BOARD OF INTERNATIONAL AFFAIRS
PAN-AFRICAN DIVISION
QUARTERLY NEWSLETTER
AFRICAN INTERNATIONAL DIVISION,
ROYAL COLLEGE OF PSYCHIATRISTS
FROM THE EDITOR
– OLUFEMI OLUGBILE”
I welcome readers to the mid-year edition
Volume 6 Issue 2, June, 2012
of the Newsletter of the African Division
for 2012.
INSIDE THIS ISSUE
2012 is a busy year for mental health care in
FROM THE EDITOR – p. 1-2
Africa. One is able to get the sense of the
The Africa Discussion
giant stirring itself to action, moving its
Group p. 3 - 8
limbs here and there. The most inspiring
A The Latest from Lusaka
thing is that the positive developments are
on Psychiatry p. 8 -9
taking place in some of the areas that would
p. 6 -7
The Recognition of Global
be considered most challenged (and most
Mental Health Gathers Pace
9 p. 9 – 11
challenging to mental health care service
Coming Events p 12
development!). It is interesting, for
EXECUTIVE COMMITTEE
instance, to read of the efforts that are being
Chair: Dr. Olufemi Olugbile
made to get a handle on mental health
Vice Chair: Prof David Ndetei
problems in Liberia. Liberia, as most people
would know, recently came out of a long
night of war, a particularly vicious type of
war in which the hopes and dreams of a
whole generation of people appeared to
have been amputated – needlessly, along
with the limbs of several of their members. The trauma of living
through such an experience can only be imagined. Professor Sam
Okpaku’s report on the deliberations of the Africa Discussion
Group at the recent conference of the American Psychiatric
Association contains a presentation on work being done in Liberia
to create a nation-wide Mental Health Service from virtually
nothing. The pragmatic can-do attitude with which the task is
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being approached, the implicit task-shifting that is the only way to
get people on the ground attending to the problems of real-life
citizens at the grassroots is very inspiring.
David Ndetei revisits the Mental Health training and service
infrastructure in Zambia a scant year after his first write up on the
subject in this Newsletter. The increase in personnel resources and
scope of ambition is remarkable.
It would seem that the very fact of getting discussion going about
services and structures in any African country has a momentum of
its own that it is able to add to the drive to scale up services and
put up structures where none existed before. Your Newsletter is
striving actively to get materials from every country on the
continent. We solicit the assistance of members and fellows of the
African Division in this drive. It will really help to achieve the
founding ambition of the Newsletter, which is to serve as a
platform for communication and exchange of ideas on the whole
of the African continent, for the purpose of improving mental
health care for the people of Africa.
The edition rounds off with Julian Eaton exploring the
opportunities presented by the decision of the 65th World Health
Assembly which took place in May this year to adopt a resolution
on ‘Global Burden of Mental Disorders and the need for a
Comprehensive Coordinated Response From Health and Social
Sectors At Country Level’. It is important that we all dig into
these arguments instead of feeling, as professionals often do, that
they are in the province of politicians, and so removed from them.
The outcomes of such discussions will ultimately play a major
role in deciding how much of the finite resources of governments
and international bodies are allocated to mental health services, in
competition with other demands and pressures for those self-same
resources.
Do enjoy your Newsletter.
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The Africa Discussion Group
- Sam Okpaku
Report of the meeting held at the May 6-9th, 2012 Annual
Conference of the American Psychiatric Association in
Philadelphia, PA, USA
The meeting was well attended. There were three featured
speakers. These were Dr. Janice Cooper (Carter Foundation
Liberia), Joyce Kangori (Basic Needs Africa) and (AMPATH)
Mental Health in Liberia.
Liberia is a West African Country with a population of almost of
3.9 million. The country has suffered 2 civil wars (1989 - 1996),
and (1997 - 2003) The current President, Ellen Johnson Sirleaf, is
a woman who has brought some stability to a post-conflict region.
Dr. Janice Cooper is a Liberian who studied and worked in the US
before returning to her home country to head the Carter Center.
Dr. Cooper spoke for about an hour regarding her 18 months
leadership in Liberia using Skype. She discussed several areas of
her work.
Summary of presentation by Janice Cooper, to Africa Section,
APA
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•
Three objectives of the Liberian Mental Health Initiative, a
partnership between the Ministry of
Health & Social Welfare (MOHSW) and the Carter Center, are to
1) train a sustainable mental
health workforce; support the implementation of a national mental
health policy; and, to reduce
stigma, and support and empower families.
Types of disorders most frequently seen in Liberia include:
epilepsy, depression, anxiety,
psychosis, and culturally bound syndromes such as open mole.
There are three major providers of specialized mental health care
in Liberia. There is one inpatient mental health
facility.
The urgent need for mental health services is buttressed by the
documented rates in county-wide or multi-county studies which
indicate PTSD and depression as high as 40% and substance abuse
14% and suicidal
behaviors 11%,
The post-conflict setting underscores the need to build treatment
capacity and systems.
