Global Psychiatry

A major goal of the Division is to develop global mental health sciences leadership in the US and abroad. As communicable diseases are supplanted by non-communicable, chronic, and neuropsychiatric diseases, the academic medicine workforce must be realigned with the emerging health priorities for the new century.

african childrenResearch

The focus of the Division’s research is to address challenges that impact health outcomes and barriers to delivery of quality psychiatric care. The goal is to identify clinically-relevant, culturally appropriate strategies that improve overall health and wellbeing of individuals and communities worldwide. Faculty conduct innovative clinically-relevant scientific studies to develop an evidence-base for mental health policy and practice in low- and middle-income countries and settings, and conflict-affected areas. They translate research into public health practice by evaluating the impact of diagnostic, prevention, treatment and delivery strategies on overall community functioning. They disseminate findings in scholarly journals.

Faculty are drawn from diverse backgrounds of psychiatry, public health, health economics, healthy policy and social and behavioral sciences. Their expertise spans the social-ecological determinants of both mental health and overall health, and major diseases, special populations, diverse settings, and specific social problems. All international research projects are conducted in collaboration with in-country health professionals and academic institutions.

The diversity of global-health research in the Department of Psychiatry includes projects in Liberia, Uganda, India, Cambodia, China, Ethiopia, South Africa, Zambia, Peru, and Lebanon, among other places. It also includes research in ethnically diverse and refugee populations in the US.

Recently completed studies:

Substance abuse and sexual behaviors of secondary school students in Liberia

PI: Benjamin Harris, MD
This study was the first post-war investigation of the behaviors of young people in Liberia.

Key informant survey of mental health needs of young people in Liberia

PI: David Henderson, MD
This mixed methods pilot study sought to identify the mental health needs of young people in Liberia, a post-conflict country in West Africa. The results informed the country’s first National Mental Health Policy, and priority areas for follow-up research.

Building Primary Care Physicians’ Attitudes and Confidence in Mental Health Skills in Peru

PI: David C. Henderson, MD
This study evaluated a training program to integrate mental health in primary care settings in Peru to determine the impact on mental health knowledge, confidence in performing psychiatric procedures, skills, and attitudes of primary care physicians.


Technical Assistance Mental Health Policy and Strategic Planning

The Division develops informed mental health policies and strategic plans for governments and organizations (e.g. hospitals, academic institutes, and humanitarian groups) seeking to define a vision, specify a framework and ensure high stands of care for psychiatric, neurological and behavioral disorders. Faculty have done this work in Ethiopia, Haiti, Iraq, Liberia, New Orleans, and Rwanda.

Past project: Liberia Mental Health Policy

Between 1989 and 2003, Liberia experienced a brutal civil war marked by widespread human rights violations, sexual violence, and the use of child soldiers. Mental health had not been addressed in a meaningful way since the end of the war despite substantial trauma; there is currently 1 psychiatrist for a population of 3.7 million and virtually no mental health services in the country. This has a significant impact on every aspect of life and hinders Liberia’s ability to move out of its post conflict state.

Dr. David Henderson led a team of faculty from MGH/Harvard in 2009 to provide technical assistance to the Liberia Ministry of Health and Social Welfare to develop the country’s first National Mental Health Policy. In partnership with the country’s only practicing psychiatrist, Dr. Benjamin Harris, they conducted a pilot needs assessment to identify and prioritize the mental health needs of young people, who make up 51% of the country. The policy included integrating care into the general hospital and primary care medicine systems, and recommendations for vulnerable populations including children, victims and perpetrators of sexual and gender-based violence, and the chronically mentally ill. Parliament and the President passed the policy in December 2009.

President Ellen Johnson Sirleaf cited the Policy in her 2011 Annual Address as an integral part of the country’s basic package of health services.

Click here to download the pdf of the National MH Policy.

Disaster Response

When a large-scale disaster impacts a country, often mental health services are the last forms of treatment to be administered. Especially at these exceptional times of need, finding ways to deliver this much needed form of care becomes imperative.

The Division’s faculty conduct rapid assessments to identify priority needs, develop action plans, and provide training and education for relief workers in the pre- and post-deployment skills. The ultimate objective is to reduce the mental health burden of civilian populations exposed to endemic political violence and episodic natural disasters, foster the process of healing, psychosocial rehabilitation and recovery, and generate improved mental health policies and services in the participating countries. It is also to ensure that first responders are appropriately briefed and cared for in the pre and post deployment stages.

Faculty have conducted clinical care and research, provided policy recommendations and developed service plans in Bosnia, Haiti, Iraq, Japan, New Orleans and New York City, among other places.

Click here to learn about Mass. General Hospital’s Disaster Overall Response efforts: http://www.massgeneral.org/globalhealth/disasterresponse/

Past project: Haiti

Drs. David Henderson and Gregory Fricchione advised Partners In Health for the mental health response in the immediate aftermath of the 2010 earthquake. Dr. Linda Williams, a PGY4 MGH/McLean Psychiatry Resident, also traveled to Haiti for a month to work on the ProjectHOPE ship.

http://www.massgeneral.org/globalhealth/news/multimedia.aspx?id=398

Past project: 9/11

A group of faculty worked to coordinate health centers to deal with the effects of the violence, and develop a training program and toolkit for primary care providers to help them assist patients suffering from violence.

Past project: Hurricane Katrina

Dr. David Henderson conducted a field study to advise the National Red Cross on the impact of the disaster on the relief workers as well as the victims in New Orleans; a policy document was developed with recommendations to the Red Cross for future program development.


Evaluation

Rigorous evaluation of programs are essential to maximize goals and develop an evidence-base for successful models of delivery and training.

Click here to learn about program evaluations in Bosnia and Cambodia.