Members in the News: Psychiatry Residency Builds Global Reach by Using Local, Overseas Settings

Members in the News: Psychiatry Residency Builds Global Reach by Using Local, Overseas Settings

by Aaron Levin

Mental illness knows no boundaries, a fact that some psychiatry residency programs are incorporating into their training.

“Global mental health is mental health anywhere but here,” said James Griffith, M.D., chair of psychiatry at George Washington (GW) University, with perhaps a touch of irony, given that his residents can begin their “global” clinical work in the next county.

Global mental health has its roots in three overlapping domains, said Griffith—cultural anthropology, acute disaster, and postconflict response, and a public health tradition of alleviating suffering in a world where resources can be scarce. Programs typically combine local work with immigrants with several months overseas, usually in the fourth year of residency.

Just how many residency programs include such components is unclear.

“My impression is that the majority of training programs don’t have a global mental health component, but I think there is increasing interest,” said Christopher Varley, M.D., a professor of psychiatry and behavioral health at the University of Washington and president of the American Association of Directors of Psychiatric Residency Training.

A survey of 171 residency training directors (which received just 59 responses) published in 2011 found that they “endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.”

So GW and a few other programs appear to be unusual in their embrace of global mental health. Several factors may complicate their establishment. For instance, how will programs cover the cost of an overseas placement or make up clinical coverage or research time for a resident who may be away for months at a time?

Nevertheless, there may well be increasing interest in the concept, said Giuseppe Raviola, M.D., an assistant professor of psychiatry and of global health and social medicine at Harvard Medical School and director of mental health programs for Partners in Health.

“More medical students today are interested in global health, including those going into psychiatry,” said Raviola in an interview. “So psychiatry residency programs will need to offer global mental health options to attract the best new residents.”

“I think global mental health reflects an understanding that in addition to serving communities locally, one way we can do more good is to look beyond our borders,” said PGY-4 Michael Morse, M.D., a 2014-2015 APA American Psychiatric Leadership Fellow.

“Global mental health is not something you tack onto a residency training program,” said Morse in an interview. “Rather, it’s like any other competency in residency, where you need to do it and do it a lot and have mentors and supervisors who can help you learn from their experience.”

Within the GW program, all residents take a 12-week seminar in global mental health in their second year. PGY-3s who select the global track then spend several hours a week at Northern Virginia Family Services, an independent agency across the Potomac River in Fairfax County.

“We think you don’t learn this by going to other countries,” said Griffith. “You train residents and work with immigrant and refugee populations here, develop the skill sets, and when they have them, go on to international sites.”

Anjuli Jindal, M.D., began working at the clinic as a PGY-3 in 2007 and has served as a consultant for four hours a week since 2009. She evaluates immigrants and people seeking asylum in the United States and also supervises GW residents.

“You feel the world is so much bigger than your own small community,” she said. “I continued here because I felt this was so important, so needed.”

In addition to the tales of the difficulties in adjusting to a new country or the graphic stories of trauma in their home countries experienced by refugees, Jindal has heard and is heartened by her patients’ resilience and recovery.

“It restores your faith in kindness and the human connection.”

Fourth-year residents can elect to work on a mental health program overseas or a general medical project in another country as a team psychiatrist.

In recent years, GW residents have participated in global mental health research, training, or human-rights projects in Liberia, Uganda, South Africa, Greece, the West Bank, Cambodia, Nepal, and India, said Griffith.

Psychiatrist and anthropologist Brandon Kohrt, M.D., Ph.D., has applied lessons from his George Washington University residency to his work in Mongolia, Nepal, and Liberia. Photo Credit: American Psychiatric Association/Aaron Levin

Psychiatrist and anthropologist Brandon Kohrt, M.D., Ph.D., has applied lessons from his George Washington University residency to his work in Mongolia, Nepal, and Liberia.
Photo Credit: American Psychiatric Association/Aaron Levin

Brandon Kohrt, M.D., Ph.D., finished his residency in 2013 and is now an assistant professor of psychiatry at Duke University and a member of the Duke Global Health Institute in Durham, N.C. He values the time spent in the North-ern Virginia clinic.

