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GMH Newsletter Practicum Feature – July 2021

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July 2021 Newsletter

Bebe Moore Campbell National Minority Mental Health Awareness Month

July is National Minority Mental Health Awareness Month. Since the US House of Representatives passed the resolution in 2008 in honor of Bebe Moore Campbell, mental health advocates in the United States have focused attention on improving access to mental health care and increasing public awareness among BIPOC communities, in particular, about mental illness. Ms. Campbell, an award-winning novelist and journalist, co-founded the National Alliance on Mental Illness Urban Los Angeles and worked to end stigma associated with mental disorders.

Emerging from COVID-19 – a year in review from regions around the world…

Over the past year, our students explored responses to mental health needs during the COVID-19 pandemic.

Paige Liscombe sets the stage.

On May 13, 2020, the United Nations (UN) Secretary-General António Guterres  released the Policy Brief: COVID-19 and the Need for Action on Mental Health. Not only is this ongoing pandemic a physical crisis, it has and will continue to be a mental health crisis. The three recommended areas for action outlined in this policy brief are: 1) consciously including this issue in response plans taking a whole-of-society approach; 2) ensuring widespread availability of emergency mental health and psychosocial support; and 3) building mental health services for the future, overcoming the long-standing underinvestment in this area.1

Linda Nzabamwita reported on Rwanda.

The first COVID-19 case in Rwanda was confirmed on March 14th, 2020. The Rwandan government responded swiftly by closing schools on March 16th, airports on March 20th, and implementing a national lockdown by March 22nd which was lifted on May 4th. Rwanda continues to work closely with the World Health Organization to conduct surveillance activities and implement preventative measures including a national lock-down, encouraging the population to wear masks.2 By  August 5, 2020, the Rwandan Ministry of Health, reported that there were 2,104 cases and 5 deaths.3

The Government of Rwanda prepared a yearlong COVID-19 national preparedness and response guiding document named the “Standard Operating Procedures for Preparedness and Response to Corona Virus (COVID-19) Disease”. This document specifically addressed mental distress caused by COVID-19 with the following guidelines:

  • Integrating mental health interventions into case management, preventions, and control
  • Identify high-risk groups and understand their mental health needs
  • Conduct psychological crisis interventions for high-risk groups and provide mental health education and services for the general population

The Context of Mental Health Care

Rwanda has had a unique set of challenges regarding mental health: a high prevalence of mental illnesses, including depression and post-traumatic stress disorder as a result of the 1994 Genocide against the Tutsi.4 The country struggled with high rates of mental illnesses and, at one point, had only one inpatient mental hospital, Caraes Neuropsychiatric Hospital Ndera, which was established in the early 1970s. In 1995, the Ministry of Health launched the Mental Health Division, which would work on addressing the population’s mental health unmet needs. Although there has been increased awareness and effort to address these mental health illnesses, there remains a shortage of funding, human resources, interventions, and treatments to adequately do so.5

Over the last few years, has taken steps to expand implementation of  mental health services. The Rwanda Health Sector Strategic Plan 2018-2024 (HSSP IV), a guiding document outlining national strategic plans to improve the health standards in Rwanda briefly addresses mental health as one of its main outcomes by increasing coverage for mental health interventions. 6 Some of the main strategies to promote mental health include the following:

  • Set up mental health services interventions in all health centers and community units in line with expected service standards
  • Strengthen the quality of mental health services at all levels
  • Expand services for prevention/management of drug addiction and harmful use of alcohol
  • Construct a National Mental Health Care Center to improve the quality of care and strengthen the referral system

In addition, in 2010, the Mentoring and Enhanced Supervision for Mental Health (MESH MH) Program was implemented. This initiative integrates mental health care into the primary care system health and improves the quality of care provided by nurses at primary care facilities through clinical mentoring. As of now, each district hospital has one psychologist and one psychiatric nurse trained to provide mental health services to patients.7

Reporting on the WHO Southeast Asia region, Evelyn Le captured relevant highlights from the start of the pandemic.

