#studyGMH: student perspectives from the AFFIRM Fellowship

Broadening the horizon 

Megan Malan, self-funded student, and a registered Counselor working in Midwife Obstetric Units in Cape Town, South Africa. She registered for the AFFIRM (African Focus on Intervention Research in Mental Health) MPhil in 2014 and is currently completing her analysis and writing up.

In the beginning of our introduction week to the MPhil course, I found myself overwhelmed by all that lay ahead for those of us embarking on this academic journey. However this past year and a half I have learned an enormous amount about research, its procedures as well as the importance and benefits thereof.

I firmly believe that through my journey as an MPhil student I am now able to conduct research, understand academic journals more accurately and, more importantly, get to experience all aspects of research, from collecting data to analysis of the data.

Working as a registered counselor in Mitchells Plain Midwife and Obstetrics Unit (MOU), I was interested in the levels of intimate partner violence experienced among pregnant women. I was fortunate enough to be working in a field where I would later conduct my data collection. I got to experience first-hand the functioning of the MOU health care facility, and what services were and weren’t available to the pregnant women. Adequate mental health services is one such service which is lacking from this particular health care facility. I have been able to experience what data collection entails in such a setting, the challenges that are faced with lack of understanding, and the importance of mental health services, time, space, staff relationships, just to name a few.

"Being an MPhil student has enabled me to broaden my views"

Thus far my contributions to the field have included identifying women who might be experiencing intimate partner violence during pregnancy. I am able to offer immediate and adequate counselling and education around intimate partner violence as well as provide information about other services and shelters in the community.

Being an MPhil student has taught me the value and importance of disseminating results, and through proper networking I feel that I will be able to disseminate my findings through my working relationship with the staff (nurses, doctors, counselors, social workers, etc) at the facility so that awareness is created and psycho- education can take place. A need will be created through such awareness. If staff are able to identify a need for mental health services and bring it up in weekly and monthly meetings, the need will be recognized. 

Working at the MOU on both the service delivery and the research side of things has allowed me to gain a closer look at how the internal working of such facilities operate, which in turn provides opportunities for disseminating valuable information across these internal workings to the facility manager and sister in charge. Also, I have managed to work closely (network) with certain drug rehabilitation centers in the community, various other home based lay counselling services, as well as social workers and mental health nurses from different clinics. My study`s finding would be able to be accessed broadly within these networks. Education should be provided not only to patients but also to the staff working in these health care facilities as well.

Being an MPhil student has enabled me to broaden my views. And therefore I believe mental health service delivery in health care settings across Africa cannot exist without proper research.

Life changing realizations: a student’s role as a researcher

Nyamadzawo Chivese is an AFFIRM Fellow and Psychiatric Nurse working in Harare, Zimbabwe. She registered in for her Mphil in 2015 and is currently preparing her study proposal for review and ethical approval.

Having worked as a clinical practitioner for over a decade, I never imagined myself as a researcher. My dream was to become a nurse practitioner. When I searched the internet, it would be to look at current events that are happening across the globe, except when I was doing an assignment. Thus my database consisted of newspapers. For me, coming to Cape Town for the Masters in Philosophy: Public Mental Health was a means of obtaining that criterion. Before coming for the program, when one would ask me what I would do after the program, I did not know how to answer. I would only tell them that I would have obtained a qualification.

I have done research studies in the past in partial fulfilment of the diploma in psychiatric nursing as well as the Bachelor of Science Nursing Education. I came for the MPhil program from that background.

The initial lectures were from a background that I had some knowledge of, and so I was “comfortable” as I had a little background and was adding to my prior knowledge. New items such as statistics and statistical analysis using a software system were interesting and eye opening. My wake-up call was when we went through the workshops on writing an academic paper. This was when I realized that I was no longer a clinical practitioner offering bedside services. I am now a researcher. My responsibility now is to question phenomena, and to investigate its role and impact on the mental health of individuals, families, communities or society. Now when I search the internet, it is for information that can enable me to contribute to the welfare of others and the community. If anyone asks me now what I am or will be after the program, I can lift my head up high and respond that I am a researcher, an investigator. I am now an academic person.

Thank you very much African Focus on Intervention Research in Mental Health (AFFIRM) for the opportunity to allow me to discover the new me. I have now shifted my focus and am willing to contribute to the welfare of others. Thank you all at the Alan J. Flisher Centre for Public Mental Health, you made a life changing impact on my life and career path. Thank you all, this was a life changing moment for me. 

