Summary

The Division will focus on educational programs and practical clinical and research initiatives in the near future. At all times, we will safeguard the notion that we have at least as much to learn from colleagues abroad as they do from us.

Education of our residents and fellows will be a key. We hope to have them educated in cultural/anthropological psychiatry, public mental health and mental health services, mental health advocacy and policy, international mental health research, and especially important, in primary care psychiatry since training of primary care doctors, nurses and health care workers is the principal way to get services to the developing world. MGH has written a key text entitled The MGH Guide to Psychiatry and Primary Care.

One hope would be that a career trajectory could be established through the development of clinically oriented fellowships in international psychiatry and that someday there could be a bona fide subspecialty field to attract and guide young trainees. In developing such a clinical training in international psychiatry, we would hope to develop ties with the Harvard School of Public Health, which would enable our fellows to earn credits towards a Masters in Public Health. Associations with other Schools at Harvard such as the School of Education, the School of Law and the Kennedy School of Government would also be considered in due course.

We also would like to develop programmatic initiatives early on in the life of our Division.

A) Education Initiative

We feel it would be helpful to assist foreign universities in developing countries in the setting up of psychiatry residency training and primary care psychiatry programs. The recently produced World Health Organization Mental Health Atlas points out very clearly that a major need in terms of resources exists for mental health in regard to the number of psychiatrists available in developing countries. For example, in Ethiopia there are still only twenty-two psychiatrists for eighty million people. Right now, talented medical students interested in learning psychiatry as a subspecialty go abroad to Europe or to the United States and oftentimes do not to return to their country of origin. This story is repeated over and over in the developing world. By developing a cadre of trained international psychiatrists in the United States, we could disseminate them to major universities in developing countries, where they can work alongside local colleagues to help start up residency training programs. Through the development of the young academic professional staff, these could become self-sustainable. Such an effort is now being planned at the University of Addis Ababa where a residency program in Psychiatry under the direction of Atalay Alem, MD, Ph D, was begun in 2002. With the help of the University of Toronto reciprocally, our international psychiatrists would return from their assignments abroad with an expanded knowledge base about mental illnesses, their management, and cultural effects, thus better preparing them to treat diverse populations here in the United States.

B) Clinical Initiative

We hope to provide consultative services to clinical programs in the developing world. The Massachusetts General Hospital Department of Psychiatry is renowned around the world for its approach to consultation, for example having produced a classic book devoted to this field entitled, the MGH Handbook of General Hospital Psychiatry. MGH Psychiatry is uniquely positioned to help deliver pragmatic, efficient and effective psychiatric management ideas and approaches to primary care doctors, nurses and health care workers in the developing world. For example, we would hope to establish connections with the Harvard AIDS Institute and the Partners AIDS Research Center under Bruce Walker, MD working with them in their efforts in South Africa.

C) Research Initiative

We would also like to provide consultative services to researchers in the developing world. MGH Psychiatry research under Maurizio Fava has been very successful in studying a wide range of psychiatric disorders, especially the management of depression and bipolar illness. Depression is one of the world’s greatest causes of disability, and this promises to worsen in the years to come, especially in developing countries. Attempting to identify evidence-based approaches in developing countries is a key task. Much practice is based on anecdotal report, as service delivery mechanisms have not been well studied. We would like to improve service delivery by providing consultative research services.

In our efforts overseas, we would like to emphasize mental health promotion and mental illness prevention whenever possible, an innovative strategy. Having helped plan the Inaugural World Conference on Mental Health Promotion and Mental Illnesses Prevention held at The Carter Center in November 2000, we have seen that the time is right for a Division of International Psychiatry to pick up the gauntlet and apply what we now know about public health approaches to mental illnesses.

To achieve these educational and programmatic initiatives, we would like to set up a structure that would include a “nuclear family” consisting of a divisional core in our Department of Psychiatry and the experts here in the MGH Global Health Center as well as other experts in the Boston area and an “extended family” of collaborators nationally and internationally. Here in our Division at Massachusetts General Hospital, we envision having groups for Refugee/Trauma Psychiatry, Cross-Cultural Psychiatry, Mental Health Promotion and Mental Illnesses Prevention, International Best Practices in Psychiatry, Psychiatric Education and International AIDS and HIV Psychiatry.

Summary

The need for international psychiatry has developed a new urgency now that the burden of disease secondary to mental illnesses around the world has been recognized as a public health crisis. The Division at MGH will serve as a source of relevant expertise and assistance to developing nations, fostering clinical and research expertise relevant to local needs and conditions. We also emphasize the value of internationalism as a critical point of view which can further our understanding of the nature and treatment of mental illness globally. The Division plans to join and pursue efforts that not only offer expertise and assistance, but also emphasize the vision and expertise of colleagues abroad in understanding diagnosis and treatment of mental illnesses and their management within different systems of care, contexts, and cultures. Together with these colleagues, we may be better able to address widely applicable and important questions in mental health policy, prevention, and treatment. The Division should be a site for research, education and collaboration in action-oriented programs as we foster bidirectional academic and practical exchange.


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