A little more than a year ago, Dévora Kestel, the Director of Mental Health and Substance Abuse at the World Health Organization (WHO), reported an increase in distress and vulnerability among 35% of the population in China, 60% in Iran, and 45% in the US.8 Mental health services around the world were disrupted due to the risk of spreading the infection when conducting  face-to-face visits. Some mental health facilities were even closed and converted to facilities to treat people with COVID-19.9 Teams from Nepal, Malaysia, and other countries across the WHO Southeast Asia region added emergency telephone lines to reach people in need. The Jakarta Post wrote that hospitals in Indonesia were not ready to accept people with COVID-19 due to lack of hospital beds.10 Stress from lack of appropriate COVID prevention and care created more mental health problems.

Travel restrictions were another likely source of anxiety and stress. Among Southeast Asia countries, thousands of the existing foreign workers—around 95,000 in Indonesia, 2.2 million in Malaysia, and 74,000 in Vietnam11—were banned from returning to their home countries due to COVID. In Vietnam, Indonesia, and Malaysia, foreigners were banned from entering the countries unless they were essential workers.  Similarly, foreign workers in the United States could not travel home to visit family in the region.  Additionally, students studying abroad faced restrictions. A Yale University international student from Wu Han reported “lots of uncertainty” when the student visa expired during the COVID and job offers decreased due to an economy in free fall.12

Mental health service innovations during the pandemic:

Despite the negative impact of COVID,  there were many innovations to address mental health in Southeast Asia. There was a need to move to digital platforms of health services and information dissemination. In Indonesia, therapists, psychologists, counselors, and practitioners utilized Zoom, WhatsApp, Meets, and other virtual platforms to support their patients. Information on the prevention of COVID-19 related to mental health was disseminated through websites, YouTube video tutorials, short movies, and online discussion. Online mental health services in Indonesia were conducted via Mobile App Survey (AMMS).13 In response to COVID, researchers from Indonesia, Malaysia initiated the Southeast Asia Mental Health and Counseling Association (SAMHCA), which became a mental health forum for healthcare professionals.14

In Thailand volunteers were trained to recognize stress, burnout, and anxiety in their communities. Once a resident showed signs of depression and suicide ideation, he or she would be referred to mental health nurses or psychiatrists.15 The preventive intervention called “mind vaccine” was created to help residents build resilience and different ways to navigate around challenges of the COVID. 16

Rumors and misinformation about the COVID-19 spread rapidly on social media and digital platforms. The United Nationals Children’s Fund (UNICEF) invited more than 100 young UN volunteers from Nepal to participate in the virtual discussion forum about the impact of COVID-19 on their mental health. The youth included teens with disabilities, members of the LGBTIQ community. As a result, the #V4ACTION volunteer initiative created an online rumor-tracking platform with videos in many languages to promote positive messages and encourage physical distancing.17

Paige Liscombe investigated the public health and mental health responses to COVID-19 in Papua New Guinea:

After Papua New Guinea’s first reported case of COVID-19 on March 20, 2020, Prime Minister James Marape declared a State of Emergency and mobilized a whole-of-society response. This decision brought together the Government, UN agencies, donors, NGOs, private sectors, and churches to support this response. Quarantine officers were deployed to the airport, seaports, and land borders; surveillance, contact tracing, and laboratory testing were conducted; infection prevention and control practices were heightened; and clinical management was reassessed and redistributed.

Papua New Guinea’s Disaster Management Team (DMT) released a multi-sector response plan on May 15, 2020 to align with the Department of Health’s COVID-19 Emergency Response Plan (issued April 24, 2020). The DMT designed this plan to address the first six months of the country’s response and socio-economic impact and recovery.  The comprehensive plan included many sectors of PNG’s government – such as health, education, protection, and socio-economic recovery – and had both short-term and intermediate actions.

Psychological Impacts of COVID-19

Across the country, many health care workers, emergency responders, and those who had been sick with the virus were the targets of discrimination. Stigmatization from family and community members was one of the most significant stressors for medical professionals. A front-line nurse shared that her husband told her “not to come home” if she continued working in the hospital. Not only were these individuals dealing with the possibility of the potential death of their colleagues or patients and the exhaustion of their work, but they were also fearful of getting infected and/or transmitting the disease to their loved ones.18

To combat fear and the widespread rumors, a daily television and radio program called “Hour of Hope” was launched by the PNG Council of Churches. This program provided information on COVID-19 and spiritual guidance to help reduce fear and anxiety. Two weeks of this program focused on mental health issues. A hotline and regional psychiatric teleconsultations were established, and communication materials were developed to address stress management.19

