A key gap in current mental health professional training in Africa and globally is an orientation to public mental health. This means an orientation to the mental health needs of populations, and the policies, laws and services that are required to meet those needs.
The WHO has highlighted this critical shortage and has put out an urgent call to improve and strengthen professional mental health capacity in Africa.
The Alan J Flisher Centre for Public Mental Health has heeded this call and has produced a steady stream of graduates over the last few years. This year has been no different with 5 MPhil and 1 PhD graduates.
Japhet Myaba from Malawi focused his MPhil on the prevalence and predictors of antipsychotic medication non-adherence among clients with psychotic disorders in Mzimba, Malawi. (Supervisors: Katherine Sorsdahl & Emily Baron)
Megan Malan from South Africa studied the prevalence and predictors of intimate partner violence among women attending a midwife and obstetrics unit in the Western Cape. (Supervisors: Katherine Sorsdahl & Maxine Spedding).
Hailing from Ethiopia, Tigist Zerihun, conducted a qualitative study on family planning for women with severe mental illness in rural Ethiopia. (Supervisors: Katherine Sorsdahl & Charlotte Hanlon)
Prasansa Subba from Nepal conducted a formative study on the adaptation of mental health promotion programmes for perinatal depression in West Chitwan. (Supervisors: Erica Breuer & Petal Petersen)
Also conducting a qualitative study, Winifred Nalukenge from Uganda, focused on mental health explanatory models, and the perceived impact of life experiences on mental health, in HIV-infected adolescents in rural and urban Uganda.
Both Megan and Prasansa graduated with distinction.
Maxine Spedding from South Africa made the CPMH proud by obtaining her PhD. She focused her doctorate on the prevalence and predictors of intimate partner violence among women attending a midwife and obstetrics unit in the Western Cape. (Supervisors: Katherine Sorsdahl, Dan Stein & Tracey Naledi)
Based on an inter-disciplinary approach, the courses include inputs from staff from diverse academic backgrounds, including public health, psychiatry, psychology and the social sciences. The courses are focused on the context of African public mental health, and thus draw on the experience of the lecturers and the participants, and all assignments are related to the ongoing work conducted by participants in their respective countries. In this way, the CPMH hopes to contribute to knowledge generation about low and middle-income countries by scholars of these countries, and graduates are strongly encouraged to publish their work in peer-reviewed journals.
The capacity development programmes of the CPMH are groundbreaking in that there are currently no centres that offer public mental health training and research on the African continent. We take pride in pioneering this work in Africa, and are confident that our position in the developing world offers a unique training experience.
The overall goal of the African Mental Health Research Initiative (AMARI) is to build an Africa-led network of mental, neurological and substance use researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programmes that meet the needs of their countries.
The AMARI scholarships funded by the UK Wellcome Trust have been established to provide support for two PhD students to join the team in the Centre for Public Mental Health, in the Department of Psychiatry & Mental Health at the University of Cape Town. Although the topic is of the successful Fellows’ choice, AMARI aims to create a sustainable career pipeline for these researchers with emphasis on integrating MNS research into existing programmes such as HIV/AIDS, and maternal and child health. Priority will be given to applicants who show evidence of leadership potential in the field. Although applicants from any of the four participating countries will be considered, we encourage applications from South Africans from previously disadvantaged communities.
At present time no specific fellowships are offered by CPMH, however if you’d like to discuss PHD opportunities, please contact Prof Katherine Sorsdahl at email@example.com.
Professor Gureje is a member of the Editorial Board of several journals including International Review of Psychiatry, Social Psychiatry and Psychiatric Epidemiology, Drug and Alcohol Dependence, Epidemiology and Psychiatric Services and Lancet Psychiatry. He has been active in global mental health for over two decades with leadership roles in several collaborative studies in epidemiology, randomized controlled trials and health system strengthening. A well-cited author (citations > 12,000; H-index: 51), he has published over 300 peer-reviewed articles, 30 book chapters, and 6 edited books.
He plays a leading role in mental health policy development in Nigeria as the Chair of the Federal Ministry of Health’s Mental Health Action Committee. A Fellow of the Nigeria Academy of Science, he was, in 2008, conferred with Nigeria’s highest award for academic achievement, the Nigeria National Order of Merit, by the country’s President for his contributions to medicine.
36 Transferred Psychiatric Patients from Life Healthcare Esidimeni Deceased
The Alan J Flisher Centre for Public Mental Health expresses concern over recent deaths and the DOH’s response
15 September 2016
The Alan J Flisher Centre for Public Mental Health (CPMH) wishes to express its concern over the recently reported deaths of 36 psychiatric patients transferred from Life Healthcare Esidimeni earlier this year.
