Best-practice community mental health models: Regional publication

Clinical Education Online: Creative programs emerging from travel constraints

Online Training

Asia Pacific Expert Forum on SMI Policies- the Present and the Future

Specialist mental health presence in emergency and general hospital departments

A journey of a thousand miles begins with new shoes

Linking up through global friendships

Successful training program underscores the consistent international collaboration

Responding to health priorities in Myanmar

Focus on Women’s Health: IAWMH Congress hosted in Asia

In 2008 AAMH published the Asia-Pacific Community Mental Health Development Project Summary Report. Written and edited by the region’s mental health leaders, this unique document contains country-specific examples of best practice in community mental health development, as well as key guiding principles for development of these services in the region.

Download the summary report [pdf, 2.57mb, 92 pages]

The World Psychiatric Association (WPA) has published the APCMHDP examples of best practice in their newsletter distributed globally. View here (pages 11-22).

The 2021 Ophelia Training will conclude on Wednesday 30 June, with over 100 Pacific Island health workers over the last 12 weeks attending the sessions online, and learning together about the mental health issues that affect children and young people.  Ophelia- which stands for Online Pacific Health Exchange- is a short course in delivering child and adolescent mental health services, with a structure that allows interdisciplinary networking and a focus on sharing best practices and evidenced based health care.

As a response to travel restrictions, Ophelia was first piloted in 2020, St. Vincent’s Mental Health, Royal Australia and New Zealand College of Psychiatrists Faculty of Child and Adolescent Psychiatrists, and the Fiji National University, College of Medicine, Nursing and Health Sciences.  The partners have expanded the course for 2021, now featuring;

  • 12 weeks of 60 minute online sessions, focusing on practice examples and sharing interdisciplinary experiences.
  • A structured approach to learning via reflective practices and peer exchanges.
  • Access and support for training materials and other foundational education resources

The participants in the 2021 group have gathered from a wider range of health settings, and bring varying levels of experience.  With an expanding technological capacity in the Pacific generally, the participants are from major centres and rural health settings in Fiji, Solomon Islands, Cook Islands, Papua New Guinea, Kiribati, Vanuatu, Marshall Islands.  Some are accessing the training with their first few years of working in mental health, others have more than 15 years experience.

Thank you for this session. I am sitting and listening and realised that I have come a long way.”(Ophelia Participant)

At times, the technology has created difficulties, but the group are growing in confidence and capacity, as well as persistence.  Being able to record the didactic sections of the presentation, and sharing the resources after the sessions has been helpful, although not as good as being able to talk with each other.

 “Thank you everybody ,really enjoyed the session but my connectivity was a bother. However, I did sit and listen to the presentation…till the end.  See you all next week.  Moce.” (2021 Ophelia Participant)

“Thank you so much! This was so great and informational. Vinaka!” (2021 Ophelia Participant)

Accessing specialist mental health studies in our region can be difficult, and the WHO country guide for Adolescent Health notes that adolescent mental health and well-being are often overlooked.  More than half the group reported that they had not had formal studies in working with children and young people, including within specialist mental health studies.

“Thank you so much for this important topic and yes staff are the most important resource in a work place.” (2021 Ophelia Participant

 “It would be great to learn more in depth as well if we could have time to understand and being trained on how to use any particular assessment tool so that we could use it in our clinical practice.” (2021 Ophelia Participant)

With a young demographic in our region and with adolescences as the foundational period in the lives of individuals and for the health of our community, it is crucial that health workers will have a good understanding of children and young people’s health and well being.  Additionally, with the majority of mental health providers providing services for the whole population, there is even more motivation for prevention, early detection and treatment of problems, and the opportunity to set a pattern of healthy lifestyles and reduce morbidity, disability and premature mortality later in adulthood.

This program builds on the collaboration between St. Vincent’s, Fiji University’s College of Medicine, Nursing and Health Sciences, and RANZCP’s Faculty of Child and Adolescent Psychiatrists.  Further workshops are planned with a strong commitment from these 3 organisations to training and education of health professionals in the Pacific region.

 

2021 Ophelia Training Vinesh                  2021 Ophelia Training Sandra

RANZCP presenters during 2021 Ophelia Training sessions

In Dec 2016, the Hong Kong Association of Psychosocial Rehabilitation invited professionals from South Korea, Australia and Taiwan to participate in the Expert Forum on Serious Mental Illness Policies.