“I can lift my head up high […] I am a researcher, an investigator.”

Adding to the body of evidence: a crucial role for students

Michael Udedi is an AFFIRM fellow and Assistant Director of Clinical Services (Mental Health) in Malawi. He registered for his MPhil in 2012 and graduated in 2013. 

As a recent graduate from the AFFIRM MPhil, I have been able to make many contributions to the field of global mental health. In my role in the coordination of mental health services at the national level in my country, I have contributed to the field by developing the mental health action plan, as well as being involved in reviewing the mental health policy, programme, services and various research projects.

With the knowledge gained from the MPhil programme I have been able to appraise, synthesize and research evidence in order to inform policies in my line of duty, for example during the review of the mental health policy. I have also been able to instigate the initiation of various mental health services, for example I recently assisted the Christian Hospital Association of Malawi (CHAM) institution to establish services on mental health.

"students can play a crucial role in field of global mental health"

I am currently involved in different research projects within my unit where I make various contributions at various stages. Importantly, I have also published papers (see links below) in different local and international journals, which policy makers, program managers, technical people and academics can access and use in their line of duty.

The most important factors that enabled me to contribute to the global mental health field include the mentorship during the Masters course, the fellowship opportunity I had from AFFIRM for the short course on Randomized Controlled Trial in November 2013, and finally the fellowship through AFFIRM for the Implementation Science for Public Health Intervention Distance Learning Course in 2014.

I feel the students can play a crucial role in field of global mental health, specifically through research in areas which can add to the body of evidence. This evidence is important for informing policies, which in turn will improve global mental health. Students could be empowered through the following opportunities:

• mentorship programmes
• providing them with research funding which would help them conduct research
• fellowship opportunities to attend short courses
• volunteering opportunities

To learn more about Michael Udedi, see his researchgate and linkedin page. You can also access his publications here:

• http://intl-isp.sagepub.com/content/60/5/454.abstract
• http://intl-isp.sagepub.com/content/61/2/121.abstract

The science of mental health innovation

Lynda Nakalawa is an AFFIRM fellow and Clinical Psychologist working in Kampala, Uganda. She registered in 2012 for her Mphil and has recently been informed of her success in passing her dissertation.

I was one of the AFFIRM sponsored pioneer Mphil Public Mental Health class. Although my Mphil dissertation focused on "Perceptions of mental illness among HIV counselors in Uganda", today I offer free online mental health counselling/coaching to young people. These may sound like disconnected ideas, but they both speak to my core learning experience on the program. I was motivated to help bridge the gap between clinical mental health knowledge and community needs, and translating mental health services and information into language that is accessible to the lay community. Therefore, to reach adolescents, I set up a free online mental health service at http://www.free2live.net, which offers young people in Uganda an opportunity to be the champions of their own mental health.

My motivation for setting up the website is two-fold:

1. One is to make young people in Uganda aware, and talking about mental health issues and how they associate to their daily life, and perhaps knowing that there is help available for issues they are grappling with. The mental health issues among the young generation in Uganda include substance abuse, depression/anxiety, including conversion problems. Mental health service providers have knowledge about these problems among adolescents in Uganda, but in a rather academic way.

2. The other motivation for the website therefore is to provide a platform to hear about what the actual issues are; from the horse's mouth as it were. To this end, I write blogs that apart from making for interesting reading, I weave in mental health information and invite readers to comment. My hope is that over time I can build a bank of knowledge about lay conceptualizations and needs regarding adolescent mental health in Uganda, which goes beyond academic knowledge. 

I have a number of young people talking about the website, especially through social media, with over 400 facebook followers since the websites' inception in November 2014. Most people involved in teletherapy know that this may not mean much, given adolescents' tendency to "like" pages without necessarily being interested in the content. However I am fascinated with exploring innovative methods of starting and maintaining dialog on mental health with these "digital natives".

I have also had a positive response from my students (I teach undergraduate community psychology), who say that the language of the website appeals to young people. Also, some of my students have been motivated to set up their own community mental health initiatives. I see myself as a mental health advocate, and am happy to use my position as a teacher to inspire the next generation of mental health service providers in Uganda to carry services from the clinic into the community, even as I proceed on my own education journey. For this, continued mentorship will be an invaluable resource to help ensure that the science of mental health intervention is not lost, but can be supported by continuous dialog with the actual and potential mental health service users in Uganda.

