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Unifying our Approach to Mental Health

Andres Barkil-Oteo, MD, MSc, Assistant Professor of Psychiatry, 
Yale School of Medicine 

I was invited to visit Ghana by GHLI to discuss the incorporation of a mental health component, known as the “Psych Corps,” into Ghana’s National Health Service. Ghana graduates 300 psychology students per year who serve one required year posted to clinics across the country. 

This is the second year of the program and we see many issues that still need to be addressed, but largely the feedback was positive and Psych Corps members look forward to expanding the program. Why were my team and I involved? Although none of us had ever been to Ghana, and its culture and customs were foreign to us, somehow the setting felt familiar.  

For the last two years, our group has overseen a student run clinic in New Haven, CT offering behavioral health services to a large, undocumented Latino population in a low income neighborhood. The problems of lack of access, stigma, and lack of professional staff in Ghana’s clinics mirrored many of the problems we face in the U.S. We shared our model with our Ghanaian counterparts, and sought feedback from a group of enthusiastic nurses and psychology graduates on how this could be adapted to their current situation. We, in turn, learned from them how to go about performing outreach and home visits, things we currently lack in our complex, hospital-focused system. 

Our travel to Ghana further illustrated to us that problems of access are universal, as are problems of under utilizing evidence-based therapies, and problems of marginalization and stigma. We need to change our mental perspective to one that assumes that we all deal with similar problems, with differences in intensity, but not in kind. Students wishing to work in the area of global health would be well advised to find a similarly local under-resourced setting, where they could learn skills and practices not taught inside large hospital settings; only then could they approach global initiatives with a mentality of solidarity rather than a mentality of difference. After spending a full day with Psych Corps, exchanging ideas, I came back optimistic about this collaboration, and look forward to continuing the shared learning experience.

My Week in Ghana

Katherine Bradley, Yale ’17

Recently, I traveled with a team from Yale’s Global Health Leadership Initiative and witnessed the treatment and lack thereof, of those dealing with mental health issues in the country of Ghana.  GHLI has partnered with senior health practitioners, policymakers, and health care officials for several years to assist their efforts in treating those with mental health disorders.  Our team spent a majority of the time in Accra where we visited Accra Psychiatric Hospital, and met with the Ghana GHLI delegation to discuss progress made to improve mental health care. 

My most memorable experience of this trip was visiting the small city of Koforidua to better understand how the mental health care system works outside of Accra.  During our day there, the community psychiatric nurse scheduled many activities. We first met with the regional health director and the director of the regional hospital. We then went on home visits where we followed community outreach workers who remind patients to return to the hospital for follow up treatment including medication. We also a visited a clinic focused on child mortality, and a prayer camp. The prayer camp housed mostly mentally ill patients who were there to pray their sickness away, but they were also given medicine by the local hospital through outreach by a community psychiatric nurse. 

The day was overwhelming, but also inspiring as I witnessed the passion that the mental health staff had for their work.  With no additional government funding beyond their basic mandate, the staff at the regional hospital managed to find funds to create a new psychiatric ward with eighteen beds because they knew it was important.  I also saw dedication of one psychiatric nurse, Akosua, who took it upon herself to start “Project Dignity,” an initiative where staff rehabilitates homeless persons with mental illness.  

Discussing the challenges of improving mental health care in Ghana for the first half of the week, I could see there was a long way to go. After meeting the frontline people who were making this happen, I had a lot more hope that Ghana could achieve their goal of improving mental health care. 

Similarities: A Healthy Nation and Body

Kristina Talbert-Slagle, PhD,
  Photo by Peter Hvizdak / New Haven Register
Associate Research Scientist, GHLI

A healthy body, like a healthy nation, contains many systems that need to work together in order to defend against threats.  A breakdown of these systems will render both a body and a nation susceptible to invasion – be it insurgency or infection.  As retired Gen. Stanley McChrystal and I recently presented at Yale University, for both the body and a nation to fight off insurgencies, the internal systems must be well organized with a holistic approach to maintaining overall health and stability so the insurgencies cannot win the support of the population in a nation or take over the human body.

We identified and examined how threats to a country and human body are similar. As with the case of the AIDS epidemic and the war in Afghanistan, both are issues that would have benefited from early action and counterinsurgencies. Just as microorganisms infect the body of someone with AIDS by exploiting the unhealthy body’s resources to replicate and spread, insurgents in Afghanistan focused on gaining power in an unhealthy nation in the same way. Sustained stability is essential in both the health of a nation and the health of a body. In Afghanistan, stability is sought by keeping schools open, providing access to electricity, water, and sanitation and aiding farmers as well as in targeting insurgents. To combat AIDS, funding, education and research also prove key factors in building and maintaining health of the body.

When the body’s circulatory, nervous, musculoskeletal and immune systems all work together, it wards of multiple infections every day. When these systems do not work in coordination, the body can be overcome by an infection, as happens with untreated HIV infection leading to AIDS. Medical treatments and social determinants affect the success of the compliance and treatment among AIDS patients. By linking complex systems to fight insurgencies in a nation and infections in a vulnerable human body, we can fight off constant threats and rebuild health. To read a news article about this event, click here.

World Leaders Meet to Encourage Global Collaborations

Elizabeth Bradley, Ph.D.
Faculty Director, GHLI/GHI
Master, Branford College

I was warned about the long train ride from Zurich and the icy walks in Davos, but nothing truly prepared me for the World Economic Forum. As a professor accustomed to more limited signs of power, I had never seen so many prime ministers, CEOs of mega-corporations, and global influencers in one place as last week nestled in the Alps.

