Author's Accepted Manuscript
The Early-Career Consultation Psychiatrist: The Role in Global Settings Hussam Jefee-Bahloul MD, Pedro Fernandez MD
PII: DOI: Reference:
S0033-3182(14)00086-3 http://dx.doi.org/10.1016/j.psym.2014.05.011 PSYM469
To appear in:
Psychosomatics
Cite this article as: Hussam Jefee-Bahloul MD, Pedro Fernandez MD, The EarlyCareer Consultation Psychiatrist: The Role in Global Settings, Psychosomatics, http: //dx.doi.org/10.1016/j.psym.2014.05.011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Early-Career Consultation Psychiatrist: The Role in Global Settings
Hussam Jefee-Bahloul, MD, Pedro Fernandez, MD Yale School of Medicine, Department of Psychiatry, Psychosomatic Medicine
The longstanding vision of the Academy of Psychosomatic Medicine is to “vigorously promote a global agenda.”(1) It embodies a field that eloquently bridges the gap between the psychological and traditional medical model of illness. Fulfilling this global agenda is made difficult due to the growing burden of mental health disorders in developing countries and the increasing need to access quality mental health services. (2) Recent graduates of psychosomatic medicine fellowship training have a unique opportunity to significantly contribute in answering the global mental health challenge.
The writers of this letter come from two different low-and-middle-income countries (LMIC) and as early-career consultation psychiatrists are interested in advancing mental health services in global settings. The potential impact in the global settings can manifest in different ways: 1. International Outreach: One of the more dynamic roles for early-career consultation psychiatrists is to serve as academic educators and mentors for mental health or primary care providers, trainees, or students in LMIC (Low and Middle Income Countries). Implementing models of institutional psychosomatic education in LMIC is a vital, and under-reported venue for early-career consultation psychiatrists.
2. Asylee and Refugee Mental Health: The health care needs of asylee and refugee patients can be complex and often require collaboration between physicians, psychologists, social workers, and immigration lawyers. (3) Consultation psychiatrists are specifically trained to work at the interface between these various disciplines. On the other hand, many nonpsychiatric providers are not trained in the detection of mental illness in culturally diverse groups where psychological distress may solely manifest somatically. Hence, earlycareer consultation psychiatrists can function as Cultural Brokers by helping non-
psychiatric providers navigate the cultural nuances of the clinical encounter while helping to de-stigmatize mental illness among patients through psycho-education.
3. Collaborative care (CC) models: In response to the lack of access to specialized care in the developed world, collaborative-care (CC) models were developed. These models integrate the management of mental health needs by mental health specialists in the primary medical care setting. It has already been theorized that integrated care has the potential to improve global mental health systems and reduce their over-all cost. (4) Early-career consultation psychiatrists have a unique advantage when it comes to CC models given that they are trained in an era of major focus on the integration of psychiatry into primary care settings. Thus, the role of early-career consult psychiatrists in this global CC model can be clinical: i.e. providing consultations or supervision for CC projects, or research-oriented: i.e. designing effectiveness studies and adding to the available, yet limited, evidence of CC models in LMIC. (5)
4. Technology-based interventions: Technology can serve in connecting treatment teams globally, and can be utilized for education, supervision, and case reviews in the above illustrated CC model. Other uses of technology can be to provide direct education to mental health or primary care providers through telemedicine. In addition, technology can be utilized in the innovations of e-mental health projects, such as the (eData K) project in Kenya where an e-learning module allows workers in primary care settings to identify and treat substance use disorders through an efficient internet-based program. (6) The role of the early-career consultation psychiatrist in such projects can be in providing support to technology makers, or provide ideas for new interventions that aspire to improve mental health services of medically ill patients. Early-career consultation psychiatrist can advance the “global agenda” by helping to promote cultural diversity among the next generation of consultation psychiatrists. The growing diversity of the academic medical field (7) brings trainees from different ethnic and cultural backgrounds to work together and exchange cultural expertise in clinical and academic settings. This cultural diversity enriches the journey that psychosomatic medicine trainees embark upon on the frontiers
of medicine, surgery and psychiatry by projecting training programs into a global setting. This global setting allows for global psychosomatic research projects, and cultural growth for the trainees. This letter addresses just a few of the potential roles that early-career consultation psychiatrists can play in advancing the understanding of collaborative care in the global setting and promoting the Academy of Psychosomatic Medicine’s “global agenda.”
Disclosure: The authors disclose no conflict of interest.
References: 1.
Academy of Psychosomatic Medicine www.apm.org 2014.
2.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global
burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013;382(9904):1575-86. 3.
Bhugra D, Gupta S, Bhui K, Craig T, Dogra N, Ingleby JD, et al. WPA guidance on
mental health and mental health care in migrants. World psychiatry : official journal of the World Psychiatric Association. 2011;10(1):2-10. 4.
Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in
global mental health. Nature. 2011;475(7354):27-30. 5.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness
of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086-95. 6.
Mental Health Innovation Network http://mhinnovation.net/innovation/ 2014.
7.
Price EG, Gozu A, Kern DE, Powe NR, Wand GS, Golden S, et al. The role of cultural
diversity climate in recruitment, promotion, and retention of faculty in academic medicine. Journal of general internal medicine. 2005;20(7):565-71.