“I am fascinated with exploring innovative methods of starting and maintaining dialogue on mental health”

Exploring pertinent issues in public health and interventions

Rabia Khan is an AFFIRM fellow and a psychiatrist working with adolescents in Harare, Zimbabwe. She registered for her Mphil in 2014, and is currently completing her analysis and writing up.

I finished my Masters degree in Psychiatry in 2013 and the following year I joined the MPhil public mental health program. Before that my research experience was limited to the one and only quantitative research project, which I performed as a requirement of my Masters degree. I was very anxious about my choice of research methodology which was required for my MPhil project, but at the same time I wanted to explore this avenue with the assured research support through MPhil. This MPhil program gave me the knowledge and the support to explore qualitative research methods. Supervisors are a pertinent support, and during one-to-one discussions with your supervisor, you learn the practical aspects of research. Another important aspect of this course was emphasis on economic aspects. The economic analysis of the situation is an important way to impress people in authority, to write a policy brief or convey message to donors or politicians. Even talking to the general public, impact of disease in the form of DALY’s is important to bring the attention to mental health.

While attending the course, I came across a few colleagues with similar interests. We shared our interests and ended up doing a research project together. This research project comprises validation of screening instruments for common mental illness and depression among adolescents in Zimbabwe. Validation of such tools is an important part of public mental health by improving detection of mental illness and timely referrals. So networking is an important part of this course.

As a part of mental health promotion and prevention, I also presented to audiences like school teachers, counsellors and general practitioners on screening for depression. Talking about the impact of illness in the form of DALY’s helped the audience to understand the importance of the disease. Detailed lectures and discussions during the lectures about public mental health prompted me to take such actions on a small scale.

As a student, our role is to explore pertinent issues in public mental health and also to start looking at the interventions. This programme can be further improved by linking the MPhil to funding opportunities for a PhD. If we have explored an issue at MPhil level, a PhD should help us to work on interventions to try and solve such issues. Assisting students to publish their findings is important and, if relevant, study findings should be made available to a wider audience in the form of policy briefs, newspapers or attending conferences.

“As a student, our role is to explore pertinent issues in public mental health”

Inspiration and motivation: a move to greater heights

Connie Olwit is an AFFIRM fellow, and a Mental Health Nurse working in Kampala, Uganda. She registered for Mphil in 2014, and is currently completing her analysis and writing up.

As an Mphil student, I have been inspired and motivated to move to greater heights in my career as a mental health nurse. The program has influenced my ability to contribute towards research, education and clinical practice. First and foremost, I was inspired to publish my old research works, which were all in the field of mental health, in peer-reviewed Journals. This was after getting professional advice from experienced researchers from the Mphil program who made me feel that it was possible, however challenging it is to publish research work. Now I move with the saying “if you don’t publish, you perish.”

Secondly, I have been able to inspire more students to specialize and carryout research in the field of mental health. Currently I am supervising two students conducting studies in experiences of caregivers of mental health patients and epilepsy. I believe this is going to attract more specialized health professionals to practice mental health, a field that is just developing in Uganda.

With the experience I got from the University of Cape Town, I learnt the importance of professionally engaging students and supporting them in a friendly learning environment. I have been able to replicate this experience in my class by creating a conducive environment that enables my students to freely interact and consult with me.

One of the factors that has contributed to my growth has been networking both locally and globally. I have received mentorship and support from psychiatrists from the department of psychiatry Makerere University and University of Cape Town which have been very helpful. A flexible and conducive environment gives me time to participate as a fellow in the program. I have also been able to submit an abstract and secured funding to attend an international conference (5^th Malawi Mental Health Conference) and workshop on Operations research. Having a committed and experienced supervisor has enabled me to progress in my research project amidst busy schedules. I will forever be grateful to Dr. Katherine Sorsdahl who has greatly inspired me and improved my research skills in many ways.

The MPhil program creates an opportunity for students to receive support while undertaking research projects of their interest. This improves one’s ability to fully take charge of their career with support and mentorship. I believe that with more networking and exposure in both clinical settings and research environments, students can be able to get motivation to better their practice. For example, having an opportunity for student exchange in different environments would expose students to different experiences. A forum for all the alumni should be created where they can interact and mentor other fellows. PhD funding and opportunities should be created as a follow up of this program.

"I have been inspired and motivated to move to greater heights in my career"