Keynote Addresses
Mental Health for All-by-All
Vikram Patel, MSc, MRCPsych, PhD, FMedSci, Professor of International Mental Health & Wellcome Trust Senior Research Fellow, London School of Hygiene and Tropical Medicine
Thursday, November 1
9:00 a.m. - 10:15 a.m.
The Road Less Traveled? Bringing Effective Trauma Interventions for Youth and Families Into Community Settings
Rochelle Hanson, PhD, Professor, National Crime Victims Research and Treatment Center (NCVC)
Friday, November 2
9:00 a.m. – 10:15 a.m.
Internet and Mobile Technologies to Support the Implementation of Evidence-Based Practices in PTSD Treatment
Kenneth R. Weingardt, PhD, National Director, Web Services, VA Office of Mental Health Services, Veterans Health Administration Consulting Assistant Professor, Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine
Saturday, November 3
9:00 a.m. – 10:15 a.m.
Public Mental Health as the Future Paradigm for our Trauma Societies?
Joop de Jong, MD, PhD, Professor of Cultural and International Psychiatry, VU University and University of Amsterdam, the Netherlands, Boston University School of Medicine, Rhodes University South Africa
Saturday, November 3
1:30 p.m. - 2:45 p.m.
In addition to the usual collection of high quality peer-reviewed presentations scheduled in the program, ISTSS is excited to offer four keynote addresses.
Thursday, November 1, 9:00 a.m. – 10:15 a.m.
Mental Health for All-by-All
Vikram Patel, MSc,
MRCPsych, PhD, FMedSci, Professor of International Mental Health &
Wellcome Trust Senior Research Fellow, London School of Hygiene and
Tropical Medicine
Primary Keyword: Clinical/Intervention Research
Presentation Level: Intermediate
Region: Global
The scarcity of specialist mental health human resources in all countries, but especially in low income countries, is further compounded by their inequitable distribution and inefficient utilization. This human resource gap will remain large for the foreseeable future, and is likely to be worsened as populations grow in many countries and as specialists immigrate from poorer to richer areas.
In this context, this presentation considers 'task-sharing' as one of the most significant advances in improving access to affordable and effective mental health care. Task sharing, the strategy of rational redistribution of tasks among health workforce teams, has become a popular method to address specialist health human resource shortages in other areas of health care such as HIV/AIDS and maternal and child health. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of the available human resources for health.
This presentation will synthesize the growing, and compelling, body of evidence on the safety and effectiveness of task-sharing to improve access to care for a range of mental disorders, by unpacking complex psychological treatments and empowering community and lay health workers to deliver specific treatment strategies. Not only are such interventions more affordable and accessible, but they also empower individuals to better manage their own mental health and care for others who are affected, thereby reducing the large 'treatment gaps'. Such task-sharing interventions are also very relevant to better resourced settings which also face high levels of 'treatment gaps' (in particular for psychological treatments), and spiraling costs of mental health care (mostly driven by the high costs of specialist delivered care). The role of mental health specialists in such intervention programs needs to expand from providing direct clinical care to incorporate a number of additional roles, for example advocacy, training, consultation, evaluation and supervision. In doing so, the goal of 'mental health for all' may be realistically achieved, in partnership 'with all'.
Dr. Vikram Patel is a professor of International Mental Health and Wellcome Trust Senior Research Fellow in Clinical Science at the London School of Hygiene & Tropical Medicine (UK). He is the joint director of the School's Centre for Global Mental Health. |
His primary research spans three themes: investigating the social and cultural determinants of mental disorders; describing the inter-relationship of mental disorders with other public health priorities; and evaluating interventions aimed at improving access to effective mental health care in low resource settings. He serves on a number of committees including the WHO's Expert Advisory Group for Mental Health and the Technical Steering Committee of the Department of Child & Adolescent Health and the World Economic Forum Global Agenda Council on Brain and Cognitive Sciences.
He is a co-founder of Sangath, a community based NGO in India which won the MacArthur Foundation's International Prize for Creative and Effective Institutions in 2008. He is a member of a group constituted by the Ministry of Health (Government of India) tasked with writing India's first mental health policy and designing the National Mental Health Program for the period of 2012-2017.