WHO released COVID-19 guidance that emphasized the critical role that faith-based communities play in supporting local health systems, advocating for vulnerable populations’ rights, providing support and comfort to communities, and being a trusted source of information.20This suggested guidance was also adopted by front-line health responders in PNG. To address mental health concerns, in July 2020 the International Committee of the Red Cross (ICRC) sent delegates to PNG to hold four workshops in various provinces to help approximately 60 participants manage uncertainties caused by the pandemic.  The workshops led by the ICRC delegates included discussions on identifying changes in  emotional reactions (i.e., uncertainty, fear, aggression, denial, and minimalization), the importance of only following credible sources of information related to COVID-19 since misinformation can lead to anxiety, breathing techniques, and encouraging physical and psychological fitness during these times. The lessons learned during the workshops were not just for the attendees but also for their families and communities. Due to the workshops’ success, ICRC planned to continue offering this support network to those in need.21

Since the start of the pandemic, the global community of mental health practitioners and decisionmakers has actively sought and implemented responses to  pandemic mental health crises as well as adaptations to permit continuation of routine care. 22 Of course, much more is needed to meet the mental health needs of all of our communities.  As we move forward in a world where inequities in public health system funding and access to care continues to shape the pandemic and its impact globally, our responses require ever louder advocacy for better access to vaccines and funding for health systems. These also form the bedrock for mental health.

BIRCH SPARC awards

On behalf of the Developmental Core of the UW Behavioral Research Center for HIV (BIRCH), I am very excited to share the Request for Applications (RFA) for the Synergistic Pilot AIDS Research Center (SPARC) Awards! Through this RFA for pilot awards, the UW BIRCH aims to support researchers to conduct work that examines mental health and associated conditions in the context of HIV. Successful awardees will be included in the SPARC Scholars program which includes monthly fellowships meetings, access to mentors across the UW BIRCH network, and opportunities to collaborate with other SPARC scholars.

Some key details (please see the attached RFA for full details)

  • Direct costs: $8,000 per year for up to 2 years ($16,000 maximum for the 2-year duration, no more than $8,000/year)
  • Letter of intent due August 9, 2021
  • Eligibility check due August 9, 2021
  • Consultation with the Methods Core due August 13, 2021
  • Final application due August 22, 2021 at 11:59 PM
  • Notice of award by September 10, 2021
  • Period of performance: September 13, 2021 to August 30, 2023

[Find full details on the temporary BIRCH website]

Special Issue on “Global Mental Health and HIV Prevention and Care”

In June 2021, the Journal for International AIDS Society published a Special Issue on “Global Mental Health and HIV Prevention and Care” with guest editors Robert H Remien, Melanie Amna Abas, Vikram Patel, and Dixon Chibanda. Two publications by Global Mental Health faculty and staff were published in the special issue:

  • “Intervening for HIV prevention and mental health: a review of global literature” by Pamela Y Collins, Jennifer Velloza, Tessa Concepcion, Linda Oseso, Lydia Chwastiak, Christopher G Kemp, Jane Simoni, Bradley H Wagenaar
  • “Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre-exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial” by Jennifer Velloza, Sybil Hosek, Deborah Donnell, Peter L Anderson, Mike Chirenje, Nyaradzo Mgodi, Linda-Gail Bekker, Sinead Delany-Moretlwe, Connie Celum, for the HPTN 082 study group

[You can access all the articles for free here]

 

Global Mental Health and Psychosis

Psychotic symptoms are sometimes the main signs of a mental illness that family members, friends, or doctors recognize. Psychoses can cause considerable disability and are associated with higher mortality, and social exclusion, and human rights abuses. Early interventions can avert morbidity, and support for recovery can enable people with psychoses to manage their lives successfully. Resources for mental health services in many parts of the world flow disproportionately to institutional care, where services for these conditions are frequently located.

This month we shine a light on studies aimed at the care and support for people for people with psychoses.

Digital Mental Health Toolkit for Healers in West Africa

Global Mental Health faculty member, Dror Ben Zeev, and Professor Angela Ofori-Atta (University of Ghana), show that partnering with healers in West Africa to create a mental health application is possible, expanding options for quality care. The study, is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices that support mental health and reduce human rights abuses.

