Mental Health GAP training in kashmir in collaboration with Royal College of Psychiatry and DHServices Kashmir supported by WHO
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EXPERT RECOMMENDATIONS BY MENTAL HEALTH PROFESSIONALS ROUND THE WORLD
Recommendation of Professor Vikram patel
Professor Vikram Patel, Professor of International Mental Health and Welcome Trust Senior Research Fellow Sangath Centre, Goa India.Member 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
· I think it’s a great idea to evaluate the training but I think that knowledge and attitudes are very weak predictors of the desired impact of health worker training because of the very weak association between knowledge/attitudes and behaviour. What matters most is competencies, and evaluation must address competencies. We have developed scales for evaluating core mental health competencies which we are now using in a number of projects in Nepal and India. The IOM report on competencies (attached) offers an example of what training programs should aim to achieve, and my presentation attached provides an overview of competency based learning which we are developing for a national training program for primary care doctors in India, in collaboration with the Ministry of Health (Government of India) and the Indian Psychiatric Society. We are soon to host a national workshop to define competencies for the full range of MNS disorders and use these to design a competency based training program to be delivered by regional mental health professionals and centres throughout the country in the near future. One of the major reasons for using local experts/centres is to also use the training as an opportunity to develop collaborative relationships between primary and specialist care, a key requirement for the successful integration of mental health in primary care
Recommendation of 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
Thank you for bringing this to my attention, and congratulations on getting this initiative going.
It will be important to
1. establish mental health professionals at district level who can support and supervise primary care staff; and organise regional mental health professionals to support and supervise district level staff....in my experience
it is these layers of support and supervision which are likely to be missing in Kashmir, and which are likely to make a large difference to the long term sustainability of the impact of the training. If they are to give adequate support, these higher levels also need training about mental health in prmary care, as it is so different from secondary care.
2. develop health managment information systems to monitor assessment, diagnosis, treatment and referrals
Outcome of meeting with WHO Mental Health and Substance Abuse which was endorsed by Dr Shekhar Saxena Director WHO Mental Health and Substance Abuse Geneva
WHO will be providing technical support and access to training material which WHO has given permission to print and use for training.
WHO will be providing regular advice and support as project proceeds
Dr Sayed Aqeel Hussain will serve as a link between WHO, RCpsych and The Kashmir Government.
Dr Sayed Aqeel Hussain to discuss with Kashmir Government as to how district mental health programme can be effectively used in monitoring effective implementation after the initial training part.which both Dr Peter of Royal college and Dr Yuto of WHO stressed on .
Dear Aqeel,
I am very pleased with this arrangement and wish you all best.
Shekhar
Dr Shekhar Saxena
Director
Department of Mental Health and Substance Abuse
World Health Organization
CH-1211, Geneva, Switzerland
Continuing ongoing support by Dr Shekhar Saxena
Dear Aqeel,
It was very generous of you to send me the plaque with beautiful Chinar leaf! It is very nice; thank you.
I am very pleased to know that the training went well. our support will be there; whenever you need it.
All best,
Shekhar
Dr Shekhar Saxena
Director
Department of Mental Health and Substance Abuse World Health Organization
CH-1211, Geneva, Switzerland
Feedback by WHO mhGAP team from WHO Headquarters Geneva
Dear Peter (and Aqeel),
Thank you very very much for sending this feedback. I congratulate your work done in Kashmir-more than 100 people trained!
The feedbacks are very valuable and will be definitely used when revising the training materials.
I am sure that the training will have clinical impact and show increase in numbers of patients seen. I am eager to learn about the outcome of it.
Also I am glad to hear the Manchester orientation workshop was well accepted. Thank you for raising awareness on mhGAP and the training materials, which we recently think we need to promote more so that it is used more widely. Many people are still not aware of its availability and this kind of workshop really helps disseminating mhGAP.
Thank you so much
Best wishes,
Yuta
Yutaro Setoya
On behalf of WHO mhGAP team
Dear Sayed Aqeel Hussain
It was wonderful experience meeting you and the very keen participants. I enjoyed meeting all of you. I fully appreciate the courtesy shown to us and your magnanimity in not accepting the registration fees. I thank you profusely for the service rendered to us especially Dr.Musthafa. Your hard work and planing are worthy of much praise.
Myself and my wife will remember our stay at Kashmir and near by places. In case you intend to visit Kerala which is God's Own Country we will be glad to take you round.