Looking at community care models that have been developed in our countries over the past 25 years, and identifying influencing factors for policy change, the presentations involved practical experience in both clinical leadership, and directing mental health service development.

St. Vincent’s Chair of Psychiatry, Professor David Castle and Mental Health Manager, Ms. Bridget Organ were invited to speak about recent changes in Australia’s mental health services.  Co-production and co-design was highlighted, shifting approaches to government policymaking from seeking involvement or participation after an agenda has already been set, to seeking it at the outset.  Released last year, Victoria’s 10 year Mental Health Plan states that “Co-production requires a shift in how government, services and professionals work with service users, recognising that positive outcomes cannot be delivered effectively to or for people; they can best be achieved with people.”

In Victoria, accessing the lived experience of mental health issues and recovery through consumer and carer peer workers has provided unique services with peer workers, working as team members alongside mental health workers in all public services in Victoria. The Mental Health Workforce Strategy reflects these opportunities, building a strategy for the system of care to be highly responsive to the changing needs of service users, new models of care and service delivery, ()

The picture emerging was hopeful, with community mental health now being established in many more provinces in all nations.  There has been a significant investment in community resources and social welfare, and much focus on building workforce to match these changes.

 

1612-smi-policies

Expert Forum on SMI Policies

December 2016, Hong Kong

 

 

Consultation Liaison (CL) mental health services to general hospitals have been running in Australia from the 70’s and also started in Hong Kong in the early 80’s.  This means for developing best practices, international exchanges are very valuable.  This month, Kwai Chung Hospital CL nurse Lam Yiu Chau spent some time with the St. Vincent’s Mental Health CL team.  Here in the hustle and bustle of a busy workplace, Lam found a few differences but some familiar territory.

 Broadly, a CL clinician provides support for the mental health care of people in non-psychiatric (generalist) settings, with co-morbid mental health problems such as depression, anxiety, dementia or delirium contributing to poor health outcomes, including increased rates of mortality and morbidity.   It is also a feature of modern emergency departments, for teams needing to provide expert assistance with a wide range of mental health and psychiatric needs.  CL clinicians advise and assist general hospital staff on management of patients as well as directly providing assessment and counselling.

 After 10 days of activities and observations, Lam Yiu Chau was surprised to note the CL team at St. Vincent’s had only one nurse, and was staffed mainly by psychiatrists and training psychiatrists, compared to his Hong Kong team which is made up of psychiatric nurses.  The St. Vincent’s multidisciplinary team had a strong collaborative model, and while the assessments often followed similar lines of enquiry to Hong Kong, the treatment and community liaison reflected the greater availability of resources in Australia.  The local and district- based supports appeared to be more developed and more accessible for people experiencing mental illness, than Lam had experienced with his work. 

 The CL team in Australia welcomed the opportunity to host their Hong Kong colleague and felt that the visit gave them also the opportunity to reflect on the key aspects of the consultation and liaison role, and how their capacity to deliver best practice care can be impacted by complexity and high demand for services.

 Specialist roles like the CL team in general hospitals are developing throughout our region, working in primarily in general wards and emergency departments to positively influence hospital care by addressing physical and mental health issues.  Whether considered as a subspecialty as in the US, or as a special interest group, there is growing recognition of the skills and benefits of addressing the impact of psychosocial factors and improving holistic care by integrating general and mental health. 

Autism spectrum disorder (ASD) is the name given for a group of developmental disorders that include a wide range of symptoms, skills, and levels of disability.

Located in Guangdong Province on a southern tip of the Chinese mainland, Shenzhen has over 20,000 children diagnosed with a range of developmental disorders.

Shenzhen Kangning Hospital, the city’s only public mental health hospital, also provides assessment, diagnosis and treatment for children with ASD from across Guangdong Province.

In response to Shenzhen’s growing imperative to support children diagnosed with ASD and their families, The University of Melbourne’s Department of Psychiatry and Kangning Hospital launched an International Autism Training and Research Centre in December 2015.

On 22-25 November 2016, the University of Melbourne and Kangning Hospital jointly hosted over 100 mental health professionals, teachers and parents at a Parenting Workshop, facilitated by Asia Australia Mental Health, supported by the Shenzhen Municipal Government and Shenzhen Disabled Person’s Federation.  Expertly led by Associate Professor Sandra Radovini, Director of the Department of Psychiatry ’s Mindful Centre and Ms Frances Saunders,  Mindful‘s State-wide Autism Coordinator, the workshop provided practical, evidence based skills and information to improve quality of life for children diagnosed with ASD.