[Read the full article here]

New Lancet Psychiatry Commission on Psychosis

A new Lancet Psychiatry Commission on Psychoses in Global Context, led by Professor Craig Morgan from the Institute of Psychiatry, Psychology & Neuroscience, has been launched to address the challenges that people with psychosis in low-income countries experience. The report, set to be published in 2022, will evaluate existing evidence on psychoses and make recommendations to guide research, policy, and development in this area.

Psychoses affect more than 20 million people around the world. People who experience psychoses are at high risk of experiencing impoverishment, premature mortality, marginalization and discrimination, human rights violations, and poor social outcomes. Discrimination has been further highlighted by the COVID-19 pandemic, with vaccination programs neglecting to prioritize those with psychoses despite evidence of increased infection rates and poorer outcomes. Moreover, people with psychoses experience many barriers to accessing mental health services, particularly in low-income countries where services are severely under-resourced.

[Read more here]

Other GMH events and opportunities

  • In June 2020, CBM Global and their partners launch the first five Community Mental Health “Good Practice Guides”, which share lessons learnt from our global work on mental health for over 20 years. These can be used by anyone, regardless of role, expertise, or area of focus. The guides focus on Peer-Support, Community Mental Health Forums, Stigma and Awareness Raising, Mental Health System Strengthening, and Neglected Tropical Diseases & Mental Wellbeing. Access the guides here.
  • Consortium on refugees’ and migrants’ mental health (CoReMH) publishes an advocacy brief on the issues emerging from the screening regulation of new EU pact on Migration and asylum. Read the full press release and advocacy brief.
  • Natasha Muller Impact, United for Global Mental Health and Arabella Advisors launched a new report: ‘Unlocking The Power of Philanthropy: How Next Generation Philanthropists Can Transform Mental Health Funding’. With practical guidance and case studies, the report provides an initial playbook for philanthropists wanting to get started in mental health or looking for ways to expand their support.
  • The Behavioral Research Center for HIV (UW BIRCH) is now accepting membership requests. BIRCH members are faculty, research scientists, clinicians, staff, trainees, and other personnel involved in HIV, mental health, or related behavioral science research or practice at the University of Washington, as well as partners and affiliates in the U.S. and across the globe who are interested in these topics. Complete the BIRCH membership request to join.
  • The Department of Psychiatry and Behavioral Sciences is hosting its 2nd annual conference on “Re-Imagining Behavioral Health: Race, Equity, and Social Justice Conference.” The conference will take place on Sept 23 and 24. Topics will include an overview of the Indian Healthcare System, leading inclusion through the lens of safety, mattering and belonging, LGBTQA primers and racial equity action plans. More information and registration information coming soon.

 

