Global Mental Health & Psychiatry Newsletter

Global Mental Health & Psychiatry Newsletter
Eliot Sorel, MD, Editor-in-Chief, CLM Founder
Zonal Editors
Africa: Prof. David M. Ndetei,
Kenya and Prof. Solomon Rataemane,
South Africa
Asia/Pacific: Prof. Yueqin Huang,
China and Prof. Roy Kallivayalil, India
Americas: Prof. Fernando Lolas, Chile
and Prof. Vincenzo Di Nicola, Canada
Europe: Prof. Gabriel Ivbijaro, United
Kingdom and Dr. Mariana Pinto da
Costa, Portugal
Associate Editors
Miguel Alampay, MD
Rajeev Sharma, MD
Veronica Slootsky, MD
Mona Thapa, MD
Milangel Concepcion-Zayas, MD
Layan Zhang, MD
Eliot Sorel, MD
Editor-in-Chief
CLM Founder
Leadership, Innovation, and
Early Career Development
Eliot Sorel, MD
Newsletter
Volume II, No. 3
September 2016
CLM/WPS
Career, Leadership
and Mentorship Program
Leadership, innovation, and early
career development are the essential
elements of our Newsletter’s current
issue.
We are delighted to launch the new
Early Career Reports from Around
the World section in thisissue
of the Global Mental Health and
Psychiatry Newsletter. Contributions
from Doctors Mariana Pinto Da
Costa, Wasseem El Sarraj, Michael
Morse, and Rajeev Sharma are only
the beginning of what we hope
will become an ongoing forum
for leadership, innovation and
stimulating early career development
ideas, projects and global mental
health initiatives.
We also appreciate the innovative
and thought provoking contributions
from Professors Luis Risco and
Fernando Lolas of Chile regarding
the intrinsic link between Social
Psychiatry and Ethical Medical
knowledge, and the establishment of
the Social Psychiatric Association of
Chile; Professor David Ndetei thought
provoking and inspiring rendition of
the Africa Mental Health Foundation
of Nairobi, Kenya; Professor Yueqin
Huang’s sharing her country’s historic
development of the Mental Health
Survey, first of its kind in China;
Professor Roy Kallivayalil’s sharing
with us highlights of the rich scientific
program of the XXII World Congress
of the World Association for Social
Psychiatry Congress in New Delhi,
India, this December with the theme,
“Social Psychiatry in a Rapidly
Changing World”; and Professor
Di Nicola’s inquisitive essay on
“Where is the Family in Global
Mental Health.”

2
Volume II, No. 3 • September 2016
Table of Contents
CLM/WPS
GMHP Newsletter
Career, Leadership
and Mentorship Program
Career, Leadership and Mentorship
(CLM) is a program of the
Washington Psychiatric Society.
Career, Leadership and Mentorship
(CLM),a program for Residents
Members and Early Career
Psychiatrists was founded by Eliot
Sorel, MD, with the generous support
of the Washington Psychiatric Society,
the Area 3 Council and the American
Psychiatric Association. It was started
in 2008. CLM generates educational,
research, leadership and mentoring
opportunities for our young colleagues
to enhance the career development and
leadership skills of the next generation
of health leaders.
