#studyGMH: student perspectives from the Centre for Global Mental Health
How can students help tackle mental health issues?
During the MSc programme we had the opportunity to have a couple of informal gatherings with the academic staff and other guest speakers at lectures. As a result of networking through these gatherings, I had the opportunity to work as a research assistant at the Psychosocial and Epidemiological Research Unit at the National Institute of Psychiatry in Mexico City. In this position I collaborated on a binational project coordinated by Luis Zayas from the University of Texas at Austin that assessed the psychological distress caused by parent deportation to American citizen children. This research project grew out of the need to create evidence in support of advocacy for fairer immigration laws in the United States. Thousands of families in the US suffer from the incarceration and deportation of family members due to an unauthorized status. I recruited cases for the project and collected data through interviews to assess how a child’s mental health is affected when members of his or her family are in a vulnerable situation, either because of incarceration or deportation or because of the constant threat of these measures. These findings have contributed to the existing knowledge of the effects of immigration and immigration law enforcement and how this social problem is determining the lives of millions of families, and thus affecting health. This research project formed part of the evidence for extensive advocacy that led to an immigration policy reform headed by president Obama.
Later on this year I will be starting my doctoral research project which focuses on a mhGAP based intervention being conducted in the state of Chiapas, Mexico. I hope this project will contribute to the understanding of the impacts of mhGAP based interventions1 in resource poor settings and offer insights into how such programmes can be improved to maximize the benefits to people who have traditionally had very limited access to mental healthcare.
Students can contribute with new and broader perspectives of how to tackle existing mental health issues. I think students can be benefited by opportunities to work in the field, allowing them to experience, first-hand, how mental health interventions are applied. I feel this is particularly relevant in limited resource settings, where the logistics of implementation of interventions are a major challenge that often have to be overcome in creative ways.
“I think students can be benefited by opportunities to work in the field, allowing them to experience, first-hand, how mental health interventions are applied.”
Studying Global Mental Health: A Life Experience
Having gained admission to the Global Mental Health Master's degree at the London School of Hygiene & Tropical Medicine and King’s College London, I moved to London from India in September 2014. Before moving to London I had completed my postgraduate training in Clinical Psychology in India and subsequently dipped my toes in the exciting field of global mental health by working in a project that aimed to develop a contextualized psychosocial intervention for perinatal depression in India. This experience stoked my passion for the cause of global mental health, and motivated me to pursue the Global Mental Health Master’s to further my skills and capacities. It is now seven months since I embarked on this new academic adventure, and the breadth of my experiences have deeply instilled a sense of contentment in me. On reflection, many factors have contributed to this:
1. The course is a learning haven
The structure and content of the course matches the learning needs of students who wish to work in the area of mental health research. The hallmark of the course is the unique collaboration of two institutions of excellence with differing but complementary areas of expertise. The course is jointly offered by the London School of Hygiene & Tropical Medicine and King’s College London, and hence, students learn in both environments and consequently develop both a public health and clinical approach to health and illness. The course heavily invests in providing a rich academic experience, conducive to learning, which allows students to develop and achieve personal as well as professional goals in the long-term. With the course spread across three academic terms, students have an opportunity to strengthen core skills to understand, evaluate and undertake research critical to the field of global mental health.
2. The classroom whets the curious mind
The classroom environment is an exciting mix of didactic teaching by some of the world leaders in global mental health, passionate discussions critiquing core issues in the field, independent learning, and practical skills building. The course on the whole fosters a sense of scientific spirit in its students, and provides excellent opportunities for academic learning and participation in the wider network of public health research.
The single most crucial factor of shared learning environments is its people. The typical tutor in the course possesses immense knowledge and a wealth of experience that one can draw from. The most invaluable lessons have come from learning and working with tutors who are leaders in their own fields, and have worked in the real-world setting. As in any other course, the student community as a whole defines the experiences of individual students in an institute. When one is in the global mental health classroom, one will find students not only from different countries, but different backgrounds and interests, which lends much character to the course. The eclectic mix of students represents the real world setting in global mental health, where cross-setting and cross-discipline collaboration is the norm rather than an exception. As a result, one learns meta-skills that can help foster a spirit of learning and working together, and to build on each other’s strengths.
“The eclectic mix of students represents the real world setting in global mental health”
3. The course is more than a degree, it is a life experience
The future of global mental health lies in leaders who have walked the talk, as well as young people who begin by learning to talk the walk. The degree, with its structure and people, supports and strengthens early career development in the field. Apart from career development, the focus of the course resonates with students at a deeper, personal level. With every passing day in the course I have found that I am being continuously drawn and committed to contribute to efforts directed towards making mental health care more accessible and acceptable.
All of these factors coalesce and form a unique experience that is life affirming, and more importantly, motivates you to be the agent of change for tomorrow.
Strengthening existing interventions: a student’s role
As a recent graduate of the Global Mental Health MSc programme at King’s College London and the London School of Hygiene and Tropical Medicine, I look back on the year as one of the most stimulating and rewarding of my life. One of the best parts of the course was the ability to choose a topic of interest and develop it into a research question for the course’s Summer Project. This gave me the ability to conduct some research on the use of mobile technology in improving the wellbeing of people in resource-limited settings, a subject that has long interested me.
