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Member Spotlight: Dr. Samuel Okpaku on Scaling up Mental Health Services in Resource-Poor Settings

By Sarah Arnquist | 25 Jul, 2011 Last edited by Sophie Beauvais on 29 Dec 2011

Hello Everyone,

We're spotlighting the work of GHDonline member Dr. Samuel Okpaku. This is a new feature to highlight our members and also start discussions.

For this discussion, Dr. Okpaku will introduce himself, ask the community some questions, and then answer some questions himself related to mental health needs, stigma, and capacity building.

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I am a Nigerian-born psychiatrist and currently the Executive Director of the Center for Culture Health and Society. Previously, I was Chairman and Professor within the Department of Psychiatry at Meharry Medical College and a Clinical Professor of Psychiatry at Vanderbilt University Medical School. I hold a PhD in Social Welfare Research from the Heller School at Brandeis University.

My research interests have included psychotherapy, reduction of disability, quality of life issues, depression, culture and social factors in mental health and illness. My interest and involvement in Global Mental Health derive from several factors. I have a strong interest in culture, having either studied or worked in a variety of countries and cultures. I am sensitive to the issues of poverty as it relates to mental health and equality.
I feel it is time to pay back and contribute in some meaningful way, no matter how small the contribution to my homeland. Also, I have always felt that trained individuals from low- and middle-income countries can always serve as examples and mentors to the younger generation. Their perspective can contribute to a more balanced view of low- and middle-income countries by perceived “experts” from high-income countries. They can be watchful of any attempts conscious or unconscious to recolonize intellectually and otherwise. In addition, I have never had the opportunity to work in my homeland.

I have several questions for the members of the GHDonline NCD community and hope we can have a robust discussion around:

1) What do you see as the major needs of your country in providing mental health services?
2) What do you see as the role for grass root movements?
3) To what extent do you see other professionals contributing to your mental health system?

To start off the discussion, Dr. Okpaku answered several questions:

Q: What is CHCS and its mission?

A: CHCSglobal.com stands for the Center for Health, Culture and Society. This serves as a website that is dedicated to scaling up mental health services and research in Africa. It also serves as a ‘Secretariat’ for the Africa Discussion Group of the American Psychiatric Association. This group of individuals is committed to contribute to the above mission. The group meets annually during the Annual Conference of the American Psychiatric Association. During the year, important announcements are sent from here to members of the group.

Q: What are some of the mental health needs or resources in poor countries?

A: In discussions with African colleagues and in the United States the most frequent mentioned needs are:
1)Education of the community¸ families, allied professionals and traditional leaders as to what mental illness is
2)reduction of stigma and the need for the patients to be treated with respect
3)availability of modern drugs and access to modern care
4)more attention and funding by the government
Other needs include jobs, financial resources, homes, and reduced isolation of the mentally ill individuals.

Q: What are some strategies to reduce stigma?

A: More comprehensive public health policies,public education using news media, and public advocacy by influential community agents. Also attempts to emphasize treatment in primary care settings and reduce the need for large custodial hospitals can help to reduce stigma.

Q: What are some of the major challenges to building mental health capacity in resource-constrained settings?

A: Major Challenges to capacity building include: 1) Lack of priority by the government. 2) Lack of funding, 3) Some traditional beliefs, and 4) Brain Drain internally and externally.
In terms of capacity building I favor the approach described by Michelle Chino and Lemyra DeBruyn “Building True Capacity indigenous models for indigenous communities” (America Public Health, in this article they emphasize different ways of knowing a “transformation of power relationships.” They remind us as to the significance of “direct experience, interconnections, relationship and value” which all go beyond mere objective achievements.

Chino and DeBruyn described four stages in capacity building. These are : 1) building relationships, 2) building skills, 3) working together, and 4) promoting commitment.

The Social Definitions of health and illness became paramount. The agenda should be driven by the local low- and middle-income countries, service delivery and therapeutics should be based on a local value system, which is open to innovation but autonomous. Grassroots movements and service users and survivors should play important roles in this endeavor.

Replies

 

Sandeep Saluja Replied at 9:00 PM, 25 Jul 2011

My salute to Dr.Okpaku for crusading such an important area.
I am a clinician actively involved in delivery of health care to remote and inaccesible areas.One key hurdle in my view is that while most health professionals are willing to apply themselves to anything ranging from cardiology to surgery,when it comes to this set of illneses,they want to find a way to involve a psychiatrist(which is a rare breed in the periphery) or just use some drug like diazepam on long term basis.
Education of doctors and other health professionals is paramount and so is their motivation.One possible initiative can be to have a network or community of doctors working at grass root level and ask them to feel free to discuss all such cases.Such web based communities can be moderated by experienced doctors who may guide their colleagues.
In fact,such initiatives may be extended to other chronic diseases too and may be GHD can take a lead in development of such communities.

Sonya Jakubec Replied at 3:26 PM, 2 Aug 2011

Agreed on the kudos to Dr. Okpaku. Mental health concerns are, world-wide, in need of our thoughtful attention to culturally conscious practice, but also to the influence/impacts of globalization.

My own interest in global mental health was born in the mid-1990s when I worked in The Gambia with a team of nurses to develop community mental health services/training programs. From this experience, as you also note in your comments, I will emphasize the work of the nursing professions (at all cadres and levels of training), families, village health workers and traditional healers as existing services to support and bolster. Most often these carers were the first points of entry to mental health care and provide most mental health care/services. This is not to down-play the work of psychiatry, however access/availability to psychiatry is very limited in many areas with abundant resources, let alone resource poor areas.