Participants learned ways to help parents understand and manage their child’s often very challenging behaviours and most importantly how to best promote their child’s independence and quality of life.

In her summary, at the conclusion of the intensive four day program, the Director of the Child and Adolescent Department of Kangning Hospital, Dr Jianping Lu, said: “This workshop provided our participants with a way to collect and shape previously fragmented information into a logical and systematic approach to help parents. The workshop was well-prepared and thoughtfully presented by the two Department of Psychiatry presenters, the incredibly fantastic Associate Professor Radovini and Frances.”

A moving tribute came from a parent attending the workshop: “Thank you Australian trainers, you have brought us a new way to positively think about our child.   Now we have some hope and can see a brighter, different future.”

Finally on behalf of all participants and the Kangning Hospital, Dr Lu presented the two University of Melbourne workshop leaders each with a pair of new shoes.  “We hope that by wearing these shoes,” Dr Lu explained, “that you are able to come more frequently and keep bringing to Shenzhen the most advanced skills and knowledge in ASD.”

As a specialist in an industry full of specialists, the Consultation Liaison Mental Health professional will necessarily be social, but Prof. Dr. Soerojo Magelang Hospital’s Dr. Santi Yuliani has been networking globally for best practices in liaison mental health.  Through regular exchanges of ideas with Malaysian colleagues, Santi learnt of Melbourne’s POST program and collaborated on a professional development placement with St. Vincent’s Consultation Liaison team this July.

Consultation Liaison (or CL) specialises in the interface between general medicine and psychiatry, reflecting the close links between mental and physical health. Traditionally, barriers such as separate funding mechanisms and wide ranging stigma can prevent an integrated approach to treating physical and mental illness, but CL has been shown to improve outcomes and reduce costs of medical care. The proposed leadership and specialist skill training program was identified as significant and aligning with Indonesian’s mental health strategies.

Initial discussions on the potential collaboration between St. Vincent’s Mental Health and Prof. Dr. Soerojo Magelang Hospital led to expansion with Dr. Santi’s colleagues Dr. Sutantri and Dr. Anita Budijanto also agreeing to be part of the challenge of an international exchange.  Working with the 3 psychiatrists, the POST program designed a 4 week program with the support of St. George’s Aged Mental HealthSunshine: Aged Mental Health, The Melbourne Clinic, Orygen and St. Vincent’s Hospital.

  And the results?

Whilst a very different setting to the hospital in Indonesia, peer exchanges found many shared areas of interest.  In CL, Santi noted that the team approach was favoured, including registrars and mental health nurses in the team rather than working as sole practitioners.  The multidisciplinary meetings are suitable to be implemented in CL, because of the need to involve a holistic approach for effective patient management.

Dr. Anita explored the development of community teams which visit people in their homes and residential services.  Also relevant to the Indonesia context was the use of different interventions with people with behavioural disturbance, other than medication, such as sensory stimulation.  Currently, sensory modulation treatments are available for children and adolescents, but Dr. Anita is keen to return to the workplace with plans to increase access to older people who may benefit.  Similarly, developing the model of care to include community outreach is an area to explore within current resources.

Dr. Sutantri’s experiences with the psychiatrists in Melbourne has led her to reconsider the patient experience within the Outpatients’ Department, and upon return, she is hoping to secure a room that is private and promotes confidentiality, with suitability for psychotherapy.  She will also explore the potential for sharing ideas with colleagues- to support each other and have regular meetings.

Prof. Dr. Soerojo Magelang Hospital and St. Vincent’s Hospital are keen to continue their collaboration, and hope to establish sisterhood agreements with ongoing shared visits between the services.

 

Whilst braving the workplace in the heart of the Melbourne winter, the intrepid travelers also managed to do some sight seeing in the city, including the Federation Square, Yarra River and the little Penguins. The Victoria Market every Saturday was a must for preparing their cooking adventures, and everyone reported thoroughly enjoying the trams and the orderly footpaths for pedestrians.

For more information about the POST program or our work, please contact Asia Australia Mental Health.

