Our teams operate in 12 locations around the world and we have been working with PIH to support mental health and improve access to care since 2009.

The team that will be conducting this AMA will be: Bepi Raviola, MD, MPH - Child & Adolescent Psychiatrist and co-Director of PIH Mental Health Stephanie Smith, MD - Consult Psychiatrist and co-Director of PIH Mental Health Ksakrad Kelly, Psy. D. - Senior Psychotherapy Technical Advisor for PIH Mental Health Father Eddy Eustache, MA - Priest and Psychologist, co-Director of PIH Staff Wellness

Together we have spent decades providing clinical care, mentorship, and expertise to promote and improve access to lifesaving mental health care in communities and facilities around the world, as well as fight stigma and advocate for the inclusion of mental health in the fight for universal health care. We have supported the rebuilding of communities after earthquakes and cyclones, and helped strengthen health systems ravaged by Ebola and other infectious diseases.

Drawing on our years of experience working in mental health across Latin America, Africa, and the Caribbean, we’re here to answer any questions you may have for mental health awareness month.

Thank you all for asking your questions, we're hoping off but here are some resources if you have questions or want to learn more:

Learn more about work - https://storymaps.arcgis.com/stories/8dca051575aa4dd983e9fe1e21bcff6b

If you have any questions to ask us - [email protected] 

If you want to stay up to date on all of our work - https://act.pih.org/soc-sign-up

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Comments: 115 • Responses: 16  • Date: 

cannotdecideaname85 karma

Hey I support PIH through John & Hank Green and their efforts to fund a maternal centre of excellence in Sierra Leone! Do you have plans for more mental health care in that country?

PartnersInHealth73 karma

In Sierra Leone, starting in 2018, we have rebuilt the oldest psychiatric hospital in Africa, opened in 1820, in Freetown. In a country of 8 million people, with 2 psychiatrists, we have started a new psychiatry residency program that was last year accredited by the West African College of Physicians. Separately, but linked, in Eastern Sierra Leone, in Kono, and linked to Koidu Government Hospital, we have developed a continuum of mental health care that includes a range of providers. They go into the community and work with people directly. The heart of this work is non-specialists, that is, community members who provide support at a household level. We are excited to continue this commitment!

Learn more: https://storymaps.arcgis.com/stories/f133e3f4f4a64710ba559944eb10777c

Alisa18047 karma

In my state (WA), at minimum, there's maybe one assisted living facility for disabled who aren't seniors or have 'severe' developmental disorders. Its where I currently live, and despite having autism, I didn't qualify for other facilities because I'm literally too smart. The only other place we could go is possibly a group home, which wouldn't afford the same dignity.

IMO, us 'low care' mentally disabled who aren't seniors are an under-served, under-acknowledged demographic. We can't live on our own, or hold a job, but are too, ahem, 'high-functioning' and young to qualify for anywhere else. I suspect many like us are homeless in the streets, even.

Can I get your opinion on this?

PartnersInHealth5 karma

We must solve the mental health systems crisis in the US! We are so sorry that you are experiencing this challenge.

lstock2914 karma

What are your thoughts on self-screening and an apparent trend in self-diagnosing mental disorders? If someone is using a self-screening tool, what's the most realistic call to action beyond their results page?

I work in public health in Missouri, and we're kicking into high gear with mental health programming. I appreciate the time you're taking to do this! It's so important to talk about how we can increase access and decrease stigma!

PartnersInHealth22 karma

Self-screening for a mental health condition using validated scales could be one way that someone can begin to describe what is happening in their lives. It would be important for people screening positive for any mental health condition to be linked to care and to be able to access professional evaluation as a follow-up. This is much easier said than done given the limitations in mental health care availability and delivery across the US and in other settings. Across our Partners In Health sites, we focus on building human resource capacity among both mental health providers and non-specialist providers to deliver care in places where there are few mental health resources. 

Learn more: https://www.pih.org/mental-health/program-planning-and-clinical-guidelines-development

FrizbeeeJon12 karma

Do you have any advice for the parent of a 13 year old girl in these modern times? It seems like a desire for a diagnosis or ailment is ubiquitous amongst her friend group and many others. She likely does struggle with ADD and we are taking action on that front.

I just want to fix everything wrong with her and while she has started counselling, anything suggested she works on just feels like more work and stress. She's overwhelmed by school a lot of the time.

