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

Name of Facilitators		Week	Gender        mhGAP ExP
Dr. Peter Hughes             FRCPsych	Adult Psychiatrist-UK	1	M	Yes
Dr. Sophie Thomson      MRCPsych	Learning disability/Psychotherapist Psychiatrist-UK	1	F	Yes
Dr. Eleni Palazidou          MRCPsych	Adult Psychiatrist-UK	1	F
Dr. Jane Mounty               MRCPsych	Adult Psychiatrist-UK	1	F	Yes
Dr. Henrike Klasen          MRCPsych Phd	Child Psychiatrist-NL	2	F	Yes
Dr. Sally Browning           MRCPsych	Adult Psychiatrist-UK	1	F	Yes
Dr. Lucy Potter                 MRCPsych	Adult Psychiatrist-UK	2	F	Yes
Dr. Sajad Yousuf              MRCPsych	Adult Psychiatrist-UK	1,2	M	Yes
Dr. Mina Bobdey              MRCPsych	Oldage/neuro Psychiatrist-UK	2	F
Dr. Aqeel Hussain            MRCPsych	Adult Psychiatrist -Kashmir	1,2	M	Yes
Dr. Muzaffar Khan	Psychologist-Kashmir	1,2	M

 

 

 

Overall comments by trainers:

 

The course was very well organized, the accommodation good and the food excellent. Thanks to Dr. Aqeel and Dr Muzaffar on the whole we felt very well looked after and safe at all times.:

 

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.

 

Overall trainers felt more time was needed if one wanted to follow the full modules as designed by WHO mhGAP (35 hour instead of the 23hours we had). When trying to follow the slides training had to be rushed at times. The slides did not always correspond to the manual and there were too many slides (sometimes up to 80 for one module). Slides frequently had a lot of text on them and it might be good to edit them. Many participants asked about a module on anxiety disorders/OCD as this seems to be a major problem in the area. For the non-Indian trainers it would have been good to do some field visits to get a better impression of the situation locally and to apply teaching better to local circumstances.

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Impressed by students. Sometimes hard to control as talkative. Knowledge good. Participants struggled to cover DEP and OTH together. Golden questions and problem solving could be included in mhGAP. Parenting tips need to be clearer.

Need to cover OCD, anxiety. Big box for breathing exercises. OTH needs to be improved and linked to DEP and STR. Issue of people with dysthymia and somatization for years needs address.

Stress module needs specific headings such as conversion disorder. MhGAP needs a more explicit physical screening at the beginning.

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Need to be clear for future trainings that PowerPoint facilitator slides are for mini-lecture only then group work based on mhGAP. Timing in the facilitator guides is unrealistic.

Drug chapter is very important for Kashmir. Epilepsy, dementia not seen as so much of a problem. PSY is referred on readily.

Somatoform disorders need to be more fully emphasised in any training in Kashmir. Anxiety disorders including OCD very important for Kashmir.

 

Students were knowledgeable and keen to participate. Keen for practical skills that could use.

Need cognitive test for DEM that can be used easily. Needs to be in mhGAP. Problem solving important to be more explicitly covered in mhGAP.mhGAP can be too waffly at times. Simpler language needed

Some revision of mhGAP in terms of language and structure needed.

BEH is repetitive and confused in layout. Need to emphasize practical information.

 

Important to meet before in London before training. College could help facilitate more in terms of preparations before travel.

Impressed by students and high standard. Hospitality impressive. mhGAP is comprehensive. Golden questions are very useful.

PowerPoint’s could match mhGAP IG more

 

No previous exposure to mhGAP so took time to get to grips with it. Easier if had done some training before. Some chapters could be covered quickly. Need to have more on interview skills and communication. Manual could be shorter. PowerPoint presentations could be linked to mhGAP more

 

Students were very knowledgeable. Lot of engagement about mhGAP.Some difficulty translating into ways of asking on Kashmir. Self harm. Need culturally appropriate ways of asking questions. Good manual, much appreciated. Need local adaptation. College could help more with visas and help around trip.

 

Well organized. Lot of hard work put in. Facilitators for students and materials very good. Beautiful folders. . Buses on time apart from day 1 even with hartal (strike day). Good mixture of professions. . Groups enthusiastic. mhGAP a little but difficult to follow. Slides are very good but a bit long and hard to match with mhGAP. Need to go forward and backwards with slides. Anxiety should be separate chapter. Somatization is overwhelming problem. Supervision was a good sessions. Overall comments that should be longer than 5 days, use real patients, visit to local PHC and patients, video of patients, supervision systems in place from start of training and timetable, Identify future trainers a useful exercise.

 

To make difference on ground level work has to continue, and for that training local psychiatrist and mental health worker to deliver the modules is essential. Module and delivery methods have to be modified to local needs, keeping local culture in mind. Human and monitory cost is not sustainable if foreign trainers deliver modules and it is more cost effective to train locals and get them to train others with supervision. At times it felt some of the basic things we were suggesting psychiatrist and GPs present found very difficult to understand, hence having a separate group work for medics would be more helpful.

Finances were transparent with registration fee to show commitment. However was generally waived for many and programme was not for profit.

 

“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!”