“We got daily practice with refugees and asylum seekers here as preparation for our overseas work,” Kohrt told Psychiatric News.

Both Morse and Kohrt developed their overseas connections before they arrived at GW.

Kohrt’s doctorate is in anthropology. Even before he came to GW, he did extensive field work in Mongolia on a culturally specific syndrome analogous to chronic fatigue syndrome and with former child soldiers in Nepal. He helped produce documentary films on those topics in each country. He also worked as a consultant to an antistigma program in Liberia.

“I had an awareness of the context and needs of low-resource settings, but GW gave me the tools,” said Kohrt.

Read the entire article on Psych News.

Copyright © 2014 by the American Psychiatric Association. Reprinted with permission from the September 5, 2014, issue of Psychiatric News.

Things to Do in Providence

It takes about 45 minutes to drive across Rhode Island, or just enough time to watch the opening scenes of Interstellar on your laptop. Forstall, because historic Providence is worth a visit.

East Side of Providence
Brown University is located on the East Side of Providence, a fifteen-minute walk from the Omni. From Exchange Street take a left onto Westminster. Cross the Providence River and head up College Street to historic, 1.2-mile long Benefit Street, which is definitely worth a stroll in either direction for its outstanding examples of simple colonial and ornate Georgian-style homes.

Providence Athenaeum Library

Providence Athenaeum Library

Benefit Street is home to the Providence Athenaeum Library (corner of Benefit and College; photo, right) and the RISD Museum (Rhode Island School of Design). Nearby historical museums include the John Brown House Museum and, farther afield, the Governor Henry Lippitt House Museum, an American National Historic Landmark, at 199 Hope Street.

Thayer Street

Thayer Street

You can grab one of Geoff’s spectacular sandwiches (163 Benefit), a local favorite, or continue to walk up College Street to Prospect and take a peak inside Brown’s campus (corner of Prospect and Waterman), with its eclectic mix of architectural styles. Then take Waterman Street down the opposite side of the hill and turn left onto Thayer Street (photo, left), where you’ll encounter a lively stretch of cafes, restaurants, bars, and shops, as well as the Brown University Bookstore and the Avon Cinema. Be sure to stop by Blue State Coffee (300 Thayer Street) before you leave.

Blackstone Blvd footpath

Blackstone Blvd footpath

A longer walk takes you along Thayer to Lloyd Avenue, which you can follow past Moses Brown School all the way down to Blackstone Boulevard. The north and southbound lanes are divided by 100-foot wide parkland. The center, 2-mile-long footpath (photo, right) is a favorite spot for runners and walkers.

The cultural tour of Providence ends with a visit to Trinity Square Repertory Company, which will be performing A Flea in Her Ear by French playwright Georges Feydeau (March 26 – April 26, 2015; call 401-351-4242 for tickets, or visit www.trinityrep.com/a-flea-in-her ear).

If you have a full day to spare, you can travel by car to Newport, Rhode Island, and time-travel back to the Gilded Age (www.newportmansions.org). Newport was the first city in world history where all people were allowed to express themselves freely, worship without interference, and was governed by an elected, secular government. The King Charles II Charter of 1663 provided the first formal recognition of these freedoms.

President’s Letter

Dear SSPC Colleague,

I hope you are planning to attend our 2015 conference. The theme this year, global mental health (GMH), is on the minds  of many cultural psychiatrists right now. Look over this year’s program which can be found on the SSPC Annual Meeting page. You will see the people and issues you  definitely will want to hear,  Right now you can get a head start on these issues by  looking at the special issue of Transcultural Psychiatry (December 2014) which is largely devoted to GMH.  It is available to members online at no cost.  If you haven’t accessed your copy of the Journal until now here’s how to get there: On the website under Membership, go to the “For Members Only” section and once on your profile scroll down to “Transcultural Psychiatry Online.” Board member and TCP editor, Laurence Kirmayer, opens the issue with a very helpful framework for understanding GMH.  This is followed by five articles covering important issues in the GMH discussion: why mental health matters to global health; research ethics in global mental health; creating synergy between global mental health and cultural psychiatry; ritual healing and mental health in India; and, the making of global and local scale.