The Early-Career Consultation Psychiatrist: The Role in Global Settings Hussam Jefee-Bahloul MD, Pedro Fernandez MD
PII: DOI: Reference:
S0033-3182(14)00086-3 http://dx.doi.org/10.1016/j.psym.2014.05.011 PSYM469
To appear in:
Psychosomatics
Cite this article as: Hussam Jefee-Bahloul MD, Pedro Fernandez MD, The EarlyCareer Consultation Psychiatrist: The Role in Global Settings, Psychosomatics, http: //dx.doi.org/10.1016/j.psym.2014.05.011 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Early-Career Consultation Psychiatrist: The Role in Global Settings
Hussam Jefee-Bahloul, MD, Pedro Fernandez, MD Yale School of Medicine, Department of Psychiatry, Psychosomatic Medicine
The longstanding vision of the Academy of Psychosomatic Medicine is to “vigorously promote a global agenda.”(1) It embodies a field that eloquently bridges the gap between the psychological and traditional medical model of illness. Fulfilling this global agenda is made difficult due to the growing burden of mental health disorders in developing countries and the increasing need to access quality mental health services. (2) Recent graduates of psychosomatic medicine fellowship training have a unique opportunity to significantly contribute in answering the global mental health challenge.
The writers of this letter come from two different low-and-middle-income countries (LMIC) and as early-career consultation psychiatrists are interested in advancing mental health services in global settings. The potential impact in the global settings can manifest in different ways: 1. International Outreach: One of the more dynamic roles for early-career consultation psychiatrists is to serve as academic educators and mentors for mental health or primary care providers, trainees, or students in LMIC (Low and Middle Income Countries). Implementing models of institutional psychosomatic education in LMIC is a vital, and under-reported venue for early-career consultation psychiatrists.
2. Asylee and Refugee Mental Health: The health care needs of asylee and refugee patients can be complex and often require collaboration between physicians, psychologists, social workers, and immigration lawyers. (3) Consultation psychiatrists are specifically trained to work at the interface between these various disciplines. On the other hand, many nonpsychiatric providers are not trained in the detection of mental illness in culturally diverse groups where psychological distress may solely manifest somatically. Hence, earlycareer consultation psychiatrists can function as Cultural Brokers by helping non-
psychiatric providers navigate the cultural nuances of the clinical encounter while helping to de-stigmatize mental illness among patients through psycho-education.
3. Collaborative care (CC) models: In response to the lack of access to specialized care in the developed world, collaborative-care (CC) models were developed. These models integrate the management of mental health needs by mental health specialists in the primary medical care setting. It has already been theorized that integrated care has the potential to improve global mental health systems and reduce their over-all cost. (4) Early-career consultation psychiatrists have a unique advantage when it comes to CC models given that they are trained in an era of major focus on the integration of psychiatry into primary care settings. Thus, the role of early-career consult psychiatrists in this global CC model can be clinical: i.e. providing consultations or supervision for CC projects, or research-oriented: i.e. designing effectiveness studies and adding to the available, yet limited, evidence of CC models in LMIC. (5)
4. Technology-based interventions: Technology can serve in connecting treatment teams globally, and can be utilized for education, supervision, and case reviews in the above illustrated CC model. Other uses of technology can be to provide direct education to mental health or primary care providers through telemedicine. In addition, technology can be utilized in the innovations of e-mental health projects, such as the (eData K) project in Kenya where an e-learning module allows workers in primary care settings to identify and treat substance use disorders through an efficient internet-based program. (6) The role of the early-career consultation psychiatrist in such projects can be in providing support to technology makers, or provide ideas for new interventions that aspire to improve mental health services of medically ill patients. Early-career consultation psychiatrist can advance the “global agenda” by helping to promote cultural diversity among the next generation of consultation psychiatrists. The growing diversity of the academic medical field (7) brings trainees from different ethnic and cultural backgrounds to work together and exchange cultural expertise in clinical and academic settings. This cultural diversity enriches the journey that psychosomatic medicine trainees embark upon on the frontiers
of medicine, surgery and psychiatry by projecting training programs into a global setting. This global setting allows for global psychosomatic research projects, and cultural growth for the trainees. This letter addresses just a few of the potential roles that early-career consultation psychiatrists can play in advancing the understanding of collaborative care in the global setting and promoting the Academy of Psychosomatic Medicine’s “global agenda.”
Disclosure: The authors disclose no conflict of interest.
References: 1.
Academy of Psychosomatic Medicine www.apm.org 2014.
2.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global
burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013;382(9904):1575-86. 3.
Bhugra D, Gupta S, Bhui K, Craig T, Dogra N, Ingleby JD, et al. WPA guidance on
mental health and mental health care in migrants. World psychiatry : official journal of the World Psychiatric Association. 2011;10(1):2-10. 4.
Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in
global mental health. Nature. 2011;475(7354):27-30. 5.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness
of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086-95. 6.
Mental Health Innovation Network http://mhinnovation.net/innovation/ 2014.
7.
Price EG, Gozu A, Kern DE, Powe NR, Wand GS, Golden S, et al. The role of cultural
diversity climate in recruitment, promotion, and retention of faculty in academic medicine. Journal of general internal medicine. 2005;20(7):565-71.
