An electronic publication for mental health in developing countries - promoting fresh ideas to reduce suffering worldwide.

Welcome to this the first ever electronic edition of Developing Mental Health.

Developing Mental Health is designed and prepared for all healthcare professionals who have an interest in and concern for mental health care – psychiatrists, clinical psychologists, general physicians, mental health nurses, general nurses, occupational therapists, pharmacists, physiotherapists, dieticians, community health workers, social workers, administrators, chaplains and interested faith and community leaders.

Developing Mental Health started life as a hard copy journal distributed free of charge in over 200 countries - this is the start of its regeneration…

We are aware of a greater sense of responsibility towards mental health care amongst health care professionals - and our hope and prayer is that Developing Mental Health will contribute to both the training and the practice of mental health care in communities world-wide.

DMH is produced and published by PRIME Partnerships in International Medical Education

An interview with the previous Editor of Developing Mental HealthProfessor Andrew Sims MD, DM, FRCPsych, Hon FRCGPsych, FCPS (Pakistan), FCP (South Africa), FAEP

Looking back over your career, what were the biggest changes in international psychiatry that you witnessed? I have been very privileged to see the birth and infant development of psychiatry in several countries. When I first visited Pakistan in 1984 there were fewer than one psychiatrist per million population, and all of those in the biggest cities. Psychiatry, as a discipline, was controlled and therefore held back by the rest of medicine: a trainee said to me, “If I want to become a consultant psychiatrist I have to be examined in the detailed anatomy of the knee joint”. Now, although there are still too few psychiatrists, the specialty is progressing dramatically. There are established academic departments carrying out research and there is outreach into the community in many places. There is also a thriving British Pakistani Psychiatric Association which supports the specialty at home from Britain.

More about Andrew Sims:Andrew   qualified   in   medicine   from  Emmanuel   College,   Cambridge   and  We s tm i n s t e r   Med i c a l   S c hoo l .  Postgraduate  training   in  psychiatry  was  in  the  University  of  Manchester,  and  in  Birmingham.   His   MD   was   granted   by  the  University  of  Cambridge  in  1974,  on  a   thesis   concerned   with   the   prognosis  in  neuroJc  disorders.

A similar picture is also true of Sri Lanka where there has been a lot of growth over the 30 years since I first visited. At that time they were developing a community mental health project which has become a model for subsequent development of services. In the 1980s Sri Lanka was hampered by an old-fashioned, British-style mental hospital outside Colombo. It was an appalling place, disturbed patients were kept in cages: it gave psychiatry a very bad name. Psychiatry has made huge strides since those days. Now, good psychiatric practice is more generally available. Egypt is a country I have visited over many years and it has been good to see much progress in developing psychiatric services - but there is still a lot to do, especially outside the big cities. Sub-Saharan Africa is much more of a problem: for many years, as soon as a country, such as Zambia had a trained psychiatrist, he (usually) would be recruited by another, richer country, such as the UK. What is still frustrating all over the world including Britain is the small proportion of the health budget allocated to mental health. This has damaging consequences, especially for poorer nations.

What and who were your biggest influences professionally? The two biggest influences on my thinking as a student were CS Lewis, who inspired my generation of Christian students, and Paul Tournier, a Swiss doctor who wrote many books including The Meaning of Persons; he, in particular, sparked my enthusiasm for psychiatry. Amongst psychiatrists when I was a senior trainee or junior consultant, I was most impressed by Ken Rawnsley, Professor of Psychiatry in Cardiff and a previous President of the Royal College of Psychiatrists. When he was Dean of the College, he completely revolutionised post-graduate training in psychiatry across the whole of Britain and in even the most remote of hospitals, so that we were way ahead of every other medical discipline in training. He was supremely innovative in every area of practice and training; he was my model when I, later, became Dean of the College. Professor Sir William Trethowan was my boss when I was Senior Lecturer in Birmingham. I learnt a lot of management skills from him which have been useful subsequently. Also, his practice of psychiatry was securely based on descriptive psychopathology, which I have tried to maintain. Like most other senior doctors, I have learnt a lot from my students, my junior doctors and, especially, my patients: too numerous to be individually named.

You were part of the original Developing Mental Health editorial team. At the time of setting up the journal what were the principle motivators to the project? There was a very successful conference convened in 2001 by a number of Christian organisations and missions for promoting good practice in mental health in developing countries. Delegates came from all over the developing world and it was a big gathering, I know because I was there! To the organising committee’s

His   subsequent   research   interests  have   been   in   the   epidemiology,  phenomenology   and   response   to          treatment   of   neuroJc   disorders,  laKerly  post-­‐traumaJc  stress  disorder.  He   also   has   a   long-­‐term   interest   in  descripJve  psychopathology.  