About 2 000 psychiatric patients were moved into 122 NGOs after the Gauteng Health Department cancelled its long-running contract with Life Healthcare Esidimeni due to funding cuts. News of the contract cancellation was announced late last year and the affected patients were moved to the various NGOs early in 2016.
Despite loved ones claiming to struggle tracking down their transferred family members at these NGOs and a constant flood of reports about poor conditions (including poor medical attention, harrowing living conditions and a lack of food), the Gauteng Health Department continued to claim that all patients were accounted for and were receiving proper care.
These pleas from family members‚ Section 27 lawyers as well as mental health care institutions like the South African Federation for Mental Health (SAFMH) and the South African Depression and Anxiety Group (SADAG) were continually dismissed.
In an oral reply to some questions posed by the Democratic Alliance’s Gauteng Shadow Health MEC, Jack Bloom, Bloom, the Gauteng Health MEC, Ms Qedani Mahlangu, confirmed in Legislature on Tuesday that 36 of these patients are now deceased and the causes of death undisclosed.
Ms Mahlangu said that the patients were transferred without clinical files that detailed their medical history, and doctors were sent to the NGOs to examine the medical needs of the patients in a continuing investigation into the cause of the deaths.
“I am horrified that so many patients have died from undisclosed causes after being transferred to NGOs, many of which relatives have said are unsuitable. I am aware that eight patients died at the Previous Angels NGO and some others died at Takalani and at the Cullinan Centre,” said Bloom in a statement issued on Tuesday.
Bloom also mentioned that, after being challenged by him to apologize for the “poor manner in which the transfers to NGOs were done,” Ms Mahlangu responded that the Department apologised “where mistakes have been made.”
“The deaths of so many patients need to be accounted for and any sign of negligence by any of the NGOS or the Gauteng Department of Health needs to be addressed urgently,” says CPMH Director, Prof Crick Lund.
Prof Lund confirmed that there is a global movement towards deinstitutionalising psychiatric care and providing mental health care at community level. But this shift needs to be approached with care and that sufficient investment needs to be made into community-based facilities for the effective treatment of the mentally ill, said Lund.
“We call on the Gauteng Health Department and the National Department of Health to take these deaths as well as the reports of maltreatment of psychiatric patients very seriously and to take immediate action to confirm the proper care of the remaining transferred patients,” said Prof Lund.
The Alan J Flisher Centre for Public Mental Health (CPMH) grew out of a shared vision and commitment to collaboration between members of the Department of Psychiatry and Mental Health at the University of Cape Town (UCT), and the Psychology Department at Stellenbosch University (SU) and has recently been designated as the only mental health and psychiatry WHO Collaborating Centre in South Africa.
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“It was wonderful to see that this highly neglected issue was recognised and appreciated for its importance,” said the winning team.
The Global Challenge is a chance for students and recent graduates to learn more about the issues they care about and present their findings to the world. Tackling global challenges starts with understanding a problem and its wider context, rather than jumping straight into a business plan or an idea for a quick fix. Participants are asked to demonstrate a deep understanding of a pressing social or environmental issue by mapping out the landscape of the current solutions and identifying missing opportunities for positive change.
As part of their prize, Gururaj and Pople received some funding with which they aim to bridge the gap between research and action by taking this work further through fieldwork in December.
View ThinkStrong’s presentation below and check out the infographic they developed as part of their entry. Should you wish to contact ThinkStrong, please email Maggie Marx.
In partnership with South32, the annual NSTF awards (also known as South Africa’s “Science Oscars”) recognise outstanding contributions to science, engineering and technology (SET) and innovation by researchers and other SET-related professionals.
The TW Kambule-NSTF Award celebrates outstanding contribution to SET and innovation by an individual over a period of up to 15 years after the award of a PhD or equivalent, predominantly in South Africa.
Professor Lund’s research has pioneered the development of mental health policies and services to address the growing burden of mental illness in South Africa and other low and middle-income countries (LMIC).
His scientific work has had a significant impact on the development of norms for mental health services, drafting of national mental health policies, development of WHO guidelines for mental health policy and services, identification of major social determinants of mental illness in LMIC, interventions that address the cycle of poverty and mental illness, and delivery and evaluation of new models of mental health care.
Prof Lund received his award during the 2015/2016 NSTF-South32 Awards Gala Dinner at Emperor’s Palace in Pretoria.
“I feel deeply honoured by this award. Research is a team game, so I am receiving the NSTF award on behalf of the wonderful team that I work with – including colleagues at the University of Cape Town (UCT) and our fantastic national and international partners. Mental health is a global health and development issue that is receiving increasing public policy attention, and I hope this award can create greater awareness of this issue,” says Prof Lund.