Thanking You
Yours Sincerly
Dr.S.Santhakumar
F.R.C.P. (Edin), M.R.C.Psych,(London), M.R.A.N.Z.C.P(Melbourne),D.P.M
Director Institute of Mental Health and Neurosciences
Pavamani Road,Calicut 673004,Kerala,INDIA
91 9846136598, 91 495 2727144,Res.2720343.,2722144
Director and Professor of Psychiatry Medical College(Rtd)Calicut.
Advisor,Mental Health,Govt. of Kerala(Rtd)
Hello Aqeel,
I just wanted to let you know that I am working on the materials for a presentation on mental health and human rights as related to the UN CRPD. I’m going to be sending these materials for the Ghana MH Conference as well. I am putting together a power point presentation with notes/paper with bibliography so you will be able to use these materials however works best. I hope to have this information completed within the next week or two.
I am in New York from September 21 to 28. Mental Health Worldwide has been accredited to attend High level meeting on Disability and Development at UN Headquarters on the 23rd.
Let me know if there is anything else needed regarding this training.
Thanks.
Warm regards,
Linda
Linda Lee, M.Sc.,
Int Dipl Mental Health Law and Human Rights
Founder, Mental Health Worldwide
www.mentalhealthworldwide.com
•Dear Aqeel,
•
•Thanks for your email. I am so pleased that the training was successful...over 100 participants is amazing! Well done- you must be really pleased!
•
•Best wishes
•Sara
•Sara Cooper (MPhil/PhD Candidate)
Department of Social and Environmental Health
•London School of Hygiene & Tropical Medicine
15-17 Tavistock Place
London
WC1H 9SH
•United Kingdom
•
PRIME
programme for improving mental health care
Dr Sayed Aqeel Hussain
Dear Dr Hussain
We would like to welcome you as a collaborator on PRIME in your capacity as research collaborator with the India PRIME group. Rahul Shidhaye, Sanjay Shrivastava and Vaibhav Murhar have been identified as your contacts within PRIME.
As a PRIME collaborator we invite you to contribute to the outputs of PRIME. Guidelines for the access to and sharing of data are outlined in the PRIME Publication Policy (attached).
As a collaborator on the PRIME project, you will receive general information about PRIME activities and policies. We look forward to collaborating with you,
Yours sincerely,
Ms Erica Breuer A/Prof Crick Lund
PRIME Project Manager PRIME CEO
on behalf of PRIME
Centre for Public Mental Health Department of Psychiatry & Mental Health University of Cape Town
46 Sawkins Road, Rondebosch, South Africa 7700
Tel: +27 21 685 9106 Fax: +27 21 685 1223 www.prime.uct.ac.za
Evidence for Impact in Mental Health & Development
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001359
Dear Vikram,
Please see the mail below from Aqeel.
I was in Srinagar last Friday and Saturday and it was great experience to witness the interest and enthusiasm of Aqeel, Muzaffar and their colleagues in improving mental health service delivery in the Kashmir valley. I represented PRIME as well as you!!!
They honored you with a memento and I accepted it on your behalf. I will hand it over to you when I meet you next in Delhi.
I must say that you really missed a great event in the most beautiful part of our country. I hope that we are able to build on this momentum and take this initiative forward.
Best,
Rahul.
Principal investigator for PRIME
•Vikram Patel
•26 Sep (3 days ago)
•to Rahul, me
•Glad to hear the training went well, and thanks to Aqeel for the memento.
Vikram Patel, FMedSci
Professor of International Mental Health and Wellcome Trust Senior Research
Fellow in Clinical Science
Centre for Global Mental Health, London School of Hygiene and Tropical
Medicine
Sangath, Goa, India
Centre for Mental Health, Public Health Foundation of India
Address: Sangath Centre, Alto Porvorim, Goa 403521, India
www.centreforglobalmentalhealth.org
www.sangath.com
www.phfi.org/our-activities/research-a-centres/centres-of-excellence/869-cen
tre-for-mental-health
www.globalmentalhealth.org
Dear Aqeel
Thanks very much. Well done on the a successful training. Keep it up. Best Wishes
Kamaldeep Bhui
•Professor Kamaldeep Bhui
,Professor of Cultural Psychiatry and Epidemiology
.President elect of World association of cultural psychiatry
and Congress President for the Third World Congress of Cultural Psychiatry
Editor of British Journal of Psychiatry
RE: MOU between Royal college of psychiatry and kashmir governmentKamaldeep BhuiFebruary 1, 2014 7:28 AM
That is wonderful
Dear Aqueel
I think public mental health Perinatal mental health Treatment of depression and PTSD Tackling social determinants to prevent illness are all relevant
You might be interested in tefugee mental health
Would they be interests in military psychiatry and prevention of extremism
Happy to help
Best wishes
Kamakdeep Bhui
Professor Kamaldeep Bhui
,Professor of Cultural Psychiatry and Epidemiology
.President elect of World association of cultural psychiatry
and Congress President for the Third World Congress of Cultural Psychiatry
Editor of British Journal of Psychiatry
Dear Aqeel and all
Congratulations on a very successful event and wish you further success in your efforts.