Carter Center has trained 39 mental health clinicians who are
working in 8 of the 15 counties.
A current cohort in training will graduate in August 2012 adding
an additional 23 mental health
clinicians and ensuring that 14 of the 15 counties have at least one
practicing mental health
clinician.
Training takes place in two sites, Monrovia and Gbarnga on a
rotational basis and involves 11
clinical sites including two prisons.
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Policy support gains over the last 18 months encompass:
o A new essential medical list that includes psychotropic
medications for all mental health
disorders
o Draft mental health legislation that will be presented to the
Legislature this year
o Creation of a children’s mental health subcommittee
o Inclusion of indicators to measure access to mental health
services and supports in the
MOHSW’s health management information systems
o Creation of a Center for Outcomes Research in Mental Health
Support for implementation of a stigma reduction and family
empowerment and support
strategy that includes:
o Development of a family psychoeducation manual
o Training of health care workers, community health workers and
faith lay health workers
in family psychoeducation
o Training of journalists on stigma
o Message development and dissemination on anti-stigma and
family support
o Research on knowledge, attitudes and practices on stigma
focused on capacity
development at the MOHSW
She emphasized the close collaboration and partnership between
the Carter Center and the Ministry of Health and Social Welfare.
Thus the Carter Center has a memorandum of understanding with
the Liberian Ministry of Health and Social Welfare. The Ministry
of Health and Social Welfare staff are integral to all the work of
the Carter Center. The Ministry of Health unit staff are part of the
program faculty. The Health Promotion Division supports data
collection and analysis for message development and is integral to
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message assimilation. Also, the Carter Center representatives sit
on the technical coordination committee for mental health. This is
the policy making advisor group to the ministry of health and
social welfare. Also, Dr. Cooper mentioned that the previous
budget was less than 1% and she anticipates that this may grow.
Specific steps are taken to respect the autonomy of the local
administration. The highlights of her presentation included the
training of community nurses and the completion of a national
mental health policy. She also cited the difficulty with access to
psychotropic medications and anticonvulsants. She took questions
and the topic of shortage of psychotropics was elaborated upon by
other speakers. It would appear that some of the problem is
bureaucratic as the Ministers of health in some of the African
countries appear not sufficiently flexible about their formularies
and contractual agreements regarding purchases of drugs. During
the discussion an attendee referred to the fact that the shortage of
services was continent wide and not restricted to countries like
Liberia. As Dr. Cooper came to the end of her presentation, we
lost contact with her for a few moments. This was illustrative of
some of the conditions that prevail in low or medium income
countries. The loss of contact was due to a power failure in
Monrovia, Liberia.
Mental Health in Kenya:
Dr. Janice Cooper was to have been followed by Ms. Joyce
Kingori of Basic Needs in Africa. Ms. Kingori was less fortunate
than Dr. Cooper. Nairobi was experiencing severe weather and
we were unable to connect with her by Skype. However she had
sent ahead a set of slides. Therefore, I presented her slides which
were as follows.
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https://docs.google.com/presentation/d/1bbgkb22UxxWLqwl0pN
_2iFmJkpExvi0-KjfXMMyN2OM/edit
Basic Needs is an international development organization that has
a presence in Colombia, Ghana, Uganda, Tanzania, Kenya, India,
Laos, and Sri Lanka. This organization has a model for Mental
Health and Development.
The 3rd featured speaker was Robert Bowland, MD from Brown
University Department of Psychiatry/AMPATH. He described the
work of AMPATH (Academic Model Providing Access to
Healthcare) which is a partnership between Moi University School
of Medicine (Kenya) and a consortium of US medical schools led
by Indiana University. He stated that Psychiatry was a fairly new
addition to the consortium. A goal of the program is to provide
opportunities for visiting psychiatrists with a view to establishing
a residency program at Moi. After his presentation, some
Ghanaian colleagues who are residing here - the US and Canada
described their experiences as volunteer faculty in Ghana.
They emphasized that their training and teaching experience in
North America did not have any direct bearing on their work in
Ghana. It was a different experience.
Before bringing the meeting to a close, I emphasized the need for
the group to respond to some expectations placed on us in the
diaspora. We are expected to make some contribution in whatever
way we can towards scaling up mental health services and
research in Africa.
Another major issues discussed was the need for the APA
leadership to take a greater interest in matters related to mental
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health in Africa and to show greater interest and support for the
work of the Africa Discussion Group. Also the APA will need to
be more receptive to the needs of international psychiatrists
attending the annual meetings.
An announcement was made about a forthcoming conference to be
held in Johannesburg, South Africa on September 7-11, 2012.
And for more information, it will be best for you to go to Google
and search for South African Society for Psychiatrists.
(Professor Sam Okpaku is the convener of the Africa Discussion
Group)
THE LATEST FROM LUSAKA ON PSYCHIATRY
- DAVID NDETEI
Since I last wrote about developments in the Department of
Psychiatry, University of Zambia one year ago in this newsletter
column, there have been more and positive developments. There
are now 5 psychiatrists practicing in Zambia, 2 in the Department
of Psychiatry at the Lusaka teaching hospital, 2 at Chainama
Hospital and one part time at the Lusaka Hospital doing purely
clinical duties. They all participate in the teaching of both
undergraduate and the postgraduate students. Sadly the long
serving psychiatrist – Allan Haworth has retired back to the UK.