Eliot Sorel, MD, Editor-in-Chief, CLM Founder
Social Psychiatry as an Expansion of Ethical Medical
Knowledge. The constitution of a Chilean Association......................... 3
Luis Risco, MD, President and Fernando Lolas, MD
AFRICA ZONE:
Africa Mental Health Foundation (AMHF)........................................... 4
Professor David M. Ndetei
ASIA/PACIFIC ZONE:
The China Mental Health Survey........................................................... 6
Yueqin Huang, MD, MPH, PhD
22nd Congress of Social Psychiatry ....................................................... 7
Professor Roy Kallivayalil and Rakesh K. Chadda
the AMERICAS ZONE:
Where is the Family in Global Mental Health? .................................... 8
Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAP
EUROPE ZONE:
Early Career Psychiatrists Worldwide................................................... 9
Mariana Pinto de Costa, MD
EARLY CAREER REPORTS FROM ACROSS THE WORLD:
Low Intensity Cognitive Behavioral Therapy..................................... 10
Dr. Wasseem El Sarraj and Michael Morse, MD, MPA
Psychiatric Experiences........................................................................ 11
Rajeev Sharma, MD
Save the Date.......................................................................................... 12

GLOBAL MENTAL HEALTH & PSYCHIATRY NEWSLETTER of the Career, Leadership and Mentorship, Washington Psychiatric Society 3
Social Psychiatry is field appropriate for raising and
discussing social and interdisciplinary issues confronting
current psychiatric research and practice. Among these,
the increasing violence in our society and the world;
religious, racial, gender and cultural differences expressed
as intolerance; relation to the environment, natural and
social; benefits and problems caused by the application
of science and technology; the interfaces with other
disciplines, within and without the healthcare field;
the ethical responsibility of researchers and healthcare
providers. Beyond the usual doctor-patient realm, issues
arising in policymaking and epidemiological fieldwork are
also a major concern for social psychiatrists, along with
a reflection on the humanistic dimensions of medicine,
psychiatry, and the neurosciences.
Social psychiatry is the science of Anthropos, humankind.
It is systemic and contextual in orientation and humanistic
in tradition. (Sorel, 1998) It expands psychiatric thinking
and practice beyond the limits of the clinical encounter
and brings it closer to other disciplines dealing with
human behavior, such as anthropology and sociology,
without losing the “medical posture” that characterizes
psychiatry in general. In times past, the so-called “medical
model” was criticized because it represented what some
would have called the “hegemonic” stance of the medical
profession. It was argued that it did not address the
complexities of the human condition in health and disease.
It can be argued, however, that the correct understanding
of the medical endeavor, from past immemorial, has
always been integrative and holistic. What has sometimes
been unilateral and restricted is theorization. In attempts
at providing support for practices and interventions,
physicians have resorted to other disciplines and have
restricted their interests to biology, chemistry or social
science. Medical practice has always been more than its
alleged theoretical foundation, though in an implicit way.
When it came to expand this foundation, the result has
been juxtaposition of discourses with more apparent than
real integration (Lolas, 2015).
SOCIAL PSYCHIATRY AS AN EXPANSION OF ETHICAL MEDICAL
KNOWLEDGE. THE CONSTITUTION OF A CHILEAN ASSOCIATION
Social psychiatry, without losing ground in practice,
emphasizes one dimension and provides an interface
for a fruitful dialogue with other experts in the sciences
concerned with human activity and products. It represents
the best approach to a truly global mental health,
considering cultural determinants and the necessary
ethical grounding of a wide enterprise (Lolas, 2016)
Along with efforts currently under way in many countries,
it is expected that the creation of new associations, like
the one now being established in Chile, will bring new
momentum to the reflection on psychiatry as a discipline
and medicine as an integrative practice
Membership in the Chilean Society for Social Psychiatry
(CSSP) is available to all individuals certified or board
eligible in psychiatry or currently in an accredited
psychiatric residency training program and licensed to
practice medicine in Chile. Exceptionally, certain non-
psychiatrically trained physicians and allied mental
health professionals may be proposed for Associate
Membership status if proposed by a member in person
or in a written letter to the board and subsequently voted
into membership through a motion that is favorably acted
on. Qualification for Associate Membership involves a
demonstration of having made a significant contribution in
promoting social factors in the field of mental health.
Honorary Members will be appointed considering their
contributions to world psychiatry or their commitment to
the scientific foundations of the profession
Members are encouraged to advance their careers with a
strong humanitarian imprint, devoting time to serve the
interests of society.
Fernando Lolas, MDLuis Risco, MD
References:
(1) Lolas, F. (2015) Fundamentos para una teoría de la medicina.