I am sorry that I could not join you but hope to join you at the next opportunity .
Dr Mohammad Al-Uzri
,Consultant Psychiatrist Leicestershire Partnership NHS Trust
.Helped establish and chaired the Iraqi Sub Committee of the Royal college of Psychiatrists
VIEWS OF ONE OF THE TRAINERS FROM ROYAL COLLEGE OF PSYCHIATRY ON MENTAL HEALTH GAP TRAINING IN KAHSMIR
Aqeel,
it was a privilege to play a small part in you achieving your dreams. I know you and Muzafar have the drive and dedication to keep this going and make a real difference for people in Kashmir. Many congratulations to you both. Thanks also for your wonderful welcome and all the care and hospitality we had with you. Please pass this on to Muzafar, too as I don't have his email. Thanks again- it was an honour to see what can be achieved
With all best wishes,
Sally
Outcome of meeting between Prof Sue Bailey President of the Royal college of Psychiatry and Dr Sayed aqeel Hussain on 14 Feb
Dear Sayad,
· It was really good to meet you last Tuesday and I am really impressed by all the work that you are doing in trying to take forward both mental health and public mental health services in Kashmir.
· I suggested to you that you needed to make three priorities;
· 1. To proceed to a model as in Iraq and also as carried out by Peter Hughes for some mental health gap training. You have a paper by Peter Hughes that gives you a model.
· 2. To work out a priority plan on what you would like to achieve over the next ten years. When you send that back to me I would be very happy to discuss it with you again. We have also suggested asking Professor Dinesh Bughra, as the President elect to the WPA, for his advice.
· 3. How you are going to spearhead any of this work while carrying out all your other commitments and whether there was some way you could look towards a more formal role in service development in Kashmir.
Once again best wishes.
,Sue
Professor Sue Bailey
President
Royal college of psychiatry
Recommendations of President of the Royal College about mhGAP Training in kashmir
Dr Saleem-ur-Rehman
Director
kashmir Department of Health Service
Old Secretariat
Srinagar Kashmir
India
Dear Dr Saleem-ur-Rehman
Re: Royal College of Psychiatrists & Directorate of Health Services kashmir mhGAP training Programme, 16th September to 27th september 2013.
I am pleased to enclose the details of the WHO mhGAP training programme that was carried out in Kashmir during September 2013.This report has been prepared by Dr Sayed Aqeel Hussain who was instrumental in setting up this successful training for doctors and health professionals. Dr Hussain would be well placed to advise on any follow up activity you would wish to make.
Yours Sincerely
Prof. Sue Bailey
President of the Royal college of Psychiatry
Copy to Mr Gazanfar Hussain Commissioner /Secretary Health and Medical Education.
Dr Sayed Aqeel Hussain Consultant Psychiatrist.
PS DUE TO COPYRIGHT ISSUES REPORT CANNOT BE PUBLISHED HERE
The Challenges faced in the Mental Health Field in Kashmir which were highlighted and tabled by Dr Sayed Aqeel Hussain on behalf of Mr Gazanfar Hussain Commissioner/Secretary Health and Medical Education in the International Advisory Committee of the Royal College of Psychiatry London as part of resolution which was unanimously passed by the Advisory committee in Dec 2013 leading to formally accepting of the proposal to sign Memorandum of Understanding with the Health & Medical Education Department Kashmir J&K India.
1. Larger treatment Gap in universal access to mental health services.
2. Lack of Technical support including a range of inputs from establishing a Mental Health information system to human resource planning and implementing clinical management protocols.
3. Absence of uniform guidelines and technical support, the objectives of the program were interpreted differently in different states
· For example, the integration into primary health care and the desirability of specialist facilities or satellite outpatient clinics was interpreted by DMHP districts in different ways.
· In most places, the DMHP was reduced to specialist enabled outreach clinics rather than primary care based delivery of mental health services supported by the specialist.
4. Lack of clarity of the goals of the District Mental Health Programme
· One review found that 85% of the health personnel stated that Spreading Awareness is the main purpose of DMHP, followed by Integrating mental health and general health services is the second most important purpose (69.9%).
5. Poor inter-ministerial and inter-sectorial coordination
· Rehabilitation is the responsibility of the Ministry of Social Justice & Empowerment
· Mental health is the responsibility of the Ministry of Health and Family Welfare.
