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• W3146050726 abstract "I support Andres Barkil-Oteo and colleagues'1Barkil-Oteo A Silva MA Ramos MA Rohrbaugh RM Teaching global mental health at home and abroad.Lancet Psychiatry. 2014; 1: 328-329Summary Full Text Full Text PDF Scopus (6) Google Scholar statement that “international electives should be one part of a larger commitment of medical schools to sustain involvement in the host country”. Their model, in which medical students participate in local community mental health placements in low-resource, primary-care settings, introduces a novel means of skill development that is valuable during overseas electives.However, such approaches entail curriculum redesign and considerable administrative, organisational, and educational investment in order to be effective. In view of the current economic climate of austerity, in the UK at least, securing additional funding for such global mental health programmes might be an unrealistic prospect.Curricular adaptations have to be supplemented with low-cost educational interventions that will teach medical students cross-cultural aspects of psychiatric disorders, management of mental health problems with limited resources, and the realities of health care in low-income countries. Furthermore, as the authors identify, “ensuring shared benefit between trainees and host countries is an important challenge in global health education”. Indeed, such projects should be mutually beneficial to students in both low-income and high-income settings, whether in medicine, nursing, pharmacy, or any other health professions. Collaborations between hospitals or trusts in high-income and low-income countries to strengthen health care through exchange of knowledge and skills are common, but the integration of these collaborations at the level of medical school remains weak. The King's Tropical Health and Education Trust (THET) Somaliland Partnership (KTSP) developed a peer-to-peer global mental health e-learning programme for medical students at King's College London, University of Hargeisa, and Amoud University.2Keynejad R Ali FR Handuleh J et al.Telemedicine for peer-to-peer psychiatry learning between U.K. and Somaliland medical students.Acad Psychiatry. 2013; 37: 182-186Crossref PubMed Scopus (16) Google Scholar, 3Keynejad R Garratt E Adem G Finlayson A Whitwell S Syed Sheriff R Improved attitudes to psychiatry: a global mental health peer-to-peer e-learning partnership.Acad Psychiatry. 2014; (published online Aug 15.)https://doi.org/10.1007/s40596-014-0206-8Crossref PubMed Scopus (16) Google Scholar Medical students from each medical school are paired and meet for 1 hour online sessions to discuss global mental health topics. One result of this participation is the substantial improvement in the attitude towards psychiatry in students from Somaliland. Students from Somaliland valued the opportunity to enhance their factual knowledge, whereas students from the UK valued the cross-cultural learning.One effective component of medical training in Somaliland is the MedicineAfrica website, a telemedicine portal with a social network structure that facilitates online case-based tutorials in real time4Finlayson AET Baraco A Cronin N et al.An international, case-based, distance-learning collaboration between the UK and Somaliland using a real-time clinical education website.J Telemed Telecare. 2010; 16: 181-184Crossref PubMed Scopus (33) Google Scholar and is suitable for low bandwidth connections. The approach needs to be specifically adapted to the learning objectives, technological availability, and practical constraints of each local context, including access to internet, access to computers versus smartphones, and a shared language through which students can communicate. Although this model is still in its infancy and has yet to be trialled with large cohorts, it offers an additional, cost-neutral approach to global mental health education at home and abroad and has the potential to address many of the limitations of short-term overseas electives undertaken in isolation. Just as there can be no health without mental health5Prince M Patel V Saxena S Maj M Maselko J Phillips MR Rahman A No health without mental health.Lancet. 2007; 370: 859-877Summary Full Text Full Text PDF PubMed Scopus (2146) Google Scholar, global health education for medical students is incomplete without concerted focus on global mental health. I welcome the authors' focus on this critically neglected area.For the MedicineAfrica website see http://medicineafrica.comI am the co-founder of Aqoon, the peer-to-peer global mental health e-learning partnership between King's College London, University of Hargeisa, and Amoud Universities in Somaliland; I am the Mental Health co-Lead for the King's THET Somaliland Partnership. The King's THET Somaliland Partnership (KTSP) is funded by Tropical Health and Education Trust (THET) at King's College London. Aqoon receives no funding and is run on a voluntary basis. I support Andres Barkil-Oteo and colleagues'1Barkil-Oteo A Silva MA Ramos MA Rohrbaugh RM Teaching global mental health at home and abroad.Lancet Psychiatry. 