Interestingly enough, the lone visiting psychiatrist we had working with us at the time was Nigerian (as were many medical and nursing staff). I do believe there is considerable leadership in the field out of Nigeria as well as South Africa. Again, my experience is moreso in community mental health, but in terms of the medical perspective, the Lancet put out an excellent special issue in 2007 I will attach for your interest (if you have not seen it already).

Further, I would like to refer you on to some of our colleagues at the Centre for Addiction in Mental Health in Toronto where there are particular geographic focus interests/projects in Nigeria: http://www.camh.net/education/international_health_programs/index.html


Finally, there are a number of exemplary practices in the domains of teaching, training, treatment and advocacy I have become acquainted with over the years. In particular I'd like to point you to the work of BasicNeeds presently working in 8 low/middle-income countries. Their website will link you to many other fine resources and publications as well as some of the practitioners they partner with world-wide...their lessons learned will richly inform you as you embark on expanding your practice.

http://www.basicneeds.org/

I would be happy to discuss further experiences and options for your engagement in the field and can be reached at:

With Best Regards,
Sonya Jakubec

Attached resource:
  • Lancet Special Issue on Global Mental Health 2007 (download, 384.2 KB)

    Summary: Agreed on the kudos to Dr. Okpaku. Mental health concerns are, world-wide, in need of our thoughtful attention to culturally conscious practice, but also to the influence/impacts of globalization.

    My own interest in global mental health was born in the mid-1990s when I worked in The Gambia with a team of nurses to develop community mental health services/training programs. From this experience, as you also note in your comments, I will emphasize the work of the nursing professions (at all cadres and levels of training), families, village health workers and traditional healers as existing services to support and bolster. Most often these carers were the first points of entry to mental health care and provide most mental health care/services. This is not to down-play the work of psychiatry, however access/availability to psychiatry is very limited in many areas with abundant resources, let alone resource poor areas.

    Interestingly enough, the lone visiting psychiatrist we had working with us at the time was Nigerian (as were many medical and nursing staff). I do believe there is considerable leadership in the field out of Nigeria as well as South Africa. Again, my experience is moreso in community mental health, but in terms of the medical perspective, the Lancet put out an excellent special issue in 2007 I will attach for your interest (if you have not seen it already).

    Further, I would like to refer you on to some of our colleagues at the Centre for Addiction in Mental Health in Toronto where there are particular geographic focus interests/projects in Nigeria: http://www.camh.net/education/international_health_programs/index.html


    Finally, there are a number of exemplary practices in the domains of teaching, training, treatment and advocacy I have become acquainted with over the years. In particular I'd like to point you to the work of BasicNeeds presently working in 8 low/middle-income countries. Their website will link you to many other fine resources and publications as well as some of the practitioners they partner with world-wide...their lessons learned will richly inform you as you embark on expanding your practice.

    http://www.basicneeds.org/

    I would be happy to discuss further experiences and options for your engagement in the field and can be reached at:

    With Best Regards,
    Sonya Jakubec

    Source: The Lancet

    Keywords: member spotlight, mental health

Sandeep Saluja Replied at 5:52 PM, 2 Aug 2011

I think,we come back to the basic issue.We need all aspects of care and there is a scarcity of specialists in all areas in the areas we are talking about.In fact,I neither see the feasibility nor the need for all specialists to be available.We need to seriously nurture a breed of people with understanding of all clinical specialties appropriate for such areas.In fact,it is much more challenging take up such assignments than a so called super specialist in a big set up.It is just that society does not recognize it as such.The reward lies in the task itself and not in the recognition.

Samuel Okpaku Replied at 4:45 PM, 9 Aug 2011

Dear Ms. Sonya Jakubec,

I thank you for your contribution to the discussions on scaling up mental health services and resources in poor health settings. I have in front of me a map of Africa. I can see several countries which have less than ten psychiatrists. The issue of allied professionals in paramount. Also, there are many conflict areas: Libia, Sudan and Somalia. This raises the question of mental health in conflict areas. In many African countries HIV remains a major health and economic issue. With all of the above, it is evident that there is considerable room for anyone who wants to contribute to provide an assistance in Africa. In my experience many people are interested in contributing to provide the assistance, but are not sure how to set about this. The center for health culture and society, CHCS, serves to provide information and encourage networking for individuals interested in participating on the African scene. The address is chcsglobal.com. I'm in touch with Shoba Raja and Chris Underhill of basicneeds. In addition, I coordinate the African discussion group of the American Psychiatric Association. A group interested in facilitating mental health services and research in Africa. I thank you for your interest in Africa. You can reach me at chcsglobal.com which serves as a secretariat for the African discussion group.







Very Kind Regards,

Samuel Okpaku, M.D., Ph.D.
Executive Director - Center for Health, Culture, and Society
1233 17th Ave S ∙ Nashville, TN 37212
615-329-4182 ∙ phone
615-327-9399 ∙ fax
∙ email

Ifeoma Ozodiegwu Replied at 10:35 AM, 18 Sep 2012

Even though I am more than a year late to this discussion, I am glad to have seen and read the discussion. Like Sonya, I do agree that community members and workers need to be given the basic training to provide mental health services as there will most likely never be enough mental health capacity in the African region for a long time. Like Dr. Samuel, I questioned the mental health needs in conflict and post conflict regions and when I began to look through literature, there was indeed a high prevalence but with a a huge lack of professionals to deal with the issue. Do check my little write-up for Global Health Africa and the TED video by Vikram Patel on training lay citizens to be part of the solution for mental illness http://globalhealthafrica.org/

Best Regards,
Ifeoma Ozodiegwu
Founder and Writer
Global Health Africa

Attached resource:

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.