Andrew   has   authored   12   books,  including   three  ediJons  of   Symptoms  in  the  Mind,  and  over  200  papers.  He  edited   Advances   in   Psychiatric  Treatment  from  its   incepJon  and  was  founder   editor   of   the   original  Developing  Mental  Health  publicaJon.  

Andrew  was  Professor  of  Psychiatry  in  the  University   of   Leeds,   and  went   on  to   be   an   Emeritus   Professor.   He  served   as   Dean,   President,   the   first  Director   of   ConJnuing   Professional  Deve lopment   and   the   second  Chairman   of   the   Spirituality   and  Psychiatry   Special   Interest   Group   of  the   Royal   College   of   Psychiatrists.   He  served   on   the   General   Medical  Council   as   an   elected   member   and  was   Screener   for   Health,   concerned  with  the  health  of  doctors.  

Over   recent   years,   Andrew   has  published  and  spoken  on  the  interface  between   religious   faith   and   mental  illness.

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enormous surprise, the conference made a small profit. They wanted to put this back into mental health, which was even more of a ‘Cinderella’ service in Africa and Asia than in Britain. They decided to put the funds into pump-priming a new journal directed at the needs of people with little mental health training involved in the care of those with mental illness. Quite a challenge! I was asked if I would edit this and, as I was just stepping down from editing Advances in Psychiatric Treatment, the continuing professional development journal of the Royal College of Psychiatrists, I accepted. We set up an editorial board and aimed to produce simple, practical guidance on the management of mental illness that was of professional excellence. Dominic Beer, who was on the Board from the start and succeeded me as Editor in 2005, was an exemplar; his articles in DMH are still models of clarity, good psychiatry and common sense. It was a great loss when later he became ill and died.

In the last decade what themes do you see as emerging in the development of psychiatric care in resource poor countries? In recent years the most important development has been the realisation that psychiatric care must extend out of the big cities into the rural areas, out of the hospital into the community. Sometimes the implementation of these principles has been tantalisingly slow. There have also been new challenges such as post-traumatic stress disorder, the psychiatric consequences of HIV and the psycho-social problems of urbanisation.

Looking forward, what do you see as the main challenges internationally in psychiatric care? A two-pronged approach is required: awareness of the need for and effectiveness of psychiatric treatment has to be realised by the general public and good quality training in psychiatry must be set up for medical students, post-graduates training in psychiatry and nurses. High quality education at all levels is essential. Getting the national Department of Health on board is always a major challenge, and often a key to progress – it certainly was in Zambia ten years ago.

And the main opportunities? When we started Developing Mental Health we thought hard about making it an on-line publication. At that time we realised that too many of the people we wanted to reach had no access to a computer. That has changed almost everywhere. So the opportunity is to produce material of high quality on-line that is not subject to financial promotion.

As Developing Mental Health relaunches what space do you see it occupying in the coming years? I would love to see it going to, and being useful in, every country where English is everyone’s second language. It would be great if there was feed-back from the readers as to what they would like to receive. It needs to have an emphasis on practical treatment and avoid professional jargon. I think I have said it all. Treatment not theory. Quality – only the best will do. The Christian foundation should be maintained but never used to proselytise.

Professor Andrew Sims was interviewed for this article by Dr Andrew Wilson, DMH Editor.

“… the most important development has been the

realisation that psychiatric care must extend out of the big cities

into the rural areas, out of the hospital into the community.”

Prof Andrew Sims (centre) with a PRIME team visiting Nepal...

WHO Mental Health Action Plan 2013 – 2020We welcome the adoption by the 66th World Health Assembly (which included Ministers of Health of 194 member states) of the WHO’s Mental Health Action Plan 2013-2020. Action based on this plan has the potential to make a real difference to the lives of

many across the globe. It recognises the essential role of good mental health in achieving health for all people. We welcome the focus on providing community based solutions, on prevention and promotion of good mental health. DMH hopes that in some small way we can promote and support the fulfilment of these aims. To view a copy of the action plan see: http://www.who.int/mental_health/publications/action_plan/en/

A helping hand…This month in DMH bite-size we thought we’d give you a “hand”, in your helping people in crisis to cope psychologically. Why don’t you try this exercise for yourself … and think about it next time you are helping someone in crisis – give them a helping hand. This could be a useful offering to someone who is struggling with a crisis in their life and draws on several streams of evidence-based intervention.

DMH bite-size

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