt Medical College Srinagar who is Consultant General Adult psychiatry in London.Dr Eleni Palizadou Consultant psychiatrist ,Dr Jane Mounty Consutant psychiatrist ,and Dr  Sally Browning Consultant psychiatrist all of whom have experience of training around the world and are certified as WHO master trainers.

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• The training of first batch concluded successfully and involved interactive sessions,role play, group discussions based on practical aspects which can be delivered in the community with existing resources .it was highly appreciated by the trainees who felt empowered to identify, treat where possible and refer appropriately  .At a validatary function after the first week which was chaired by Director health services Kashmir all the national and international dignitaries who contributed to the success of the programme were awarded with appreciation awards and all supporting organisations and sponsors were recognised for their contribution in making this programme a success.

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• The second traing sessions started on Monday 23r September and was led by Dr Sajad yousuf who is consultant psychiatrist in London and has done his initial  training  and worked in Kashmir and had better understanding of the ground realities with regards to delivery of service .it is worth mentioning that Sajad Yousuf agreed to stay for the entire two sessions of training at my request in order to ensure that the best possible training could be delivered to trainees and being from Kashmir he could serve as a link between the trainees  and trainers having better understanding of culture and training of both the countires.

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• Dr Sajad has agreed to continue to provide advice and support with regards to monitoring and implementation of programme along with other team members of the royal college who attended the training programme.other prominent trainers included Dr Henrikje Klasen Consultant Child and adolescent in Holland,who specifically chaired the training sessions for teachers to help them identify problems in schools and colleges at an early stage including problems of Drug and alcohols.Dr Mina Bobdey who is also consultant old age chaired the session for dementia and advised and trained the primary care level with regard to dealing with dementia at primary care level.Dr Lucy potter a psychiatry trainee at Maudsley hospital shared her views and experience in the use of mental health gap at primary care level.

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• Having successfully concluded the training which was highly appreciated by both trainees and trainers the next phase is more challenging which means implementing it at ground level for which i need continuing support from all stakeholders so that we contribute in improving the mental health care for the people of our valley

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Dr Sayed Aqeel Hussain