Table 1
Integrated competencies for global mental health fellowship.
| Domain | Competencies | |
|---|---|---|
| 1. | Structural Determinants of Mental Health | Goal: Describe the impact of structural determinants on health A. Define structural competence and describe its key components GMH B. Describe common social, historical, structural, political, and economic determinants of mental health GMH C. Describe and compare key social, historical, structural, political, and economic determinants of mental health within different local contexts GMH D. Explain the historical and current role of global health actors, including types of global health partnerships and programs GH E. Demonstrate in-depth knowledge of diseases that disproportionately affect the poor GH |
| 2. | Cultural Aspects of Mental Health | Goal: Deliver mental healthcare in cross-cultural settings with cultural humility A. Describe and critique traditional models of cultural competency in mental health GMH B. Develop and utilize strategies to appreciate and continually refine an understanding of cultural influences on mental health and illness GMH C. Describe and compare locally-specific traditional healing practices GMH D. Understand how to incorporate traditional healing practices into clinical care GMH |
| 3. | Understanding the Health System & Resources in Mental Health | Goal: Gain fluency in systems-level approach to improving access to mental health services A. Explain the importance of health systems strengthening and health systems redesign to improving health outcomes GH B. Illustrate and contrast the roles of health systems design in either reinforcing health inequities or helping overcome them GH C. Analyze the impact of several common approaches to health care financing on health care access, health outcomes, and health equity GH D. Analyze the health system of domestic and international sites to determine: leadership, chain of command for decision making, funding streams, supply chain, interaction with local community, and players in the health system GH E. Describe and compare mental health and related resources available within specific countries and regions GMH F. Analyze and compare mental health and related resources available in local communities GMH G. Analyze and compare mental health and related resources available at local clinical sites GMH H. Describe factors that affect access to mental health and related resources at the aforementioned levels GMH |
| 4. | Engagement in the Health System | Goal: Gain experiential knowledge in strengthening health care delivery systems A. Develop skills to design, implement, monitor and/or evaluate health programs and health systems, including their inputs, outputs, effectiveness, cost-effectiveness, and financial management GH B. Elicit the goals of the local health system in choosing and implementing your projects GH C. Engage with local leaders/civic society groups targeting other social determinants of health including access to clean water, housing, food security, and economic opportunities GH D. Develop a project/intervention in partnership with local partners at your site(s) that aims to improve measurable disease-specific outcomes through health-systems level change GH |
| 5. | General Provision of Care | Goal: Gain experiential knowledge in delivering health care in a low-resource settings A. Determine the local burden of communicable and non-communicable diseases within your setting GH B. Apply the evidence-based international standards of care for the diseases affecting your population GH C. Demonstrate skills in adapting to a resource-limited setting while maintaining a high quality standard GH D. Target interventions to address both prevention and management of the most common disease in the local context GH E. Demonstrate competency in basic medical procedures, including bedside ultrasound, phlebotomy, and selected lab medicine techniques if relevant to your profession GH F. Demonstrate strong, culturally appropriate communication skills in interprofessional and patient interactions GH |
| 6. | Emergency Psychiatry and Inpatient Care | Goal: Gain clinical competence in delivering care for severe and emergent mental health problems A. Describe the most common causes of acute psychiatric presentation in different locales and formulate differential diagnoses that are site- and culture-specific GMH B. Formulate risk assessments that take into account local medical and cultural factors GMH C. Identify local laws and practices that apply in psychiatric emergencies and inpatient care GMH D. Describe systemic challenges specific to delivery of emergency and inpatient psychiatric care in low resource settings GMH E. Describe the local availability, indications, contraindications, and goals for inpatient psychiatric hospitalization GMH F. Identify the local availability and forms of medication used in different clinical settings and know how to use and monitor them appropriately in each setting GMH |
| 7. | Adult Community Psychiatry | Goal: Gain clinical competency in delivering care for common mental illnesses for adults by utilizing and improving local resources A. Describe common presentations, differential diagnoses, and appropriate interventions for each major mental illness in local community settings GMH B. Identify the availability of psychotropic medications of each major class in different community settings, and know how to use and monitor them appropriately in each GMH C. Describe systemic challenges specific to delivery of outpatient and community mental health care in different low resource settings GMH D. Identify key non-professional providers of mental health care and psychosocial support and demonstrate locally-appropriate task sharing GMH |