· Many persons with mental illness, especially those with chronic mental illness require a combination of medical treatment and rehabilitation to facilitate recovery.
6. Poor inter-departmental co-ordination at the State Level
· Departments of Psychiatry in GMC come under the Directorate of Medical Education
· Primary Health Centres are under the Directorate of Health Services or Directorate of Public Health in most states.
· In many states, the lack of co-ordination between these two Directorates impacted negatively on the implementation of the DMHP.
7. Deficit of simple treatment guidelines used by PCHW in identification and management of mental illness.
8. No technical support group to prepare and deliver such guidelines.
9. Lack of focus on the rights of person with mental illness.
10. Lack of sensitization staff to avoid rights violations
11. Poor information base for planning service.
12. No information on attendance and clinical and functional outcome.
13. Mental Health not included into Health Monitoring Information System.
14. Absence of state and central monitoring systems reduces accountability.
15. Nonexistent essential and periodic reviews with no scope for innovation.
16. No information on outcome of treatment.
17. Inadequate Human resources and training: Lack of appropriate and trained human resources, rigid recruitment criteria for specialists and lack of involvement of non specialists.
18. This uni-dimensional approach on an isolated medical model focused on symptom reduction with medicine and not on recovery using a holistic bio-psycho-social approach.
19. Emotional suffering in the region since 2 decades of ongoing turmoil.
20. Just 25 to 30 trained psychiatrists for the population of 6 million.
21. Little data on availability on psychological and psychosocial treatments. Only few patients reported access to counseling services.
22. Psychologists and social workers were largely utilized for administrative work and had little time for intervention with the clients of program
23. Inadequate provision of care for full range of mental illness
· No systematic provision of services with alcohol and substance use disorders.
· Similarly services for mental illness at the two extremes of life viz child and adolescence
· Children with development disabilities are provided by ministry of social justice and empowerment
· Some school counseling services are provided by ministry of human resource and development
· Older people were notable only for their absence.
RECOMMENDATIONS ABOUT MOU BETWEEN ROYAL COLLEGE AND KASHMIR GOVERNMENT
FROM SHEKHAR SAXENA DIRECTOR WHO MENTAL HEALTH AND SUBSTANCE ABUSE
Dear aqeel,
very pleased to hear this good news. I would suggest three areas:
Scaling up of mental health services, for mhGAP priority conditions
Training to primary care providers in treating disorders specifically related to stress. (WHO has a new mhGAP module on this).
Psychological First Aid training to health care, social care, emergency, police and other staff.
Best regards,
Shekhar Dr Shekhar Saxena
Director
Department of Mental Health and Substance Abuse
World Health Organization
CH-1211, Geneva, Switzerland
PROFESSOR AJIT AVASTHI
Dear Sayed Aqeel Sahib
Heartiest congratulations! I am so delighted. I fully agree with the suggestions of Shekhar and the same should be incorporated in the MoU, Royal College can provide expertise, but I am not too sure whether they can provide any funding assistance.
Warm regards,
Dr. Ajit Avasthi, MD
Professor
Department of PsychiatryPostgraduate Institute of Medical Education & Research,
Chandigarh 160012 (India)
PROF VIKRAM PATEL
Dear Aqeel
I am glad to hear of this development and have no doubt the College will be able to make contributions to strengthening the mental health system in Kashmir. I have no direct involvement with the College’s international activities and am therefore not sure exactly what they can offer, I suggest you should ask them this question and then the Kashmir partners can decide which of these suggestions are most valuable for their needs.
Vikram
Vikram Patel, FMedSci
Professor of International Mental Health and Wellcome Trust Senior Research Fellow in Clinical Science
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
Sangath, Goa, India
Centre for Mental Health, Public Health Foundation of India
Address: Sangath Centre, Alto Porvorim, Goa 403521, India
www.centreforglobalmentalhealth.org
www.phfi.org/our-activities/research-a-centres/centres-of-excellence/869-centre-for-mental-health
PROF INDIRA SHARMA
Dear Sayed,
Congratulations for the endeavor. You may prepare a document ad submit it the Ministry of Health and Education and to IPS. IPS may endorse it as such or suggest modification which can then be submitted to the Govt.for adoption
Thanks.
