Embed Size (px)
DESCRIPTION
" - the community associates mental illness with violence. Those who appear mentally ill but not at risk are periodically maltreated but generally left alone. Those causing risk to themselves or others (women wanting to wander or men who were violent) tend to be chained up inside a hut. Only those who couldn’t be contained this way got as far as the nearest clinic.This usually means young men; generally those who are violent after taking drugs."
Citation preview
An electronic publication for mental health in developing
countries - promoting fresh ideas to reduce suffering worldwide.
‘Violence isn’t mental illness’ Mental health educa3on in Papua New Guinea
Edition 3
We were coming back from a singularly unsuccessful home visit. Working in the North of Scotland, I’m well aware that a hospital van causes comment in a village. The van was obviously the most exciting thing all week - it having a white doctor was the month’s excitement: not least to the psychiatric nurse, who proudly explained, “She’s a doctor of sickness of thinking from Scotland.”
I was mid-way through an unusual PRIME trip: eight weeks teaching and working in Papua New Guinea. Over this time I discovered the reason for their pattern of cases - the community associates mental illness with violence. Those who appear mentally ill but not at risk are periodically maltreated but generally left alone. Those causing risk to themselves or others (women wanting to wander or men who were violent) tend to be chained up inside a hut. Only those who couldn’t be contained this way got as far as the nearest clinic. This usually means young men; generally those who are violent after taking drugs.
“I used to have two patients round here, but then one of them cut off the other one’s leg so neither of them live
here any longer.”
Teaching at various nursing schools, I found that the psychiatry curriculum was designed and taught by staff with little formal mental health background or training. Persuading these staff that violence did not equal psychosis was a struggle, though it was helped by teaching using the WHO mental health GAP guide.
Teaching child development to a group of pastors, revealed culturally embedded ideas of what was considered acceptable with regard to beating children. Although Unicef has a positive parenting project, most people still struggle to conceptualise discipline without corporal punishment. There are also many cases where young men regularly assault their parents and siblings. Once the young man is stronger than his father, no one else will step in and help to control him.
So what can you actually do with so much need?
I trained the two regional psychiatric nurses in using the WHO mental health guide, especially the diagnosis of psychosis versus substance misuse.
Concentrating on the well-women clinic (which had a domestic violence service), I gave teaching about trauma, somatised depression and anxiety and medically unexplained symptoms. The service had been given funding, but not training, to run a support group for women experiencing domestic violence and I was able to explain the basic principles of this.
At one nursing school, nurses from the psychiatric hospital were invited to attend the mental health teaching. This included role-plays on dealing with patients who were agitated or distressed. They revealed that they often saw their role as stopping escapes and giving medication - talking to a patient who was distressed by delusions or hallucinations was not something they had ever seen done.
Nursing students practising listening skills
Final year students responded well to being helped to imagine what it might feel like to experience psychosis and role-playing in groups to experiment with different approaches to the patient.
In future trips, hopefully a single session revising basic mental health will stop the atrophy of confidence and knowledge. In general though, the biggest challenge is core PRIME teaching - demonstrating by our attitudes and actions that people with mental illnesses matter just as much as anybody else.
Dr Jenny Bryden
Does teaching mental health sound like a challenge?
Are you wondering:
• “How can I usefully teach what’s needed in a short time?”
• “What do primary care workers really need to know?”
• “Where shall I get help?”
Help is at hand. In 2009 WHO published mhGAP (Mental Health Gap Action Programme), aimed at assisting primary care workers in diagnosing and treating mental health disorders. All evidenced-based and prepared by leaders in their fields, mhGAP can be downloaded from the WHO website at WHO mhGAP and it has been translated into different languages.
At first sight the manual looks daunting, with lots of diagrams and coloured boxes and pages, so some training is helpful to make it useful. Most people then like to use the manual regularly and keep it with them in the clinic. Experience shows that remembering the basic principles of care can be helped by the mnemonic CATMAP.
There are chapters on depression, psychosis, drug and alcohol abuse, children and adolescents problems, dementia and epilepsy and the latest addition is on stress. All chapters have guidance on assessment and various treatment, with emphasis on useful tools like psychoeducation, psychosocial support, problem solving and guidance on appropriate medication with doses.
Although spiritual issues are not directly addressed, there are plenty of opportunities to include spiritual care in the management of people with mental health difficulties, especially as the WHO has recently published guidance on the importance of spiritual wellbeing as part of good care.
Unfortunately many people are still stigmatised if they have a mental illness and this adds to their distress and can interfere with good care. Primary care workers are in an excellent position to challenge unhealthy beliefs and role model treating people with mental illness well.
It may surprise some people to know that mental health is treatable and many people recover and go on to lead productive lives. WHO says there is no health without mental health.
Teaching mental health
C communica*on
A assessment
T treatment
M mobilising social support
A a6en*on to overall wellbeing
P protec*on of human rights
Anyone can learn to use the mhGAP manual - nurses, care workers, teachers, doctors, pastors, lay people alike can be supported in their mission to improve the lives of people by learning from WHO mhGAP.
Dr Sophie Thompson teaching primary care workers using the mhGAP resource
The WHO mhCAP Intervention Guidewww.who.int/mental_health/mhgap
[email protected] developing-mental-health DevMentalHealth developingmentalhealth developingmentalhealth
Sign up to DMH
h;p://www.who.int/mental_health/mhgap/newsle;er_july_2015.pdf?ua=1
The mhGAP newsle6er
www.who.int/mental_health/publications/mhgap_newsletters
Your views and thoughts are
important to us! Let us know
what you think @:
Using mhGAP-‐IG on mobile phones for frontline healthcare workers to manage
depression in Kenya. The treatment gap in mental health in low and middle income countries is es3mated at 80%, compared with less than 40% in high income countries.
An area of increasing interest in delivering evidence based interven3ons across medicine is that of using mobile phone technology.
One such project is ‘Using mhGAP-‐IG on mobile phones for frontline healthcare workers to manage depression in Kenya’.
The project under the auspices of NGO African Mental Health Founda3on uses specially designed soTware mounted on mobile phones to overcome barriers of distance and travel, in order to train, supervise and support primary health care workers to deliver WHO mental health treatment gap interven3on guidelines (mhGAP-‐IG) at the Point of Care.
The project has yet to evaluate but is an interes3ng innova3on which promises much in bridging the GAP.
Further details at h;p://goo.gl/H2nwZs
DMH bite-size