PartnersInHealth10 karma

Thank you for this question. Parenting is a challenge for us all!  First and foremost, a thorough mental health evaluation can help you to sort out whether there is ADHD, anxiety, depression or something else happening. The US Surgeon General also came out with useful guidelines for social media. The advice I keep hearing from others is to keep the dialogue open. Keep having conversations and discussions about things that matter to your child. Try to be present as best you can, in order to connect frequently and with quality on your child's terms.

ninashukuru9 karma

Do you know of any mental health trainings accessible to the general public? I am aware of psychological first aid and emotional CPR, for example, but I'd welcome your thoughts on these, as well as any other courses, trainings or certifications you might recommend for someone looking to deepen their own knowledge of the field.

Clever_Mercury8 karma

Following natural (or manmade) disasters, what are the most effective mental health support strategies for children, teenagers, or young adults to minimize long-term effects?

We have so many events worldwide (war, political violence, earthquakes) and often talk about the physically injured, but I wonder what support we can/should advocate for to ensure survivors feel whole.

PartnersInHealth8 karma

Helping children and young people in the face of disaster is critically important. Here is a link to psychological first aid strategies for children and young people, which can be a good starting point. https://resourcecentre.savethechildren.net/collection/save-children-psychological-first-aid-training/

BigTiddyVampireWaifu7 karma

Are personality disorders (specifically cluster B's like sociopathy, narcissism, bpd) considered the same as a mental illness? How are treatments for said disorders similar/different from other common mental illnesses (like depression, bipolar, etc)?

PartnersInHealth7 karma

We think of mental health along a spectrum from well-being to distress to disorder and disability. This is a public health approach. We think about health promotion and prevention when thinking about well-being and distress. We think about treatment and care when thinking about a disorder. In the US, where personality disorders are diagnosed, they can be considered a disorder if they impact functioning and cause distress to a significant degree.
In the diagnostic and statistical manual of mental disorders, personality disorders are defined as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Treatments for personality disorders are complex and can include more significant psychotherapy as well as medication. Usually, the treatments take a longer period of time to work. 

Hiranonymous7 karma

Are there any concerted efforts in the mental health field to help family members who may be living with and trying to help manage those suffering from mental illness?

In my experience, families often suffer tremendously when living with those with mental disorders, even when those with the disorder are receiving therapeutic interventions. Counseling for family members might not only help family members to cope but ultimately, possibly by reducing stress and improving family interactions, help the member of their family directly disabled by mental health challenges.

PartnersInHealth5 karma

It is true that family members often suffer terribly when a family member has a mental health problem. There are some national organizations such as NAMI, Al-Anon and others which focus on helping caregivers and supporting family members in their ongoing journey to help their loved ones. There surely need to be more resources available to help families and caregivers.  

Across our PIH sites, we work to support families and caregivers for people living with mental health problems including programs that address socio-economic stressors, home visits and other psychological supports directly for family members 

Link for NAMI: https://nami.org/Support-Education/Support-Groups/NAMI-Family-Support-Group

MaintenanceAsleep1245 karma

Do you have any tips to support my mental health? Asking this more because sometimes life gets tough with work, bills and the news on TV.

PartnersInHealth4 karma

When COVID-19 hit we developed 10 tips for the situation. Most of these tips still apply today. Here they are: https://www.pih.org/article/10-mental-health-tips-coronavirus-social-distancing

Think-Might14115 karma

Working across all these different locations, what is something your team has learned has been helpful in supporting mental health?

PartnersInHealth8 karma

We’ve learned that collaborative, comprehensive, community-based care can be delivered in resource-limited contexts for people living with complex problems related to mental health. We’ve learned that mentoring and supporting people in delivering care is really important, including paying community health workers. We’ve learned that people living with mental health concerns benefit from social support and care as well as “treatment”. We’ve learned that mental health remains sorely underfunded across all countries and contexts. We’ve learned that effective mental health care strengthens health systems and communities. With climate change, human migration and other coming challenges of the future, we’ve learned that integration mental health outside of health systems, in communities and other sectors, will be essential in enhancing societal resilience. 
AND we've learned that most people feel and get better, and quickly, with mental health care!

PartnersInHealth2 karma

Thank you all for asking your questions, we're hoping off but here are some resources if you want to learn more, have any questions, or want to stay up to date:

Learn more about work - PIH Cross-Site Mental Health Program

If you have any questions to ask us - [Email us](mailto:[email protected])

If you want to stay up to date on all of our work - Sign up for updates

nbsoftware2 karma

How does PIH go about building comprehensive, community-based mental healthcare delivery systems? Do you start in one location (with more comprehensive services) and build out, or do you start distributed across a larger area (with less comprehensive services) and build up? I’m curious to hear what the process looks like, from initial planning stages to fully functioning mental healthcare systems. Thanks!

