Stories of success at mhGAP Kashmir: What can we learn?
Dr Sayed Aqeel Hussain (MRCPsych UK) is a Consultant Psychiatrist, Master Trainer and International Coordinator for mhGAP in Kashmir, and coordinator and organiser of the mhGAP psychiatry exchange programme.
Earlier this month, Psychiatry postgraduate student and MHIN member Dr Syed Bushra Imtiyaz was awarded a fellowship to present at the annual Indian Association for Geriatric Mental Health conference, held in Chandigarh India. Her presentation described the theoretical knowledge and practical experience from a project in which a group of five student-doctors from Kashmir gained first-hand experience of how mental illnesses are approached and managed in the UK National Health Services (NHS) as compared to Kashmir, a conflict zone with limited resources. The competitive selection of this project for presentation was an honour because only 30 participants were selected from all the medical colleges across India.
The idea of initiating the project originally developed around a coffee table in a café in London, where myself (Dr Sayed Aqeel Hussain), Dr Peter Hughes (mhGAP Trainer) and Dr Roxanne Keynejad (an intern at the time and foundation year doctor) all met. There, we discussed adapting Aqoon, the peer to peer global mental health e-learning project co-founded by Dr Roxanne Keynejad and Dr Jibril Handuleh of King’s Somaliland Partnership, with the idea of piloting the Aqoon model using mhGAP.
The aim of the project was to increase the opportunity among medical students to discuss, share, and experience the delivery of mental health services in two different cultures, along with the challenges they faced - which were unique to each setting. This would lead to an understanding of how mental health services can meet culture- and setting-specific challenges, in order to deliver high-quality services to those in need. Importantly, this would also help the medical students make a better-informed decision on whether to choose psychiatry as a career, and to deliver high quality care in spite of challenges.
Following the meeting in London, an interactive session was held at Government Medical College Srinagar where project design was discussed and students shared their views and recommendations, as well as how they felt this project was going to help them increase awareness about the mental health presentations across various cultures, the challenges faced, and how they were dealt with by service providers in different cultures and settings.
After formulating the blueprint of the project - an online interactive exchange programme discussing various modules of the WHO mhGAP interactive guide, followed by two weeks’ clinical observership - we invited applications from students from UK and Kashmir medical schools. Five pairs of students (1 Kashmir/1 UK) were selected by Dr Roxanne Keynejad and myself.
The project started with students filling out a pre-test questionnaire devised by the WHO to gain insight into their awareness regarding mental health conditions. This was followed by online interactive sessions lasting for nearly 6 months, and all 10 students successfully completed the online interactive project. The students then completed a post-test questionnaire and gave feedback about their experience, which was analysed, evaluated, and presented at the International Congress in London. Students from both sides reported their experience as quite positive, and reported that it increased their insight into management of mental health conditions in different cultures. The students found the mhGAP interactive guide structured and easy to follow as a ‘universal’ tool to be adapted and used across settings. They also acknowledged that after the project they considered psychiatry as a field for their future professional career.
Following the signing of an MOU* between the Royal College of Psychiatrists London and Kashmir Government (see below) we initiated the practical component of the student interactive project. The five medical students from Kashmir (Dr Syed BushraImtiyaz, Dr KhurramMaqbool, Dr Hena Amin, Dr SukpreetSodi and Dr SuhailSaifullah) were sponsored to visit the Lincolnshire Partnership NHS Foundation Trust, where they experienced the delivery of psychiatric services in both inpatient and outpatient settings, and gave presentations about their experiences. They later described their experiences in this news article.
Following the successful completion of the project, all five students considered Psychiatry as a future professional career, and so far Dr Syed Bushra Imtiyaz has passed the selection examination and joined in the Institute of Mental Health and Neurosciences Kashmir as a postgraduate student.
Dr Syed Bushra Imtiyaz was additionally selected to present at the Geriatric Mental Health conference. Her poster describing the project and results is below, and she recounts her experiences in the project in her follow-up blog.
I would like to share the support and appreciation shown to her by MHIN for successfully completing the project and being selected for the fellowship programme. Special Thanks to Professor Ajit Avasthi, Head of the Department of Psychiatry, Post Graduate Institute of Medical Education And Research, Chandigarh, for organizing the GERON 2017 Conference and considering Syed Bushra Imtiyaz for the Fellowship programme.
* Following the successful completion of the online interactive portion of the project (alongside the mhGAP training programme, in which more than 200 professionals including doctors, nurses, social workers, psychologists, teachers and allied professionals have been trained by more than 12 psychiatrists), the Royal College of Psychiatrists London and Kashmir Government signed a Memorandum of Understanding to continue collaboration to develop and share experiences in delivering mental health services in the two settings. The MOU was signed by Professor Sir Simon Wesley, President of the Royal College of Psychiatrists London, and Mr Gazanfar Hussain, Commissioner/Secretary of Health and Medical Education Jammu and Kashmir.
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