| 8. | Child and Adolescent Psychiatry | Goal: Recognize signs of pathology, avoid harm, and deliver basic care based on specialist recommendation to assist children A. Make comparisons between cultural perspectives on child development GMH B. Describe local and culturally-specific parenting strategies to promote positive child behavior GMH C. Describe local and culturally-specific attributions of child mental health GMH D. Develop and apply culturally-appropriate behavioral plans that encourage healthy behaviors GMH E. Identify local and culturally-specific risk assessments and interventions for suicide and self-harm in children and adolescents GMH F. Describe site- and culture-specific common presentations, differential diagnoses, and prognoses of psychiatric disorders that first present in childhood GMH G. Describe site- and culture-specific common presentations, differential diagnoses, and prognoses of children and adolescents with early onset of adult psychiatric disorders GMH H. Identify the availability and demonstrate locally-appropriate use of both pharmacologic and non-pharmacologic treatments for psychiatric disorders in children and adolescents GMH I. Describe local considerations for safe prescribing of medication to children and adolescents GMH |
| 9. | Geriatric Psychiatry | Goal: Recognize signs of pathology, avoid harm, and deliver basic care based on specialist recommendation to assist children A. Describe site- and culture-specific common presentations, differential diagnoses, and management of common mental illnesses such as depression and anxiety within geriatric populations GMH B. Describe the local and culturally-specific impact of geriatric depression and other mental illness on family structure and function GMH C. Describe local and culturally--specific conceptualizations of dementia and cognitive impairment GMH D. Describe the local and culturally-specific impact of dementia and cognitive impairment on family structure and function GMH E. Demonstrate how to measure cognition in a locally appropriate and acceptable way GMH F. Identify and utilize locally available and appropriate pharmacologic and non-pharmacologic interventions for cognitive impairment and dementia GMH G. Identify locally-specific risks for delirium and describe how to best address it with the resources available GMH H. Demonstrate the ability to talk to patients and families about cognitive impairment, dementia, and delirium in a culturally-appropriate manner GMH |
| 10. | HIV Psychiatry | Goal: Deliver mental health care for people with HIV with critical awareness of specific issues in this population A. Identify the local breadth and prevalence of neuropsychiatric disorders amongst people living with HIV GMH B. Describe neuropsychiatric symptoms associated with HIV infection and understand common site- and culture-specific presentations and differential diagnoses GMH C. Explain evidence-based harm-reduction strategies to address substance use and reduce transmission among people with HIV, and identify locally appropriate utilization of such strategies GMH D. Describe common interactions between HIV and psychiatric medications and develop a rational, site- and culture-specific approach to prescribing psychiatric medications for people living with HIV GMH E. Identify common psychiatric side effects of locally-available HIV medications GMH F. Describe the site- and culture-specific impact of seroconversion, stigma, and discrimination for those living with HIV GMH |
| 11. | Psychotherapy | Goal: Strengthen local capacity to deliver evidence-based psychotherapies A. Describe the key components of and indications for evidence-based psychotherapies, including major cross-cultural evidence and adaptations GMH B. Identify locally-available resources for psychotherapy GMH C. Develop locally specific thresholds for therapy referrals GMH D. Provide locally-appropriate guidance and supervision for other health workers implementing psychotherapy for patients GMH |
| 12. | Substance Use | Goal: Recognize and address common sources of substance use A. List locally-common substances of abuse GMH B. Describe local demographic patterns associated with high-burden substances GMH C. Describe locally-specific societal impacts of substance abuse GMH D. List locally-available treatments, both in the community and the hospital, for acute and chronic substance use problems GMH E. Provide other health workers with locally-appropriate training and supervision in recognizing and addressing common substance use problems GMH |
| 13. | Training and Education | Goal: Utilize training and education to enhance local capacity in improving mental health care A. Recognize the importance of learning climate, goal setting, knowledge retention, evaluation and feedback in effective teaching GH B. Describe techniques for effective cross-cultural teaching GH C. Gain comfort in multiple arenas of teaching, including one-on-one teaching, small and large group settings GH. D. Describe and apply strategies of evaluation for your trainees, peers, and mentors GH E. Develop independent goals and objectives tailored to your personal strengths and weaknesses GH F. Develop effective strategies to be both a mentee and a mentor GH |
