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.
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.