  1. United Nations (UN). 13 May 2020. Policy Brief: COVID-19 and the Need for Action on Mental Health. https://webcache.googleusercontent.com/search?q=cache:JmYV1OhrzlwJ:https://unsdg.un.org/sites/default/files/2020-05/UN-Policy-Brief-COVID-19-and-mental-health.pdf+&cd=2&hl=en&ct=clnk&gl=us
  2. Rwanda Biomedical Center. (2020). Retrieved from https://www.rbc.gov.rw/index.php?id=630
  3. Rwanda Biomedical Center. (2020). Retrieved from https://www.rbc.gov.rw/index.php?id=630
  4. Smith, S. L., Franke, M. F., Rusangwa, C., Mukasakindi, H., Nyirandagijimana, B., Bienvenu, R., … Raviola, G. J. (2020). Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study. Plos One, 15(2). doi: 10.1371/journal.pone.0228854
  5. Smith, S. L., Kayiteshonga, Y., Misago, C. N., Iyamuremye, J. D., Dusabeyezu, J. D. A., Mohand, A. A., … Raviola, G. J. (2017). Integrating mental health care into primary care. Intervention, 15(2), 136–150. doi: 10.1097/wtf.0000000000000148
  6. Rwanda Health Sector Strategic Plan 2018-2024 (HSSP IV)
  7. Smith, S. L., Franke, M. F., Rusangwa, C., Mukasakindi, H., Nyirandagijimana, B., Bienvenu, R., … Raviola, G. J. (2020). Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study. Plos One, 15(2). doi: 10.1371/journal.pone.0228854
  8. UN leads call to protect most vulnerable from mental health crisis during and after COVID-19. (2020, May 14). Retrieved from UN News : https://news.un.org/en/story/2020/05/1063882
  9. United Nations. (2020). Policy Brief: COVID-19 and the Need for Action on Mental Health. Retrieved from UN.org: https://www.un.org/sites/un2.un.org/files/un_policy_brief-covid_and_mental_health_final.pdf
  10. Siahaan, G. N. (2020, March 26). Southeast Asia’s Responses to the COVID-19 Pandemic. Retrieved from International Affairs: http://www.internationalaffairs.org.au/australianoutlook/southeast-asias-responses-to-the-covid-19-pandemic/
  11. GoinGlobal (2018). Vietnam: Employment Overview. Retrieved from GoinGlobal: http://www.goinglobal.com/vietnam-employment-overview#:~:text=It%20is%20estimated%20that%20there,are%20exempt%20from%20work%20permits.
  12. Ming, T; NG, K. (2020). As Migrant Mental Health Suffers in Singapore Dorms, Aid Groups Rally. Globe. Retrieved from https://southeastasiaglobe.com/migrant-workers-mental-health-singapore/
  13. Sukmawati, Z. A. (2019). Development and Validation of Acceptability of Mental-Health Mobile App Survey (AMMS) for Android-based Online Counseling Service Assessment. Journal of Physics: Conference Series, 1339
  14. Ifdil, I., Fadli, R. P., Suranata, K., Zola, N., & Ardi, Z. (2020). Online mental health services in Indonesia during the COVID-19 outbreak. Asian journal of psychiatry, 51, 102153. Advance online publication. https://doi.org/10.1016/j.ajp.2020.102153
  15. Almendral, A. (2020, June 16). npr.org. Retrieved from The Dark Side Of Thailand’s Coronavirus Success: https://www.npr.org/sections/goatsandsoda/2020/06/16/874198026/the-cost-of-thailands-coronavirus-success-despair-and-suicide
  16. Almendral, A. (2020, June 16). npr.org. Retrieved from The Dark Side Of Thailand’s Coronavirus Success: https://www.npr.org/sections/goatsandsoda/2020/06/16/874198026/the-cost-of-thailands-coronavirus-success-despair-and-suicide
  17. Gajurel, S. (2020, May 29). Managing mental health amidst COVID-19. Retrieved from Unicef South Asia : https://www.unicef.org/rosa/stories/managing-mental-health-amidst-covid-19
  18. International Committee of the Red Cross (ICRC). 22 July 2020. A Silent Threat: In Papua New Guinea, the impact of COVID-19 on mental health. https://www.icrc.org/en/document/silent-threat-mental-health-papua-new-guinea.
  19. Papua New Guinea National Department of Health. 17 May 2020. COVID-19 in Papua New Guinea First 100 Days of Health Sector Preparedness and Response. https://covid19.info.gov.pg/files/May%202020/100%20Days%20of%20COVID-19%20PNG%20Health%20Sector%20Response%20%282020-05-17%29%20NDOH%20FINAL.pdf
  20. World Health Organization (WHO). 7 April 2020. Practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19. https://www.who.int/publications/i/item/practical-considerations-and-recommendations-for-religious-leaders-and-faith-based-communities-in-the-context-of-covid-19
  21. International Committee of the Red Cross (ICRC). 22 July 2020. A Silent Threat: In Papua New Guinea, the impact of COVID-19 on mental health. https://www.icrc.org/en/document/silent-threat-mental-health-papua-new-guinea.
  22. Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Benjet C, Cheung EYL, Eaton J, Gonsalves P, Hailemariam M, Luitel NP, Machado DB, Misganaw E, Omigbodun O, Roberts T, Salisbury TT, Shidhaye R, Sunkel C, Ugo V, van Rensburg AJ, Gureje O, Pathare S, Saxena S, Thornicroft G, Patel V. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry. 2021 Jun;8(6):535-550. doi: 10.1016/S2215-0366(21)00025-0. Epub 2021 Feb 24. Erratum in: Lancet Psychiatry. 2021 Mar 8;: PMID: 33639109.