| 14. | Clinical Supervision | Goal: Strengthen systems to provide ongoing supervision for non-specialists in delivering high-quality mental health care A. Describe the collaborative care model and describe efforts to adapt it to different cultures and settings GMH B. Develop a clinical registry to review all patients receiving mental health services GMH C. Develop a locally-appropriate structure to meet with generalist clinicians to review difficult cases and provide clinical support GMH D. Develop a locally-appropriate structure to provide urgent or emergent support for generalist clinicians GMH E. Develop a locally-appropriate evaluation plan to assess the effectiveness of clinical supervision for clinicians and patient outcomes GMH F. Identify common and serious clinical issues presented during registry review and supervision and provide related training for all clinicians GMH |
| 15. | Interprofessionalism and Leadership | Goal: Enhance your own leadership and collaborative skills A. Recognize your leadership style and that of your colleagues GH B. Apply skills of management, including delegation, moderation, supervision, and evaluation within your project teams GH C. Be able to articulate a vision to others in the field GH D. Describe conflict resolution styles GH E. Develop and apply the communication skills to advance and disseminate your work in a public arena GH F. Describe and practice applying strategies of leading without authority GH G. Describe the model of clinical accompaniment and use this model in your clinical setting GH H. Model professionalism in your role as a healthcare provider, colleague, and patient advocate GH I. Create an interprofessional collaborative environment among local and international nurses, physicians, and other health care professionals GH |
| 16. | Advocacy | Goal: Enhance your own skills in advocating for people living with and at risk for mental illness A. Identify types of advocacy and the methods that they employ to advance a particular cause GH B. Identify key actors, audiences, policies, and policy makers within your area of advocacy GH C. Raise awareness among local population and healthcare professionals on specific disease conditions or prevention efforts GH D. Create written or media advocacy pieces with local partners GH E. Disseminate your work in scientific and academic circles GH F. Write 1 blog post each quarter to advocate for specific areas of interest GH |
| 17. | Health Equity & Ethics | Goal: Gain theoretical and experiential knowledge in ethical practice of global health to address inequity A. Analyze your health system from an equity perspective GH B. Integrate principles of social medicine into your approach to global health delivery GH C. Demonstrate increased recognition of ethical issues involved in global health work GH D. Identify strategies for dealing with these ethical issues as they arise GH E. Ensure the ethical and responsible conduct in the design, implementation and dissemination of global health research or quality improvement GH F. Involve your local colleagues in every aspect of program or project development, including any publications or presentations GH G. Describe the responsibilities of academic centers and US based clinicians in adequately preparing for global health work in communities that are not their own GH H. Establish regular and transparent communication with your colleagues, in which partners are encouraged to voice their own objectives, challenges, and feedback GH |
| 18. | Self-Reflection and Self-Care | Goal: Utilize skills in self-reflection and self-care to maintain long-term engagement in global mental health A. Describe countertransference and common challenges to countertransference caused by relocation as well as differences in culture and language GMH B. Be capable of recognizing signs of burnout and its impact on personal health and clinical care GMH C. Utilize supervision structures to pro-actively identify and discuss emotional reactions to patient care and fellowship responsibilities GMH D. Utilize supervision structures to pro-actively identify challenges to one’s personal health and ways to maintain physical and mental health GMH |
| 19. | Quality Improvement | Goal: Gain experiential knowledge in conducting a quality improvement project A. Describe the core elements of quality improvement and apply them in the field GH B. Identify the quality improvement team within your institution. If one does not exist, identify stakeholders in quality improvement GH C. Partner with the QI team and key stakeholders to choose priorities for quality improvement interventions GH |
| 20. | Research in Global Mental Health (Optional) | Goal: Gain basic competence in developing a research protocol in GMH A. Identify a small, feasible research question relevant to your site GMH B. Conduct a literature review relevant to your research question GMH C. Describe types of study design, data analysis and management, sample size calculations, and power calculations GMH D. Identify the inferences that may be drawn from findings of clinical research studies, including any limitations more common within global mental health research GMH E. Draft a clinical research protocol for use in the proposed research project GMH F. Provide peer review and be able to critique research protocols GMH G. Recognize and address ethical concerns in global mental health research GMH |
[i] GH: Competencies for all global health fellowships.
GMH: Competencies for the Global Mental Health Fellowship.