Professor Dr Indira Sharma
PhD (Forensic Medicine), MD, MAMS, Dip Yoga Sc, MIBRO
President, Indian Psychiatric Society
President, SAARC Psychiatric Foundation
Vice President, Asian Federation of Psychiatric Associations
Professor of Psychiatry
Head, Child & Adolescent Psychiatry Unit
Department of Psychiatry
Institute of Medical Sciences
Banaras Hindu University
Varanasi-221005, Uttar Pradesh, INDIA
The Statement of President of Royal college of psychiatry
The Royal College of Psychiatrists is committed to supporting mental health care and mental health education across the world. Our volunteer scheme was set up with this core belief in mind and I am very pleased that our College members are prepared to offer their time and expertise to volunteer in this way.
I am delighted that this initiative has come to fruition and thanks are owed to Dr Sayed Aqeel Hussain and Dr Peter Hughes for all their hard work in setting up this training. I hope that the participants find the experiences enriching and rewarding.
Professor Sue Bailey
President
Royal College of Psychiatrists
Advice from college regarding organising mhGAP Training
Hi Ms Cook,
Thank you for your response and the interesting report on mhGAP Kashmir.
Are you able to direct me to another contact who may be able to co-ordinate this training? I have already spoken to Dr (Peter) Hughes and he appeared optimistic.
Will an active stance and sponsorship from our end facilitate matters? There is considerable interest on ground among local psychiatrists and it will be a shame to let this wonderful opportunity go.
Please let me know.
Jay
Dear Dr Chatterjee
Thank you for your email.
In the past the College has been able to provide volunteers to deliver intensive mhGAP training to mental health professional and to primary care workers. In September 2013 the College sent volunteers to Kashmir and the report from this training is attached for your interest.
Such projects require a lot of co-ordination and organisation from the “hosts” – the College can offer advice at various stages but unfortunately does not have the resources to set up and manage such a scheme.
Do let me know if you need any other information.
Kind regards
Elen
Dear Jay
Thank you for your email. I hope I was not discouraging in my previous e-mail – it is certainly possible to arrange this sort of training but we have found that they key is having an active contact on the ground (and the size of the task should not be underestimated!). Peter was key to setting up the training in Kashmir and will be able to give advice but the leg work needs to be done by those on the ground.
Once we have an idea of the numbers looking to be trained and some possible dates then we will advertise for volunteer who can deliver the teaching. We generally have a very good response when we ask for volunteers to do one or two week training placements. Funding is an issue – our volunteer funds a very low and we can no longer fund flights for volunteers, although we may be able to make a donation towards them – naturally we get a lower response from volunteers when there is less funding available, but some volunteers are prepared to cover the costs of flights themselves. It is greatly appreciated if some or all of the local arrangements (transfers, accommodation, meals etc) can be covered by the local hosts.
If you would like to speak to people who have organised these kinds of training events then you could contact Dr Sayed Aqeel Hussain - sayedaqeel@gmail.com who arranged the Kashmir traiing.
Dr Khalid Saeed - Saeedk@emro.who.int – is out contact at the WHO and has previously used College volunteers to deliver mhGAO training in Sudan.
If you would like to speak to me about any of this then I am available on the number below today and tomorrow.
Best wishes
Elen
Elen Cook
International Liaison Manager
Royal College of Psychiatrists
Tel: +44 (0) 2037012584
INVITATION FOR POSTER PRESENTATION AT INTERNATIONAL CONGRESS OF PSYCHIATRY LONDONDear Dr hussain
Royal College of Psychiatrists International Congress
24-27 June 2014, London
www.rcpsych.ac.uk/congress
I am pleased to inform you that your abstract entitled mhGAP training in Kashmir has been accepted as an electronic poster presentation at this year’s Congre
ss. We are introducing e-posters this year due to an unprecedented number of submissions. Electronic posters will be available for viewing on the congress app, College website and viewing stations at the venue. All electronic posters, as well as physical posters, will be credited in the printed programme and certificates of presentation will be available if requested
VIEWS OF TRAINERS ABOUT TRAINEES
Trainers were very impressed by the knowledge, enthusiasm and motivation of the group. The participants all made enormous progress. Compared to European teaching situations there was extraordinary discipline and concentration in the group. At the same time students were active and not shy to give ideas for improvement and constructive criticism. Overall it was a truly worthwhile experience for us.
FINAL COMMENTS BY TRAINERS
“Thanks to the vision and excellent organizing skills of Dr. Aqeel this was a truly extraordinary and intense learning experience for both the participants as well as the trainers. The mhGAP training is well designed, easy to teach and learn from and very applicable. As one participant commented for her the course has been an “eye-opener” and I think the same can be said for some of the European trainers. Becoming aware how much can be done with little means and how much need and enthusiasm exists here to improve the lives of those with mental illness was at times a humbling experience. Thank You!” .