On a global scale, 1 in 7 mothers experience a degree of depression and anxiety during their perinatal period. The perinatal period refers to the period of time from the beginning of pregnancy, including childbirth, and ends when the baby reaches his first year. Sadly, the symptoms endured by these mothers are often undetected by health care providers, which in turn, leaves the mother and her family uninformed. If left untreated, the long-term effects can have negative consequences to both mother and child. It is with this in mind that maternal mental health organisations from around the globe have joined forces to work towards a common goal – raising awareness of maternal mental health issues with the aim of increasing resources to diagnose and treat perinatal mood and anxiety disorders. In an attempt to achieve this goal, the first World Maternal Mental Health Day will be held on 4 May 2016.
The task force:
In 2015, a Task Force from around the world began meeting to make plans for World Maternal Mental Health day. Through collective efforts, the campaign aims to raise awareness about maternal mental health by utilising social media and organising in-country events. The PMHP is a proud member of the Task Force, which includes representatives from the UK, US, Canada, Turkey, Australia, Argentina, Malta, New Zealand, Spain, Germany and of course South Africa. You can follow the first ever global #WorldMMHDay on Twitter with the hashtag #MaternalMHmatters
Zooming In: A South African Perspective – 1 in 5 mothers are affected by depression or anxiety during the perinatal period. 75% of South Africans with mental health problems do not receive the care they need.
South Africa has a high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls becoming pregnant at least once. However, when coupled with depression, the likelihood of a subsequent teenage pregnancy nearly doubles. Follow the link to get more information on teenage pregnancy in South Africa.
Who is at risk of developing a perinatal mental health disorder?
Mental disorders during pregnancy and in the first year after delivery are common. The risk increases when women face poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use, as well as low social support. 25% of PMHP clients present with 3 or more risk factors, which puts them at risk for developing psychological distress during and after pregnancy.
In South Africa, 97% of pregnant woman take up antenatal care at a health facility. However, though there are recommended and proven screening tools available, these women are not routinely screened for maternal mental health disorders. This is largely due to a shortage of qualified care providers who can provide the necessary treatment. The Perinatal Mental Health Project tries to optimise the limited resources we do have in order to create the maximum benefit for vulnerable women. We provide mental health information in three languages, screening and counselling as part of our maternity health care program. We operate at three midwife units in the Western Cape.
How you can help:
We are encouraging local and regional organisations to join the campaign by becoming a global partner and spreading the word that #maternalMHMatters.
For more information about the campaign and to see a complete list of the organisations supporting this effort visit this link.
For more information For more on maternal mental health in South Africa see our press release attached, visit our campaign blog and our website.
The well-known South African actor Fezile Mpela is the star of a new video raising awareness about the cost of mental health in South Africa. The facts and figures he mentions, are based on research conducted by the Alan J Flisher Centre for Public Mental Health (CPMH) and the South African Federation for Mental Health has agreed to partner up and disseminate this important message.
From today until the beginning of May the video will also be screened at selected Ster Kinekor Cinema Nouveau theatres countrywide.
Fezile Mpela is a South African television, theatre and film actor who has starred in a variety of popular South African productions.
He wowed South African audiences in the hit soapie 7de Laan, where he played Sello Modise. He currently plays the part of Thato Mogale (TT) in SABC3’s new drama High Rollers.
Two recent graduates of the CPMH MPhil programme chatted to Maggie Marx about their study experience and what the completion of the course means to them.
Demoubly Kokota, a research coordinator for the Scotland Malawi Mental Health Education Project at the University of Malawi says:
“My time doing the MPhil in Public Mental Health was amazing. I enjoyed every aspect of the course such as the intensive 3-week advanced mental health lessons, sightseeing of Cape Town, excellent supervisors and webinars to assist me with any problems I encountered at any stage.
The course is very beneficial for anyone trying to have a career in research or public health. It equips you with all the skills you may need to conduct good research and critically evaluate health services in any country. I would encourage everyone to consider this course.”
Dr. Qhama Cossie, another graduate is also very impressed with the programme and being able to fine tune his clinical skills during the course was of great value to him.
“I’m a psychiatrist at VBH in Cape Town, in the UCT Department of Psychiatry and Mental Health with an interest in severe mental illness and public mental health.
As a part of my work I am the consultant psychiatrist for our hospital assertive community treatment team (ACT). The ACT team manages patients with severe mental illness who have a revolving door pattern of readmission, with frequent readmissions and long stays in hospital. We conduct home visits and work very closely with available family members. My research was focused on the ACT service and my dissertation title was The relationship between patient, carer and staff perceptions of need in an assertive community treatment team in South Africa.