He was elected a fellow of the Academy of Medical Sciences of the UK and won the Chalmers Medal from the Royal Society for Tropical Medicine & Hygiene in 2009. His book Where There Is No Psychiatrist (Gaskell, 2003) has become a widely used manual for community mental health in developing countries. He was an editor of both Lancet Series' on Global Mental Health (2007 & 2011); the PLoS Medicine series on packages of care for mental and neurological disorders in developing countries (2009); and The Lancet series on promoting universal health care in India (2011). He led the efforts to set up the Movement for Global Mental Health.
He is based in Goa, India where he leads a program of public health research and capacity development with Sangath, the Public Health Foundation of India and government agencies focusing on three broad areas: child development, adolescent health and mental health.
Friday, November 2, 9:00 a.m. – 10:15 a.m.
The Road Less Traveled? Bringing Effective Trauma
Interventions for Youth and Families Into Community Settings
Rochelle Hanson, PhD, Professor, National Crime Victims
Research and Treatment Center (NCVC)
Primary Keyword: Training/Education/Dissemination
Presentation Level: Introductory
Region: Industrialized Countries
Transporting and implementing efficacious treatments into communities to reach all individuals who need them is an ongoing challenge. Implementation strategies involving multi-stakeholder participation have not yet specifically focused on empirically-supported trauma-focused treatments, particularly those that target youth and their families. As a result, these interventions are still not well-integrated within communities, nor are they yet the standard practice of care throughout many countries' mental health and public health systems.
This presentation will describe some promising examples of multilevel implementation models designed to promote and support sustained use of evidence-based, trauma-focused interventions in community settings. Research on delivery of trauma interventions in community settings will be reviewed with an emphasis on methods to promote adoption, uptake, and sustained use. Challenges to implementation, particularly involving interventions that target traumatized youth and their families will be highlighted. The presentation will conclude with a discussion on directions for the future, including implications for clinicians, administrators, researchers, public policy makers, as well as other key community stakeholders.
Dr. Rochelle Hanson is a professor at the National Crime Victims Research and Treatment Center (NCVC), Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina. She is a Licensed Clinical Psychologist specializing in the treatment of trauma among children, adolescents and adults. Her research focuses on the prevalence and effects of trauma exposure as well as dissemination of evidence-supported practices for trauma-exposed youth.
She is a former board member of the American Professional Society on the Abuse of Children. She is a core faculty member of Project BEST, a statewide initiative, funded by the Duke Endowment, whose long-term goal is to ensure that abused/traumatized children in South Carolina receive appropriate, empirically supported mental health assessment and psychosocial treatment services. She is currently serving as director of TLC for DC II, a learning collaborative focused on training and implementation of TF-CBT in Washington, D.C. Dr. Hanson conducts trainings in trauma-focused cognitive behavior therapy (TF-CBT) throughout the country and maintains a clinical practice. She is the 2010 recipient of the MUSC Teaching Excellence Award, Clinical-Professional, Educator-Mentor.
Saturday, November 3, 9:00 a.m. – 10:15 a.m.
Internet and Mobile Technologies to Support the
Implementation of Evidence-Based Practices in PTSD Treatment
Kenneth R. Weingardt, PhD, National Director, Web Services,
VA Office of Mental Health Services, Veterans Health Administration
Consulting Assistant Professor, Department of Psychiatry &
Behavioral Sciences, Stanford University School of Medicine
Primary Keyword: Technology
Presentation Level: Intermediate
Region: Industrialized Countries
Widespread adoption of Internet and mobile technologies is transforming the way in which we screen, assess, and intervene with clients who have post-traumatic stress disorder (PTSD). This presentation begins with a high level overview of the scientific literature regarding technologies to support evidence-based PTSD care, including provider-facing resources such as online clinical training programs and decision support systems, and patient-facing resources such as online self-help programs, and mobile apps.
Next, the Consolidated Framework for Implementation Research (CFIR) will be reviewed, and its utility in understanding the factors that drive the sustained adoption of these technologies in clinical practice will be discussed. Case studies of a mobile app and a Web-based self-help tool will be used to illustrate how the CFIRs framework can help researchers and clinical leaders to attend to the many contextual factors that influence whether a new technology is embraced by providers and patients.