The week was full of optimism. Nothing seemed too daunting, and the group tackled massive global problems with confidence. Dialogue about even grim challenges – the war on drugs, global climate change, and obesity – reflected a firm determination, guided by the silent and sure mantra, “We can do it!”

The Congress Center in Davos was pulsating with new ideas. Art and leadership are the same thing. We need a GPS for the soul. An eleven-year old in Pakistan knocking off straight A’s in advanced MIT physics courses online. You have to see this to believe it.

The Yale Global Health Leadership Institute (GHLI) presented its work on improving the supply chain in Tanzania for essential medicines, an endeavor of a public-private partnership between The Global Fund for AIDS, TB, and Malaria, The Coca Cola Company, The Gates Foundation, Accenture Development Partners, and Yale. As I watched academics, public health, big business, and high finance all in one space working on a common problem, I thought I was in a rarified environment of great hope and commitment.

The most exceptional session discussed the development of Sustainability Development Goals (SDGs) to replace the Millennium Development Goals. The General Secretary of the UN, Ban Ki-Moon, moderated the session with the great and beautiful – the likes of David Cameron, Bill Gates, Queen Rainia Al Abdullah. They asked for input on the SDGs, so I crowd sourced Branford College at Yale.

Here is the view from the 18-20 years old Yalies, who will someday populate the World Economic Forum themselves: 1) increase global internet access, 2) liberalize food trade policies, 3) redesign global power structures to be anti-fragile, 4) decrease global violence, 5) decrease rates of human and sex trafficking, 6) increase global response to natural disasters and climate change, 7) increase primary care, 8) improve early childhood care and education, 9) create sustainable living and urban environments, and 10) decrease corruption through increasing transparency. Selection of the SDGs will be hammered out by 2015. In the meantime with vision like this from the next generation, we should be optimistic.

Why Work in a Ghanaian Psychiatric Hospital?

By Helen Jack,

Yale 2012

Ghana’s 11 psychiatrists serve a population of more than 24 million, nearly twice that of New England. Stigma and misunderstanding of mental health adds to the burden on workers, and their efforts go largely underappreciated. In Ghana last summer, I faced the question “How can we motivate people to work in mental health care?” Data is needed to answer this question – a resource-efficient intervention cannot be designed until the problems at hand are dissected and truly understood.
I wanted to ensure that any data I collected for my senior thesis at Yale could be useful to a development project, that it would not just fill a paper that few beyond my professor would read. I approached GHLI and the Ghanaian delegation with this goal in mind.

Together, we designed a study of Ghana’s mental health workforce, aimed at exploring how staff in psychiatric hospitals can be recruited and retained. I spent summer 2011 at Ghana’s three psychiatric hospitals, interviewing staff members.

“One thing that motivates us to work is our colleagues,” said a psychiatric nurse. “Sometimes you are tired, but your colleague says, ‘my friend, let’s get up and do the work.’” Almost universally, positive interpersonal relationships and constructive feedback motivated staff. On the other hand, workers were regularly attacked by patients and not compensated for injuries, they felt that the stigma of mental health disorders extended to those who treated them, and they were frustrated with the poor hospital infrastructure, low salaries, and lack of professional development opportunities.

Following data collection, the members of the Ghanaian delegation helped me get my research findings to decision-makers in Ghana, providing them with information that could inspire and inform changes. Some of the data, for example, went to the Vice President, helping advocate for the passage of a new Mental Health Law, which would increase focus on workforce welfare. The opportunity to conduct research in global health comes with the responsibility of ensuring that information gets back to where it can be most useful.

Prayer Camps to Treat Mental Illness in Ghana

Alice Bradley, GHLI volunteer

Recently, I had the great opportunity to serve as a research assistant with the GHLI during a trip to Ghana to observe the state of mental health in that country. So many aspects about my trip with GHLI to Ghana were memorable, but it was the tour of Mt. Horeb Prayer Camp that I remember most vividly.

These religious communities (varying denominations) offer treatment to people with mental illness. They are a popular alternative to psychiatric hospitals, with 70 prayer camps just in Greater Accra. The camp leaders view mental disorders as demons inside a person and do not use psychiatric medication, but rather a regimen of fasting, prayer, and beatings to expel the demons.

Beginning our tour, I expected to be immediately outraged, but instead I was caught off guard with the natural beauty of the jungle setting and the camp’s feeling of community. There was a market, people laughing, flowers, goats, and colorful buildings. Our guide had a big grandfatherly smile. I could almost imagine the appeal of this peaceful community.

Unfortunately, the peaceful feeling came to an end as we approached the “sanitorium.”

Although warned about the use of chains, it was horrifying when I actually saw the inhumane methods used to restrain patients. In the small, bare building, there were ten men lying on the ground. Each man had a short chain on his leg that was bolted into the ground. The stench was suffocating, and a gutter ran across the room- it was the only bathroom the men had. One emaciated man (forced to fast) begged for help. Our guide explained the chain’s purposes: they ensured residents would not escape (many were forcefully brought to the camp by family) and they were a symbol: when you defeated the demon you would be freed of your chains.

Before leaving the camp, the director greeted us with a handshake and a smile, saying “God bless you.” The camp shocked me with its extreme contradictions. How could a place in such a gorgeous natural setting that seemed so peaceful and quiet employ such unimaginable tactics? This stark contrast is what made the prayer camp the most unsettling part of our trip to me.