MhGAP-HIG Training of Trainers and Supervisors (TOTS)
It has been three months since the first of multiple devastating earthquakes hit Nepal killing more than 8,000 people and affecting the lives of 8 million. Health workers throughout the earthquake-affected regions have reported patients presenting with nightmares, difficulty sleeping, fear of staying indoors, and a range of bodily complaints including headaches, heart palpitations, and the constant feeling that the earth is shaking.
This month, the Government of Nepal, Ministry of Health and Population, in collaboration with the World Health Organization (WHO) and Transcultural Psychosocial Organization Nepal (TPO Nepal), conducted a program for Nepali psychiatrists from July 5 to 8 at Kathmandu to prepare them to train primary care health workers on mental health and psychosocial care for earthquake-affected men, women, and children throughout Nepal. Dr. Rishav Koirala, the WHO mental health focal person in Nepal, and Dr. Brandon Kohrt, technical adviser to TPO Nepal and founding director of HeartMind International, trained 14 psychiatrists on the WHO Mental Health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG), a tool released in May 2015 to integrate mental health into primary care and community-based services during humanitarian emergencies.
Dr. Sagun Pant, a psychiatrist who recently completed training at Tribhuvan University Teaching Hospital/Institute of Medicine explained, “What we are trying to do is make a whole specialty into something that is very cost-effective, very feasible, and very available. And, it is integrated in primary health care because there is a big need in the public health care sector. You can’t send psychiatrists everywhere. If this can be done for HIV, why can’t it be done for mental health? … I’ve always believed and I’ve always wished to work in community interventions, and this is one big community intervention.”
Dr. Madhur Basnet, a psychiatrist from B.P. Koirala Institute of Health Sciences added that primary care-based services allow people to get mental health treatment in a way that does not stigmatize. “People feel that it’s easier to visit these general doctors than to visit psychiatrists because of the stigma. If doctors are trained well, and if people get good service, I think that will help in breaking the stigma among the people much more easily… One of the most important parts from this mhGAP-HIG is that it has emphasized empowering the patients, giving them the knowledge of illness and then empowering them in their involvement in the treatment as well.”
The training emphasized promoting personal, family, and community resilience by building upon existing psychosocial coping strategies. A central component of the training is promoting these psychosocial services and minimizing inappropriate and potentially harmful use of medications in primary care for trauma affected communities.
Dr. Sunil Shah, a senior psychiatrist working a mental health hospital in southern Nepal, remarked on the emphasis on psychosocial skills: “[mhGAP-HIG] is a guide that orients beginning from the basic qualities of what a physician needs. It’s not just psychiatrists who need to build trust between the patient and the doctor, it is not just psychiatrists that need to prioritize their patients and understand their patients. All doctors, all healthcare workers need to build trust, need to listen, need to sit down and understand, and help the patient understand the real situation and how one can be healthy in the long run… These issues are helpful for all healthcare providers.”
A special presentation on child mental health in humanitarian settings was given by Dr. Sacheen Shrestha, a child & adolescent psychiatrist based in North Carolina who is volunteering with Disaster Psychiatry Outreach. Dr. Shrestha’s presentation reinforced the need for child, family, and community-based psychosocial services including school-based programs.
Certificates were distributed and closing remarks were given by honorary guests including Dr. Surendra Sherchan, Direct of Mental Hospital, Dr. Edwin Ceniza Salvador of WHO, and Suraj Koirala, Executive Manager of TPO Nepal. The participants will embark on training and supervising primary care workers to provide services to residents of earthquake-affected districts of Nepal.