2014; 1: 328-329Summary Full Text Full Text PDF Scopus (6) Google Scholar statement that “international electives should be one part of a larger commitment of medical schools to sustain involvement in the host country”. Their model, in which medical students participate in local community mental health placements in low-resource, primary-care settings, introduces a novel means of skill development that is valuable during overseas electives. However, such approaches entail curriculum redesign and considerable administrative, organisational, and educational investment in order to be effective. In view of the current economic climate of austerity, in the UK at least, securing additional funding for such global mental health programmes might be an unrealistic prospect. Curricular adaptations have to be supplemented with low-cost educational interventions that will teach medical students cross-cultural aspects of psychiatric disorders, management of mental health problems with limited resources, and the realities of health care in low-income countries. Furthermore, as the authors identify, “ensuring shared benefit between trainees and host countries is an important challenge in global health education”. Indeed, such projects should be mutually beneficial to students in both low-income and high-income settings, whether in medicine, nursing, pharmacy, or any other health professions. Collaborations between hospitals or trusts in high-income and low-income countries to strengthen health care through exchange of knowledge and skills are common, but the integration of these collaborations at the level of medical school remains weak. The King's Tropical Health and Education Trust (THET) Somaliland Partnership (KTSP) developed a peer-to-peer global mental health e-learning programme for medical students at King's College London, University of Hargeisa, and Amoud University.2Keynejad R Ali FR Handuleh J et al.Telemedicine for peer-to-peer psychiatry learning between U.K. and Somaliland medical students.Acad Psychiatry. 2013; 37: 182-186Crossref PubMed Scopus (16) Google Scholar, 3Keynejad R Garratt E Adem G Finlayson A Whitwell S Syed Sheriff R Improved attitudes to psychiatry: a global mental health peer-to-peer e-learning partnership.Acad Psychiatry. 2014; (published online Aug 15.)https://doi.org/10.1007/s40596-014-0206-8Crossref PubMed Scopus (16) Google Scholar Medical students from each medical school are paired and meet for 1 hour online sessions to discuss global mental health topics. One result of this participation is the substantial improvement in the attitude towards psychiatry in students from Somaliland. Students from Somaliland valued the opportunity to enhance their factual knowledge, whereas students from the UK valued the cross-cultural learning. One effective component of medical training in Somaliland is the MedicineAfrica website, a telemedicine portal with a social network structure that facilitates online case-based tutorials in real time4Finlayson AET Baraco A Cronin N et al.An international, case-based, distance-learning collaboration between the UK and Somaliland using a real-time clinical education website.J Telemed Telecare. 2010; 16: 181-184Crossref PubMed Scopus (33) Google Scholar and is suitable for low bandwidth connections. The approach needs to be specifically adapted to the learning objectives, technological availability, and practical constraints of each local context, including access to internet, access to computers versus smartphones, and a shared language through which students can communicate. Although this model is still in its infancy and has yet to be trialled with large cohorts, it offers an additional, cost-neutral approach to global mental health education at home and abroad and has the potential to address many of the limitations of short-term overseas electives undertaken in isolation. Just as there can be no health without mental health5Prince M Patel V Saxena S Maj M Maselko J Phillips MR Rahman A No health without mental health.Lancet. 2007; 370: 859-877Summary Full Text Full Text PDF PubMed Scopus (2146) Google Scholar, global health education for medical students is incomplete without concerted focus on global mental health. I welcome the authors' focus on this critically neglected area. For the MedicineAfrica website see http://medicineafrica.com For the MedicineAfrica website see http://medicineafrica.com For the MedicineAfrica website see http://medicineafrica.com I am the co-founder of Aqoon, the peer-to-peer global mental health e-learning partnership between King's College London, University of Hargeisa, and Amoud Universities in Somaliland; I am the Mental Health co-Lead for the King's THET Somaliland Partnership. The King's THET Somaliland Partnership (KTSP) is funded by Tropical Health and Education Trust (THET) at King's College London. Aqoon receives no funding and is run on a voluntary basis. The diagnosis debateHayes and Bell,1 responding to Boyle and Johnstone,2 argue that the “distinction between purely functional and purely organic does not exist” and that the causes of mental health problems are likely to be multifactorial in most cases. This observation might be true, but offers little assistance to the practising clinician. In the absence of biomarkers that are both testable and map to symptoms with any regularity, the organic contribution to an individual's mental difficulties cannot even be identified, let alone analysed in a clinically useful way. Full-Text PDF" @default.
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