Through my supervisor, I was introduced to the SHM Foundation, a London-based organization doing important work on health and innovation in developing countries. The organization recently piloted Project Khuluma, a pilot study to evaluate the feasibility and acceptability of using mobile phone text messages in providing social support to HIV-positive adolescents. With the setting of the pilot being my home country, South Africa, and the emphasis on mobile technology, I was instantly drawn to the project.
Talking to the director of the Foundation, Anna Kydd, I was excited to be given an opportunity to do some research for my Summer Project using data from Khuluma. I conducted a content analysis using the several thousand text messages exchanged in the pilot. Doing so, I was able to develop an in-depth understanding of the nature of the interactions between the participants. I learnt about the topics that were important to participants, the types of exchanges that featured prominently (for example, asking or sharing personal stories), and the factors that facilitated participation, as well as those that served as an obstacle.
My hope is that the Foundation will be able use the findings of my research to strengthen the intervention as they continue to develop it. Working with the SHM Foundation, I learned a great deal about the complex challenges that go with using mobile technology to create positive social impact. But at the same time, I was also able to witness the substantial potential in doing so. Many developing countries like South Africa face serious resource constraints and have large rural populations, but still have extensive mobile phone network coverage. As such, mobile phone-delivered interventions may offer one avenue for providing access to care where more traditional health services may be limited. Additionally, another benefit of interventions like Khuluma is that they enable anonymous participation. This may be more acceptable than face-to-face interventions to people living with HIV for instance, which sadly continues to carry a stigma in many places around the world.
The rewarding experience of working with SHM Foundation, and the tremendous guidance and support provided to me by my supervisor, have stayed with me since I have returned to South Africa. I now work with non-profit organizations, health projects and university departments as a technical consultant and web developer, building online tools that support these institutions to make a positive social impact.
“I would encourage students embarking on research projects to consider those subject areas they find most interesting [and] speak to many people within the academic community to help focus their ideas”
By focusing their Summer Projects on existing interventions being developed by organizations or research institutions, students may help strengthen these interventions by contributing their own research insights. I would encourage students embarking on research projects to consider those subject areas they find most interesting, speak to many people within the academic community to help focus their ideas, and then to reach out to research teams conducting research on relevant interventions.
Task-sharing: From Local to Global
This time last year I was coordinating a UK-based project aimed at strengthening parenting practices in low-income areas, in collaboration with the Department of Health. Our goal was to design a manualized, evidence-based programme that could be delivered by non-specialists, and to train peer volunteers to run it through the platform of state primary schools and children’s centers.
In many ways, then, I was a convert to the task-sharing approach long before I started the Master’s in Global Mental Health at London School of Hygiene and Tropical Medicine and King’s College London. I’m now working with the Mental Health Innovation Network to examine challenges and key drivers of success in global mental health implementation research, and it’s remarkable how many parallels there are between my UK experiences and those of the innovators we’re interviewing from low and middle income countries.
In both settings we realized the need to enlist motivated non-specialists to deliver the programme, offer services through an established platform, provide clear supervision and support mechanisms, and systematically collect evaluation data before scaling the programme up. There were also common challenges around engaging relevant stakeholders, getting buy-in from community and political leaders, tackling stigmatized issues and establishing quality assurance mechanisms.
The challenges to be overcome in low and middle income-countries are not to be underestimated, of course. Lack of infrastructure and poor functioning of existing health systems are major hurdles to be overcome, and it’s fascinating to see how local innovators are addressing these. Perhaps the biggest lesson coming out of the research I’m doing so far is to know your community (which could arguably be the first commandment of Global Mental Health), placing huge importance on formative research in the design of an intervention. This is something we could learn from in the UK as much as in low- and middle-income countries.
Another major learning point is the focus on capacity building and systems strengthening. It’s moving away from a model of short-term assistance, dependent on external expertise, towards an approach that supports local people, organizations and institutions to provide care in a way that works for service users in that context, with the potential to enact more sustainable change for people with mental health conditions. This is no easy task, but it’s inspiring to see it being attempted, and by joining together to share lessons from around the globe – on failures as well as successes – future implementers will be better equipped to face those obstacles.
“I suspect that the creation of global networks of people working in mental health might just be our best asset”
To one day be able to take a leadership role in developing mental health programmes that make a lasting impact, these are crucial lessons to learn. I’m grateful to have received a scholarship from King’s College which has allowed me to dedicate a year full-time to studying Global Mental Health. It’s this opportunity that has provided me with the research skills and background knowledge to be able to meaningfully contribute to the knowledge-sharing efforts.
Besides the skills I’ve gained, the connections I’ve made through joining the Centre for Global Mental Health have already proven themselves invaluable, and I suspect that the creation of global networks of people working in mental health might just be our best asset. Building on the MHIN approach to knowledge-sharing, I wonder how we can better harness this network of passionate people to help students contribute to the field. Initiatives like creating a Global Mental Health careers network, or setting up an online alumni community to enable students to find out about opportunities, could give future leaders a first step up into the world of Global Mental Health.