Competencies for Global Mental Health: Developing Training Objectives for a Post-Graduate Fellowship for Psychiatrists

Abstract

Background:Despite an increase in psychiatry trainees’ interest in global mental health (GMH), there is a lack of relevant training competencies developed using educational frameworks that incorporate viewpoints from high- and low-income countries.Objective:The aim of this study was to determine competencies for a two-year post-graduate GMH fellowship for psychiatrists utilizing Kern’s six-step process as a theoretical framework for curriculum development.Methods:We conducted a targeted needs assessment via key informant interviews with a purposive sample of stakeholders (n = 19), including psychiatry trainees, generalist clinicians, medical directors, psychiatrists, researchers, and GMH educators from high- and low-resource settings in the United States and abroad. We analyzed data using a template method of thematic analysis.Findings:We tabulated learning objectives across 20 domains. Broadly, clinical objectives focused on providing supervision for short-term, evidence-based psychotherapies and on identifying red flags and avoiding harmful medication use among vulnerable populations such as children and the elderly. Non-clinical objectives focused on social determinants of health, education, and clinical supervision as part of capacity-building for non-specialists, engagement in a systems-wide project to improve care, and ethical and equitable partnerships that involve reciprocal and bidirectional education. Several competencies were also relevant for global health work in general.Conclusions:A theory-informed framework for curriculum development and a diverse set of key informants can provide educational objectives that meet the priorities of the trainees and the clinical sites in both low- and high-income settings. Limitations of this study include a small sample size and a focus on clinical needs of specific sites, both of which may affect generalizability. Given the focus on training specialists (psychiatrists), the low-resource sites highlighted the importance of educating and supervising their permanent, generalist clinicians, rather than providing direct, independent patient care.

Identifying Core Global Mental Health Professional Competencies: A Multi-Sectoral Perspective

“…It is beyond the remit of this article to discuss and contextualise each competency identified in the current analysis; many of these have been discussed elsewhere (e.g. Merritt et al, 2019; Buzza et al, 2018; Thornicroft et al, 2012; Jogerst et al, 2015). Instead, the following sections lay out some of the most distinctive insights and practical implications of this scoping study.…”

“…While an array of communication skills have invariably featured in existing competency frameworks (Buzza et al, 2018; Merritt et al, 2019), the current job market analysis shines a light on a broader spectrum of communication and political skills, including some less commonly emphasised skills such as conflict resolution and influencing skills, together with policy and political knowledge and sensitivity. Multi-stakeholder collaboration, negotiation and consensus-building are indispensable in many GMH-related roles, particularly in the policy, advocacy, capacity-building and healthcare management sectors (Ng et al, 2016; Iemmi, 2022).…”

“…Several recent endeavours have attempted to develop GMH competencies by either modifying related competency frameworks from adjacent disciplines (such as psychology), or by creating bespoke frameworks or lists of competencies (Khoury & De Castro Pecanha, 2023). Notably, most of these have been focused on psychological service delivery (Buzza et al, 2018; International Association of Applied Psychology & International Union of Psychological Science, 2016; World Health Organization and UNICEF, 2022), and (early- career) researchers (Merritt et al, 2019; Thornicroft et al, 2012; Collins and Pringle, 2016; Ng et al, 2016), and on specific interventions and settings such as humanitarian contexts (e.g. IFRC, 2016).…”

Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive

“…For instance, a key competency in the University of California San Francisco (UCSF) Psychiatry HEAL Fellowship in Global Mental Health is engagement in the health system by way of evaluating health programs, engagement with local leaders/groups, and developing interventions with local partners. 52 The training program provides an ideal environment in which training faculty can model skills in advocacy and provide opportunities to put learning into action. Understandably many psychiatry faculty and residents are concerned that getting involved in advocacy means getting engaged in politics or working outside of one’s scope.…”

Moving the Global Mental Health Debate Forward: How a Structural Competency Framework Can Apply to Global Mental Health Training

“…The experience of Kronfol et al (2016) developing a Global Mental Health track for psychiatry residents at Cornell University suggests that there is an appetite for curricula addressing political structures within global mental health training and that such training is feasible [21]. The new Global Mental Health Fellowship at UCSF features structural determinants of mental health as one of its primary educational domains, within which are included series of competencies closely reflecting the structural competency framework [22]. Including global mental health as a topic in training programs that teach psychiatric residents to intervene on structural determinants of mental health locally can provide education for trainees who might be doing single opportunities in LMICs.…”