Niram Art, Madrid (Foundations for a theory of medicine)
(2) Lolas, F. (2016) Global mental health: challenges for a global ethics.
Acta Bioethica 22(1):9-14.
(3) Sorel, E., (1998)“Social Psychiatry: A mission and a vision for the
21st century”, Int’l Med J, Vol 5 No 4; 247-249
By Luis Risco, MD, President, Chilean Society of
Neurology, Neurosurgery and Psychiatry, Associate
Professor, University of Chile and
Fernando Lolas, MD, Professor and Director,
Interdisciplinary Center for Studies in Bioethics,
University of Chile

4
AFRICA MENTAL HEALTH FOUNDATION (AMHF)
by Professor David M. Ndetei
HISTORY
Africa Mental Health
Foundation (AMHF)
is a non-governmental
organizationfounded
in 2000 by Prof David
Ndetei. AMHF was
formally registered in
2004 with a mandate
to conduct rigorous
mental health research
and inform public
policy initiatives. AMHF is committed to innovative
implementation research aimed at integrating mental health
into primary care, improving access to treatment services,
and incorporating evidence-based interventions into the
routine care of mental illness.
OUR PROJECTS
Over the past 15 years, we have played a key role in
advocating for better mental health initiatives, building
capacity for mental health researchers and clinicians,
and carrying out research to ensure the effective care and
rehabilitation for individuals with mental illness. We have
implemented over 20 projects throughout Kenya and built
an extensive network of national, regional, and international
collaborators and stakeholders.Some of our projects
include:
1. The Kenya Integrated Intervention Model for
Dialogue and Screening to Promote Children’s Mental
Wellbeing - A multi-stakeholder model for primary schools
that seeks to promote mental well-being, prevent mental
illness and reduce the mental health treatment gap for
children.
2. Community Recovery Achieved Through
Entrepreneurism - A proof of concept project using
economic engagement and psychosocial rehabilitation
modules to improve the recovery process of people with
serious mental illness.
3. The Computer-Based Drug and Alcohol Training
Assessment in Kenya - A computer-based training project
intended to build the capacity of primary healthcare workers
to identify and treat substance use disorders.
4. The Dialogue Project - A study utilizing traditional
and faith healers to deliver evidence-based psychosocial
interventions to patients seeking services.
5. Mobile Substance Use Intervention for HIV
Prevention - A technologically-integrated project where
clinicians use mobile phones to to treat substance abuse
through motivational interviewing.
6. Multisectoral Stakeholder TEAM Approach to Scale-
Up Community Mental Health in Kenya - A project
which partners with the local and national government
to integrate mental health into the mainstream primary
healthcare using existing community structures.
SUCCESSFUL OUTCOMES
Our projects have led to a reduction in mental health-
related stigma in the community, an improvement in
academic performance of school children, and an increase
in help-seeking behavior among community members.
Furthermore, we have witnessed community mobilization
and willingness to actively support mental health programs.
Our outcomes include the successful and fruitful facilitation
of a dialogue between indigenous healers and formal health
workers on the optimum ways to address mental health
challenges in Kenya. Our greatest achievement is the
strong partnerships we have formed with County, National
and International bodies integrate mental health into the
primary health care. The Makueni county government has
shown great initiative by allocating a greater proportion
of their budget towards mental health services in Kenya.
AMHF is now scaling up its successful projects to other
counties and countrywide.