Of the 3 psychiatrists, 3 are locals, one of them trained at the
Department of Psychiatry, University of Nairobi and the other 2
are expatriates and doing a great job. Between them they were
able to produce 60 graduates with good grounding in Psychiatric
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knowledge. They do eight weeks mandatory rotation in
Psychiatry and acquire skills that they can now take to Zambian
people.
The postgraduate training is taking root. Their first intake is now
in their 2nd of the 4 year programme. There is one in first year and
three more have been admitted for the September 2012 intake.
The medical students seem to be well motivated and a few have
expressed the desire to make Psychiatry their career. They in fact
came forward to talk to me about it.
The Department has also developed a thriving 2 year MSc NeuroPsychology programme. They have to write a research
dissertation as part of the course. They have 10 students in their
second year. The next intake will take place after the present
batch is through with their training.
They have arrangement with Department of Psychiatry,
Birmingham University, UK, to send people on regular basis to
participate in teaching though on a short-term basis. I was able to
meet with one such psychiatrist. They were looking forward to a
visit from Professor and Head of that Department in Birmingham.
A recent development is a recommendation that the newly
qualified doctors (MBchB) should undertake a 2 month internship
in Psychiatry as part of an18 months overall internship. Thanks to
the leadership of Dr. Paul Ravi, the current Chairman of the
Department.
So at last we can see light at the end of the tunnel for Psychiatry
and mental health in Zambia. As usual they have the best wishes
from the rest of us. But the best way to demonstrate those wishes
is to come forward and offer time, expertise or something. Tell
others about that Department.
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The recognition of ‘Global Mental Health’ gathers pace
- Julian Eaton
At the 65th World Health Assembly in Geneva in May 2012, a
significant milestone was reached – the adoption of a resolution on
mental health; Global burden of mental disorders and the
need for a comprehensive, coordinated response from
health and social sectors at the country level. This is the first
such resolution dealing with mental health in the last 11 years.
This resolution draws in part on the achievements of advocates for
greater recognition of mental health in recent UN processes such
as the High Level Summit on Non-Communicable Diseases
(NCBs), the World Report on Disability and the Convention on
the Rights of Persons with Disabilities (UNCRPD). All of these
important processes have seen significant scaling up of associated
activities at country level, and included mental health as a
(relatively small) component.
The inclusion of mental health in these broader documents is
important, because it allows for mainstreaming of mental health in
wider networks, thereby reducing stigma and raising its profile. A
good example is the inclusion of people with mental health
problems – people with psychosocial disabilities - in the
UNCRPD. This is much more than just a document, as most
countries in the world have signed up to abide by its principles,
and many, including in Africa, have gone a step further to ratify it.
This means that they are committed to working towards alignment
of relevant national law to the principles of inclusion of people
with disabilities and protection of their human rights. Importantly,
the UNCRPD has clear and strong structures established to
monitor a country’s progress towards meeting its commitments to
the relevant legal reform and implementation. This process
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includes a regular report to the UN, and must include people with
disabilities in the reporting. At the moment, people with
psychosocial disabilities are relatively poorly represented in this
process in most countries, which reflect their exclusion even from
national organisations meant to represent people with disabilities.
Given that this process is under way in most Africa countries, this
affords a great opportunity for this constituency to have their voice
included.
At the same time as making maximum use of these established
frameworks, the global mental health community is advocating for
a UN focus on mental health. The recent advocacy achievements
of the global mental health community will be strengthened by
such a focus, but taking this further will be a challenge. Not only
will there be a need to present a strong argument to a very
professional organisation with competing interests, but it will have
to be backed up with a strong evidence-base (for example of
economic impacts of mental disorders, benefits of proven
interventions) before mental health will be able to join the likes of
HIV/Aids and NCDs as a global health concern that is recognised
as deserving of attention at the highest level of global governance.
The resolution at the WHO World Health Assembly has set in
motion the development of a Global Mental Health Action Plan,
being developed by the WHO input from a wide variety of
stakeholders. This includes Governments and NGOs – a great
opportunity to communicate priorities into a plan that could have
significant impact on quality of life in Africa in the long term.
(Dr Julian Eaton, Consultant Psychiatrist, is the
CBM Mental Health Advisor. He is based in Lomé, Togo)
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Coming Events
The Conference of the Association of African Psychiatrists And
Allied Professionals (AAPAP) will be taking place from
November 22nd – 24th 2012 in Lagos, Nigeria. The theme is
‘Mental Health Challenges For Africa In The 21st Century’
The International Congress of the Royal College of Psychiatrists
will be taking place from 10-13 July 2012 in Liverpool, UK.
Contributions & comments to femi_olugbile@yahoo.com
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