#studyGMH: Addressing the burden of mental illness - a new postdoctoral fellowship in global mental health

Student Month Blog Series: Massachusetts General Hospital Global Psychiatric Training Program

 

Anne Stevenson, MSc, is the Program Director for the Massachusetts General Hospital Division of Global Psychiatry.

Jessica Magidson, PhD, is a Psychology Fellow in the Massachusetts General Hospital Global Psychiatric Clinical Research Training Program.

 

The growing recognition of mental health’s contribution to morbidity and mortality worldwide requires greater attention to training clinician scientists to deliver and evaluate mental health interventions in resource-limited, international settings 1, 2. Despite this need, there are few cross-cultural training opportunities and established career pathways for investigators committed to global psychiatry and mental health. The Massachusetts General Hospital Global Psychiatric Clinical Research Training Program was launched in 2012 to develop independent and productive clinical investigators in the US who are committed to mitigating the impact of mental illness in global, resource-limited settings.

Primary Aims of the Fellowship

The goals of the fellowship follow key priority areas for global mental health outlined by the US’ National Institute of Mental Health (NIMH) 3, including:

  1. Recruiting and developing a cadre of high-quality postdoctoral clinical psychology, psychiatry, and public health investigators with motivation and potential for independent clinical research careers
  2. Providing fellows with the financial support, scientific mentorship, didactic training, and supportive institutional environments (domestically and abroad) to develop productive careers in global mental health
  3. Addressing the national shortage of globally-oriented researchers in clinical psychology, psychiatry, and public health to address mental health needs in resource-limited, international settings

Overview of Training Program

Following the stated goals, the program aims to prepare fellows for developmental awards (e.g., from the US’ National Institutes of Health (NIH)), and position them as leaders in global mental health. Fellows receive up to three years of support under the supervision of faculty mentors and program directors. Didactic lectures, research seminars, elective coursework, travel to international sites, and attendance at scientific meetings supplement mentored clinical research.

Thematic areas

The program focuses on eight thematic areas central to global mental health: psychotic disorders, mood disorders, child mental health, behavioral medicine, HIV mental health, health services research, trauma/complex emergencies, and food insecurity. The thematic areas leverage strengths of the faculty, interest of potential trainees, available research and training opportunities at international sites, and needs of the populations in the research training environments. Areas of research currently being conducted by fellows include integrating substance abuse treatment into HIV primary care using task shifting in South Africa, developing and testing interventions for people living with severe mental illness in Ethiopia, and examining factors influencing risk and resilience for psychopathology in youth in Barbados.

Approach and core skills

The program focuses on a “learn-by-doing” approach—immersion of fellows in a global area through involvement in research projects at an international site under the guidance and supervision of domestic and international mentors. Core skills are built to:

  1. develop productive international collaborations with governmental, non-governmental, and academic institutions abroad
  2. develop research questions that are clinically and culturally relevant to identify community and public health needs and use sound research methodology
  3. consider ways in which the research program fits into the context of and may ultimately inform international mental health policies and plans

Fellows’ primary commitment is to global mental health research for the majority (e.g., 90%) of their training time. Within the remaining time, fellows have the opportunity to conduct clinical work to meet ongoing requirements for licensure depending on their field of specialization, and/or pursue other non-federal research and teaching.

Didactics and guest speaker series

On-the-ground experiences are supplemented by a weekly didactic seminar and elective coursework at various Harvard-affiliated institutions. Program faculty and leaders in global mental health provide core program didactics to fellows during 90-minute weekly training sessions and monthly global psychiatry dinner seminars. Didactics aim to provide guidance on a range of topics including scientific/grant writing, ethical considerations in global research, and case studies of implementing international research projects.

Fellowship sites

The primary international research and training sites include: 1) Ethiopia (Addis Ababa University); 2) Uganda (Mbarara University of Science and Technology); 3) South Africa (University of Cape Town and Stellenbosch University); and 4) Barbados (Barbados Nutrition Study). Sites were selected on three major criteria, including: the strength of the institutional relationship and commitment to mentoring junior investigators in global mental health, the availability of experienced mentors, and productive research environments, including a strong track record of NIH-funded studies. Each international site offers fellows and their mentors a broad range of research opportunities due to wide variation in socioeconomic status, urban vs. rural locales, and clinical challenges.  

Initial outcomes of the fellowship

Although still early in the fellowship’s development and implementation, there are indications of initial success, including: 1) level of interest in the fellowship; 2) fellows’ contribution to capacity building efforts; and 3) productivity in the fellowship. There has been tremendous interest in the fellowship from the start of its award, including 18 applicants in just two years from a wide range of disciplines, including clinical psychology PhD graduates (n=11), MD psychiatrists (n=4), and PhDs in other disciplines, including public health (n=3). Capacity building efforts have included teaching, training, supervision, and mentoring. One fellow taught a statistics course to PhD students in Ethiopia during a two-month visit, two fellows are co-supervising and co-mentoring PhD students with their local mentor in South Africa and Ethiopia, one fellow is mentoring two local researchers/psychologists in manuscript writing, and two fellows have trained local providers in evidence-based psychological interventions. Regarding productivity, in the past two years across three current fellows (one 1st year fellow, two 2nd year fellows), over 30 manuscripts have been submitted, and over 20 accepted. Three K proposals (NIH career development awards for junior faculty investigators) are in progress for 2015 submission/resubmission (i.e., K23 and K01 awards to NIMH and to the US’ National Institute on Drug Abuse).

Future directions

The level of demand from interested candidates demonstrates the need for this type of advanced training program in global mental health-focused clinical research. Early metrics of success, including number of applications to the fellowship, fellows’ productivity, and capacity building efforts demonstrate preliminary achievements and promise of this new program. As the Fellowship grows and develops, we aim to dedicate resources to understanding what components of the program can maximize the success of trainees in pursuing careers as independent investigators and guide refinement of this new fellowship.  

 

References:

  1. Patel V, Prince M (2010) Global mental health: a new global health field comes of age. JAMA, 303: 1976-1977.
  2. Bruckner TA et al (2011) The mental health workforce gap in low-and middle-income countries: a needs-based approach. Bull World Health Organ, 89: 184-194.
  3. Collins et al. (2011) Grand challenges in global mental health: A consortium of researchers, advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment. Nature, 475: 27-30.
Approach: 
Training, education and capacity building
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