1607 Sutantri and Bridget

Aligned with the annual Guangdong Psychiatric Conference, Asia Australia Mental Health, in collaboration with the Guangdong Institute of Mental Health ran the sixth annual training program for Guangdong mental health workers.  The program was planned in consultation with leaders from the areas of Zhongshan, Luoding, Shantou, Foshan, Xinhui, Shenzhen, Jiangmen and Guangzhou.

Guangdong has a population of over 110 million people, many of whom are migrant workers in the factories that supply the world with mobile phones and computers.   Despite its comparative wealth, developing responsive mental health services is challenging.  In addition to increasing its acute hospital beds, Guangdong is focussed on strengthening community programs.

To meet current needs, this training program, led by Margaret Goding, Professor Chee Ng and Yue Li from Asia Australia Mental Health team, concentrated on case-management, maximising safety in community care and building successful partnerships with other agencies.  Trainers were experienced clinicians from St.Vincent’s Mental Health Service –  Occupational Therapist Julia Oxley, Community Senior Clinician, and  Psychiatric Nurse Graeme Doidge, Community Clinic Manager.

120 people attended, and this training program was noteworthy for the attendance of more than 50 primary health doctors who are now responsible for the follow-up and ongoing care of people with chronic mental health disorders.  Other participants were psychiatrists (16%), nurses (20%), social workers (10%) and 4 people working as vocational therapists.  They had a wide range of experience with 22%  of participants reporting less than 1 year working in mental health and 17% reporting more than 15 years’ experience.  While representing a teaching challenge, this diverse mix offered a valuable opportunity for participants to share knowledge.

Program highlights were the panel presentations and discussions showcasing best practice in Guangdong. Participants also thoroughly enjoyed interactive learning featuring role-plays using Guangdong case example and group development of care plans.  As well as learning practical skills, many participants in the training course commented that they had changed their basic approach to working with clients and their families.  One person commented, “Now instead of telling them what to do, I will ask them what they need”.

The evaluation strategy included reflection sessions and written feedback with 98% of participants agreeing or strongly agreeing that overall they were satisfied with the quality of presentations.

Experts from China, Australia and Myanmar have developed a short training program for health professionals, focusing on improving the health response to depression in Myanmar.

The Global Burden of Disease  is an international study, which has increased understanding of a population’s true health challenges.  In Myanmar, a leading cause of Years Lived with Disability (YLDs) was found to be major depressive disorder.

Professor Win Aung Myint, Head of Department of Mental Health, Mental Health Hospital, Yangon, Myanmar says that the diagnosis of depression is a great challenge for services, because of gaps in knowledge and training, with the treatment gap of the depression estimated at up to 90%. People with depression usually go to general practitioners and non-psychiatric specialists for various presentations.

Mental Health Hospital, Yangon and Myanmar Mental Health Society with University of Melbourne, Australia  the Institute of Mental Health, Peking University, China collaborated with the Lundbeck International Neuroscience Foundation (LINF) to conduct an international Symposium and Training Workshop on Depression in Myanmar.

In May 2015, over 2 days, International and Local Faculty facilitated workshops to explore models of care in low resource settings, multidisciplinary approach and local considerations, best practices in minimising stigma, promoting help-seeking, as well as early intervention for depression.

Photos from this program can be found here

Read more about this symposium here

AAMH and partners were excited to be at the 6th World Congress on Women’s Mental Health held in Tokyo this month, which was the first to be held in Asia from the growing International Association of Women’s Mental Health.  Established in 2001 to improve the mental health of women throughout the world, http://www.iawmh.org/ by creating a network of national and international societies and sections devoted to mental health of women.

The Congress was co-chair Australia’s President Elect, World Psychiatric Association, Professor Helen Herrman, and attracted a large number of internationally renowned experts in the field, including, psychiatrists, psychologists, nurses, occupational therapists, social workers, general practitioners and other women’s health professionals, researchers, students, decision makers, consumers and their families, to share their knowledge and experiences about the best ways to improve women’s wellbeing.

The Congress also provided an opportunity for a symposium and meeting of delegates involved in the Asia-Pacific International Research and Education (ASPIRE) Network.  The first research collaborative initiative of the ASPIRE network is aimed at investigating the mental wellbeing and health of women – as the linchpin for improving family and child health, as well as their own.  The Maternal Child Health Project is currently being developed with an international multi-site working group approach.  Key partners at University of Rochester are continuing to work on supporting the ASPIRE network with technical expertise, and capacity building activities for emerging researchers in Southeast Asia.

Our Consortium Partners