Did you know there are almost no psychiatrists in Rwanda? That country, whose population has experienced an intense amount of strife, is not alone. Many mental illnesses go untreated in developing nations because of the lack of mental health resources. Dr. Stephanie Smith, director of the Program in Global Mental Health Equity at Brigham and Women's Hospital, learned this and many other key insights while working abroad in Rwanda to help improve the population’s access to mental health care diagnosis and treatment.
In this episode of The Menninger Clinic’s Mind Dive podcast, Dr. Smith shares her insights and experiences in looking at how to create greater access to mental health care globally where resources are scarce.
An instructor in Psychiatry for Harvard Medical School and a co-director of Mental Health at Partners in Health, Dr. Smith worked in Rwanda to set up a collaborative care model for mental health care. She worked through the government to utilize the existing primary health care clinics and systems to incorporate mental health care resources for patients. This has been particularly successful in treating noticeable and severe mental illnesses such as schizophrenia and bipolar disorder by providing the appropriate medications.
“We were at rural continuums, like general hospitals, primary care centers, and the community in thinking about how we incorporate mental health into that care continuum,” says Dr. Smith about her experiences in Rwanda, where her objective, on behalf of Partners in Health, was to strengthen the mental health care system. “At the time each district in the government had been successful at getting one psych nurse and one psychologist at each district hospital … about 40 or so in the country. Knowing the population is 10 million, it's not very many. That’s why integrating into primary care system makes a lot of sense.”
Dr. Smith further explains that expanding care involved looked at existing providers and what basic mental health care services could be provided by a non-specialist provider, in a continuum where they are supported by specialists. Dr. Smith served as one of the specialist consultants. This consultative model is how services were incorporated into the general hospital or clinic setting, with basic mental health care delivered by primary care nurses, and working at the community level, where community health workers are this liaison between villages and communities and the health system.
Dr. Smith explains some of the unique aspects of this work from a cultural perspective as well, in how some cultures view mental health and mental illness.
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Catch up on the latest Mind Dive episode: Episode 35: Understanding Bright Kids Who Don’t Care