PartnersInHealth3 karma

Separate from mental health care, we recently heard one of PIH's founders, Dr. Jim Kim, speak to the legacy of Dr. Paul Farmer on the anniversary of his passing.

Dr. Kim described:

1) a preferential option for the poor;

2) the highest possible quality of care for those who need it;

3) be truly present with the suffering of others;

4) "accompaniment" as the core of clinical and social innovation;

5) the "hermeneutic of generosity"- always assume the best intentions in others;

6) start with a single patient or program and then go;

7) invest in students;

8) commit to communities and stay the course;

9) build systems (and support staff, stuff, space and social support).

These ideas were helpful to us 15 years ago as we were starting to get going. HIV and TB care had strengthened the primary care systems within which PIH worked through the 1990's and early 2000's. But there were few formal mental health services.

We started by building small systems out of disasters: the 1994 Rwanda Genocide Against the Tutsi, the 2010 Haiti earthquake, the 2014-16 Ebola crisis in West Africa, and a number of other crises. We used these situations as opportunities to strengthen mental health support. We collaborated closely with our site based leaders to build out systems. We supported the professional development of committed, local providers. We took care of the sickest people, initially. We showed that people could get better. We collected data and measured outcomes. We adapted the concept of a health care delivery value chain, published by Farmer, Kim and Porter in the Lancet in 2013, and built out a value chain for mental health car delivery that we felt reflected the realities of where were were working. But really, we started small, as our team is small, and there are few providers.

We've tried to be responsible in not growing work too fast, beyond the capacity of the individuals providing care to meet the very significant need. Here are some resources that might build out your explorations on this topic.

Here are some links to learn more:






CX8722 karma

Can you please share your thoughts on the permanence of telehealth as a mental health treatment modality going forward and what obstacles you see ahead?

Also, to what end will telehealth service communities across Latin America, Africa and the Caribbean?

Thank you for your time, thoughts and the work that you do.

PartnersInHealth3 karma

Telehealth is certainly here to stay and has changed so much of the ways mental health care is delivered, for the better. In the news, we have read about various problems with care being provided by people without credentials to do comprehensive evaluations, medication shortages, as well as other safety concerns, related to telehealth. Yet telehealth is certainly increasing access in many positive ways. If we want to develop person-centered care, many people prefer the convenience of telehealth as well. In many instances, however, meeting with a person in person is essential to obtain the most accurate information and to provide the best quality care. It is such an interesting time to be human, to be experiencing so much rapid social change, and to be struggling to keep up with all of the technology. (No one has asked about chat gpt yet! )

IDontLikeJamOrJelly2 karma

What are the biggest challenges you face in getting mental health care to people in places without strong healthcare systems? Stigma, funding, lack of HCPs? How much does your approach change by location?

Additionally, what can those of us in developed nations do to support your efforts?

Thanks for doing this AMA!

PartnersInHealth5 karma

To respond to your question we encourage you to look at our Storymaps website, which details some of the significant challenges. We have a number of papers linked to that site which document the biggest challenges. We are going to turn this question on its head a bit. Would that be ok? In the US there are 42,000 psychiatrists (we hear) and last year 42 percent of people in a mental health crisis could not access care. All countries are "developing" in terms of mental health care. The problem of mental health care delivery might be the biggest one that we face—how do we get actual services to people when they need them and where they need them. To support our efforts you can write to us and we can tell exactly how, as well as share with you our great gratitude. Thank you in advance for your support!

PartnersInHealth4 karma

You can write to us at: [[email protected]](mailto:[email protected])

TinyLittleCut2 karma

What can one do to deal with extreme anxiety?

PartnersInHealth6 karma

It is helpful to know what kind of anxiety, specifically, in order to develop a comprehensive treatment plan that factors in biological, psychological, or social factors contributing to the problem. For example, generalized anxiety, panic disorder, social anxiety or obsessive-compulsive disorder all look and feel different, and have different approaches. Evidence-based psychotherapies, such as Cognitive-Behavioral Therapy, delivered by a mental health professional, can be an important first step. Some people benefit from medication also, which might require an evaluation by a psychiatrist. Starting with a primary care physician can also be a first step in accessing care, if that person is available. 

Relaxation and mindfulness techniques can also be helpful in reducing anxiety. However, sometimes it may not be enough.