The presentation concludes with a discussion of the concept of scalability, and a call for researchers to think about how technology interventions can be taken to scale throughout all stages of their work, rather than waiting until they have completed pilot testing and efficacy studies.
Dr. Weingardt is national director for Mental Health Web Services in the U.S. Department of Veterans Affairs (VA). He and his team are responsible for coordinating activities across three broad domains: online clinical training for VA mental health clinicians, online self-help and mobile apps for veterans and their families, and websites to support a wide range of VA stakeholder groups.
He has successfully completed several research projects funded by the National Institute on Drug Abuse (NIDA) and VA Health Services Research & Development (HSR&D) evaluating role of online clinical training in implementing evidence-based practices such as cognitive behavioral therapy and motivational enhancement therapy for substance use disorders. He serves as a consultant on a variety of current projects funded by VA, NIH and the Wellcome Trust, and provides researchers with guidance regarding the design, development, implementation and evaluation of internet and mobile technology applications for mental health.
Saturday, November 3, 1:30 p.m. – 2:45 p.m.
Public Mental Health as the Future Paradigm for our Trauma
Societies?
Joop de Jong, MD, PhD, Professor of Cultural
and International Psychiatry, VU University and University of Amsterdam,
the Netherlands, Boston University School of Medicine, Rhodes University
South Africa
Primary Keyword: Global Issues
Presentation Level: Intermediate
Region: Industrialized Countries
How do we address the psychological needs of large populations exposed to severe traumatic stressors? To answer this question, a public mental health approach is quickly gaining popularity for trauma-exposed populations in international settings.
This presentation will address how this perspective may inform prevention and care with populations exposed to traumatic stressors both in high-income (e.g. in the aftermath of 9/11 or Katrina) and in developing countries (e.g. in the context of natural disasters and armed conflicts).
Public mental health aims at protecting, promoting and restoring the mental health of a population rather than an individual. The paradigm of public mental health has several important implications for the trauma profession in the realms of prevention, resilience, research and competencies.
First, both origins and consequences of disasters play at different system levels. Hence, primary prevention can become more effective if it further develops interventions that address these multiple system levels. Universal primary prevention has much to win by distilling and addressing key predictors of ill health that show striking similarity with the determinants of disaster and war including poverty and marginalization.
Second, an ecological approach requires a shift from individual psychological resilience to ecological resilience involving diverse actors at the level of the community. An ecological approach also asks for a careful cultural critique of the salience of the neuroscience construct of post-traumatic stress disorder (PTSD) versus other expressions of distress across the globe.
Third, dealing with distress in resource-strained settings requires task sharing and task shifting by mental health professionals to locally trained paraprofessionals and lay people. It also requires a shift from specialized treatment to selective prevention involving local healers, local practitioners and a range of community interventionist from other disciplines.
Fourth, public mental health calls for a new research agenda. We need research on tipping points that convert inaction to cooperation and synergy in post-disaster areas and refugee camps. We need research on the transformation of stigma and helplessness into connectivity and remoralization of vulnerable populations. We need research to change cycles of violence (e.g. by the use of transitional justice mechanisms into peaceful coexistence). We also need research on differential susceptibility to traumatic stress transcending the macro-level of ecological resilience to the micro-level of epigenetics.
Finally, the public mental paradigm asks for a redefinition of psychological and other competencies in both high and low-income countries. It implies that psychologists and other mental health professionals become core team players liaising to other professionals involved in health and education, the economy, governance, the military, and human rights.
Dr. Joop de Jong is professor of Cultural and International Psychiatry at the VU University and the University of Amsterdam, adjunct professor of Psychiatry at Boston University, and visiting professor at Rhodes University South Africa. He was trained in tropical medicine, public health, psychiatry, psychotherapy and epidemiology. He established Transcultural Psychosocial Organization (TPO), one of the largest relief organizations in mental health and psychosocial care of post- conflict and post-disaster populations in over 20 countries in Africa, Asia, Europe and Latin America.
Over the past decades, Joop de Jong worked part-time with immigrants and refugees in Amsterdam. He has conducted research in post-conflict, post-disaster and multicultural settings, and co-authored 250 chapters and papers in the field of cultural psychiatry and psychotherapy, epidemiology, public mental health and medical anthropology.