In addition to our theme, there’s more good news about the 2015 meeting. With our increased membership and careful budgeting we have been able, for the first time, to  reduce the registration fee for trainees. We also have been able to hold our general members’ registration fees at the same very reasonable rate we have had for the past three or four years.  You won’t find another meeting where you get more for your money than SSPC, with a three day program filled with interesting sessions; meals and receptions; and most important, numerous opportunities to meet your colleagues and share  interests in a small, casual and friendly setting.

I want to mention two important developments that are currently in the works The first is a major website revision which is now scheduled to “go live” in January.  The second development is a unique mentorship program that will connect senior SSPC members to younger members in their research, clinical and training careers. Watch the website for information about both of these additional benefits of SSPC membership.

2015 elections – Last year the Board completed a major revision of its Bylaws.  Two major changes going forward  are the size (smaller) and  term limits for all Board members. The Board will now consist of 18 individuals: 5 members of the Executive Committee – President, Vice President/ President elect, immediate Past President, Secretary and Treasurer – plus 12 elected Board members, each serving a 3 year term with the option of election to a second term, plus a non-voting Executive Director.

In March 2015  we will  elect 3 members of the Executive Committee – Vice President, Secretary, Treasurer – and three Board members, for a 3-year term beginning at the annual meeting in Providence. I hope you will consider running for one of these positions, or joining one of our Committees. Finally, please plan to attend our brief but important business meeting on Friday April 24th where we will thank the retiring officers and Board members for their excellent service, and introduce our new officers, Board members and committee chairs.

Lastly, don’t forget to contribute to the President’s Fund.  We are presently working on a way for you to donate when you pay your dues or register for the annual meeting.

With best wishes for the holidays I look forward to seeing many of you in Providence.

Steven

Executive Director’s Note

Liz and post-president Jim Boehnlein, 2012 Annual Meeting in New York Photo credit: John Onate

Liz and post-president Jim Boehnlein, 2012 Annual Meeting in New York
Photo credit: John Onate

We’re busy here, actively preparing for the 2015 annual meeting which is less than five months away.  Based on those all important evaluations that we’re always asked to complete, we’ve modified the program structure a bit.  Instead of keynote speakers, and in keeping with the global theme of the meeting, this year we will be having three plenary panels, one each day, on clinical and practice issues, funding issues and the role of non-government organizations (NGOs), and one on socio-cultural issues in global mental health.

We also will be introducing a number of interactive workshops.  Some of the workshop topics include Cultural Adaptation of Psychotherapeutic Interventions, Design, Curriculum and Implementation of Training Programs in Global Mental Health, and Cross Cultural Instrument Development and Adaptation, to name just a few.  And of course we will have our usual symposia.  Please visit www.psychiatryandculture.org to view the entire program, register and book your hotel room. Early bird registration is open now. We have not raised the registration fees this year and, in fact, have reduced them for trainees. While you’re at the website, don’t forget to pay your dues for 2015.  They are due by the end of January, but we’re happy to accept your money now if that works better for you.

The program format isn’t the only thing that’s changing.  Administratively we’re shoring up a few things, too.  Sticking with the annual meeting for another line or two, the number of participants in each workshop will be limited and pre-registration will be required.  Reservations will be accepted on a first come, first served basis, a great incentive for registering early.  This is a meeting you won’t want to miss.  The program appears on Annual Meeting page.

Speaking of dues, we’re actually going to be sending out invoices for the first time this year.  They will go to all current members as well as those who have belonged in the preceding two years but whose memberships have lapsed.  Of course new members are always welcome at any time.

Many thanks to the member volunteers who are helping to make things happen on many fronts, especially the website re-development and mentorship program.  Cheers to each and every one of you.

Finally, we’re planning to sell ads in our program book this year.  If you would like to place one, please contact me for information on sizes and prices.  And if anyone has suggestions about potential corporate sponsors, please don’t keep them a secret.

The rest of this newsletter is chock full of the many other activities that are going on within SSPC.  There also is an article on Providence, a real sleeper city, for those of you who are unfamiliar with it, so I’ll sign off now with best wishes to each of you for happy and safe holidays and a healthy and happy new year.

Warm regards.
Liz