The process of completing the MPhil gave me a greater understanding of the research process and it enabled me fine tune my clinical skill. Focusing on a topic directly linked to my day-to-day clinical work it has allowed me and the team to better understand the patients we serve and it has highlighted the importance of adopting the recovery model and changing the way that the team works.”
For more information about CPMH’s MPhil programme, please click here.
Read more about how the programme is growing here.
The MPhil in Public Mental Health was initiated in 2012 and is a part-time research degree that aims to develop advanced research skills, enabling participants to undertake their own research projects (such as evaluating services, policies and interventions) as well as interpret research findings for mental health policy and practice.
The programme is designed to be accessible to practitioners who work full-time, and who are from a range of backgrounds, like social work, psychology, medicine, occupational therapy, nursing, health economics, public mental health, public health, health service management, policy making and non-governmental organisations (NGOs).
The training aims to build the professional capacity and leadership of the participants in their work, while contributing to knowledge generation in Africa. The degree requires: 1) The completion of a 3-week residential training module in research methodology for public mental health in Cape Town; and 2) The preparation of a dissertation of a minimum of 20 000 words in either monograph or publication-ready format.
The table below represents the number of students registered at UCT and Stellenbosch for each year of the MPhil. The table also gibve sinsight into trhe number of students currently studying towards the MPhil and those who’ve completed or dropped out of the programme. Since 2012, 30 students have enrolled in the MPhil (19 at UCT and 11 at SU). Overall, 12 have graduated (12 UCT and 3 SU), 15 are still registered and 2 have dropped out (sadly one student passed away).
Mphil in Public Mental Health (2012-2015)
Publications from MPhil Dissertations
To date, only two students have published their thesis. However, five students are in the process of preparing a manuscript. Given that the majority of the 12 students who have graduated from the programme did so recently (in the last year), we anticipate more students to publish shortly. In order to facilitate this, Dr. Katherine Sorsdahl, the course convener for the MPhil in Public Mental Health, will be conducting webinars to assist in this process.
Survey results of MPhil Graduates
A survey was disseminated to all 12 students who have graduated from the MPhil programme since its inception in 2012. Ten of these students completed the survey (a response rate of 83%). Overall, all of the students felt that after completing the MPhil in Public Mental Health they are now skilled in research methods and can read a journal article with a more critical eye. Three students have already enrolled in a PhD, while five more are contemplating embarking on a research career through a PhD programme. Since the MPhil programme started, five students have collaborated on writing a paper (not necessarily on their MPhil research) and two have assisted in grant writing.
When asked about the 3-week course they attended in Cape Town, 75% felt that the course was long enough and covered enough details. However, the remaining 25% felt that the course could be greatly improved if the length of this course was extended. This viewpoint was encapsulated in the words of one student who stated:
“A lot of material covered within a limited time. Really wished more time could have been allocated to important lessons like research methods and proposal development. These are very crucial areas for one to complete the course but I feel they were rushed because of time. Adding a week to the course can really help. The duration of the 3-week course should have been 4 weeks.”
In terms of supervision, all students agreed that their supervisor provided feedback in a timely manner, provided them with constructive criticism and feedback and was approachable and supportive through the MPhil process. This general high satisfaction is illustrated by one student who said:
“My supervisor was excellent. She was always there to give me useful feedback on my work. I was able to argue my case where I differed without worrying about annoying her. She was always there to answer my questions and concerns until I was satisfied. She has very high standards and it forced me to work hard. However, I was pleased to do so as I knew the end result will be worth it. Moreover, in the beginning I was worried about data analysis and she gave me a clear understanding and made data analysis an enjoyable experience for me. Lastly, I feel my supervisor was a great force who made it possible for me to finish my dissertation in the shortest possible time.”
In 2014, with the placement of an MPhil course co-coordinator, webinars were integrated into the MPhil curriculum. These occur monthly and provide an opportunity to discuss research progress and obstacles. Each webinar included a discussion on a research topic such as how to use reference managing software, responding to reviewer comments or specific data-analysis topics. All four students who participated in the webinars felt strongly that they contributed to the timely completion of their thesis and should be permanently integrated into the MPhil curriculum. The importance of these webinars to the MPhil is illustrated by one student who said:
“Wow! The webinars were really great. Firstly, they encouraged me to do more and work hard. By seeing what others were doing, they motivated me to also strive hard to finish different parts of my dissertation. The course could have really been unbearable without their support. The convener organised the webinar in such a way that each one of us was given a chance to share our progress and where we felt stuck. Immediate help was provided and we could ask more questions through emails if we still wanted more help.”