#studyGMH: Capacity building: Preparing newcomers for the Global Mental Health field

This blog is part of a series focused on our Global Mental Health MSc students' impressions of the recent King's Health Partners Global Mental Health and Psychosocial Support Conference, held 5-6 June 2017.

As a Global Mental Health (GMH) MSc student, the message is driven home fairly often: receive buy-in from stakeholders when attempting to pilot, implement, or scale-up a (usually Western-based) complex intervention in a low or middle-income country. In fact, our MSc cohort finished the year with the class Theory to Practice, roughly 64 hours of lessons aimed at learning how to work with local policy makers, understand the importance of stakeholder buy-in from the very beginning (program users to policy makers), and the importance of monitoring and evaluating the program to ensure sustainability. Sensible elements, but where are they in practice? 

As I listened to Dr. Adeyinka Akinsulure-Smith present about the Youth Readiness Intervention (YRI) in Sierra Leone at the Global Mental Health and Psychosocial Support Conference, the above lessons really began to resonate with me. Dr. Akinsulure-Smith was explaining how she and her team effectively implemented (and evaluated) a behavioral intervention for war-affected youth that was found to be both acceptable and feasible to the local community. I was at the edge of my seat in wonderment at the creative and instinctual ways the team accomplished such success.

What was so “instinctual?” And why did it seem “creative?” The YRI team grounded their intervention in the local culture, soaking it in the local language, context, and concepts as well as utilizing the community members and local agencies to help facilitate the care. They used Western-based skill-building, behavioral activation, and emotion regulation techniques, but translated them into meaningful, culturally-based tools that can be used for life, revealing the users of the program were their top priority—as it should be. 

While learning skills to regulate emotions, the YRI used euphemisms the youth are in touch with every day, such as boiling a pot of water over a fire. The youth understand that the more sticks you add, the bigger the fire becomes and the quicker the water will boil. So, when learning how to regulate anger, they teach, in the local language,

“If the pot starts to boil, pull sticks out of the fire."

They implemented unique incentives, such as offering transportation to and from the program, allowing the youth to start the day in the way they chose (i.e. clapping or saying a prayer), and always finishing the day with a shared meal, which offered the users a pragmatic solution to a typical problem of hunger while also encouraging fraternization. These techniques truly engaged users and real benefits were gained. 

The involvement didn’t end with participants. YRI respected everyone directly or indirectly involved at all angles. Family and community members were aware and encouraged to support the program, noting that users wouldn’t really benefit if family members weren’t fully committed. Partnerships were sought from local agencies from the very beginning, gaining buy-in through full participation in voice and activity (i.e. training community members as facilitators for the program). 

Lessons learned

As a GMH student, you learn that the above practices should be the norm, and rightfully so. But this presentation and intervention felt unique, part of a select few I’ve learned from that truly take into consideration the goal they are trying to accomplish: integrating Western-based care into an un-familiarized society that may not appreciate (want) what is being offered. Moreover, the YRI team kept humble, and wisely sought partnership with the locals, used concepts that were culturally relevant and would stick, and made sure supervision was secure both locally and remotely. 

Being an American and studying in the U.K., I am aware of the imperialist feeling that may come about if I were an active agent in implementing a mental health program in a non-Western country. In my MSc year, I wish I had more contact with leaders who are unafraid to admit such a possible truth. Though we learn “best practices,” Dr. Akinsulure-Smith portrayed that implementing Westernized mental healthcare can be truly beneficial if it is done with respect, and if the end goal allows for a more empowered community and sustainable change. 

Overall, I think the GMH MSc in London is on the right track as far as classroom lessons are involved. But, the message should be strengthened.  Diversify the lecturers with more global leaders, invite more opportunities to meet actual stakeholders that currently hold partnership (especially service users!), and challenge students to real-world experiences that will both humble and empower them. We’re here to learn, but many of us want to practice, and being within reach to these experiences will build our capacity. 

Note: The Youth Readiness Intervention looks forward to future funding for scaling-up the program, and has plans to collaborate with the World Health Organization to develop a youth employment scheme similar to other countries. More about YRI here: https://www.ncbi.nlm.nih.gov/pubmed/26003574

Children and adolescents
Humanitarian and conflict health
Empowerment and service user involvement
Treatment, care and rehabilitation
Training, education and capacity building
Depression/anxiety/stress-related disorders
Alcohol/drug use disorders
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