PROFESSOR DAVID M. NDETEI
WPA Zone 14 Representative Professor of
Psychiatry University of Nairobi, Kenya Founding
Director, Africa Mental Health Foundation
Email:dmndetei@amhf.or.ke/dmndetei@uonbi.ac.ke
Website: www.africamentalhealthfoundation.org
References:
(1) Ndetei, D., Mutiso, V., Musyimi, C., Mokaya, A., Anderson, K.,
McKenzie, K., & Musau, A. (2016). The prevalence of mental disorders
among upper primary school children in Kenya. Social Psychiatry
and Psychiatric Epidemiology, 2016; 51(1), 63–71
(2) Ndetei DM., Mutiso V., Maraj A., Anderson KK., Musyimi C.,
Kwame M. Stigmatizing attitudes toward mental illness among
primary School children in Kenya Soc Psychiatry Psychiatr Epidemiol
2015). DOI 10.1007/s00127-015-1090-6

AFRICA
Cape Town, South Africa
Africa Mental Health Foundation team, Nairobi Kenya.

6
THE CHINA MENTAL HEALTH SURVEY
Mental disorders, as a community common disease with
complex aetiology and increasingly prominent burden,
have been paid more and more attention globally.
Currently, with rapid economic development of China,
psychosocial stress in different ways has increased. It
probably results in higher prevalence and incidence of
mental disorders, and increases instability of the society.
In regard of mental health services, the contradictions
between absolute lack of mental health resources for
demand and low utilization of mental health services
have become more and more prominent. The study
on disease burden of mental disorders was paid little
attention in the past because of limited research resource,
which led to the lack of authoritative scientific data.
Therefore, it is urgent to obtain the basic information of
national disease burden of mental health by means of
high-quality scientific research.
Based on the recent 30-year experience of mental
health survey in community population in China, China
Mental Health Survey (CMHS) aims to conduct high-
quality mental health survey in China. In this survey,
the latest psychiatry theory and diagnostic criteria and
epidemiological methods will be used. For the purpose
of getting data with high validity and reliability, the
experience from international investigation, quality
control and organizational management approach will
also be drew during the project. The prevalence rates
and their distributions of depressive disorder, anxiety
disorders, substance use disorders, schizophrenia,
dementia and other types of mental disorders have been
obtained, and various pathogenesis and risk factors
for these mental disorders have been explored by
observational and analytic epidemiological methods.
In addition, an integrated system of screening and
diagnosis of mental disorders, and a general system of
data collection and quality control of epidemiological
research will be developed in Chinese population.
CMHS has showed the prevalence, disease burden,
psychosocial and environmental risk factors of mental
disorders, and mental health service uses in China.
National Health and Family Planning Commission of
People’s Republic of China will release the report of
CMHS on October 10, the World Mental Health Day.
As a consequence, valid evidences will be provided for
policy makers in mental health so as to allocate national
health resources more scientifically, effectively and
equitably. CMHS also can enhance Chinese academic
position in the world, in terms of the researches of
disease burden of mental disorders.
byYueqin Huang, MD, MPH, PhD
Professor of Psychiatric Epidemiology
Institute of Mental Health, Peking University
Yueqin Huang, MD, MPH, PhD
Professor of Psychiatric Epidemiology
Vice-president, China Disabled Persons’Federation
Director, Division of Social Psychiatry and Behavioural
Medicine, Institute of Mental Health, Peking University,
P. R. China
President, Chinese Mental Health Journal
President, Society of Crisis Intervention of Chinese Association
of Mental Health
References:
(1) Liu Zhaorui, Huang Yueqin, Chen Xi, Cheng Hui, Luo Xiaomin.
The prevalence of mood disorder, anxiety disorder and substance use
disorder in community residents in Beijing : A cross-sectional study.
China Mental Health Journal, 2013, 27(2): 102- 110
(2) Yueqin Huang. Epidemiological Study of Mental Disorders in Mainland
China. Taiwanese Journal of Psychiatry (Taipei), 2013, 27(2): 101-109
(3) Shen YC, Zhang MY, Huang YQ, He, Y-L., Zhao, Z-R., Cheng, H., Tsang,
A., Lee, S., Kessler, R.C. Twelve Month Prevalence, Severity, and Unmet
Need for Treatment of Mental Disorders in Metropolitan China,
Psychological Medicine. 2006, 36(2): 257-268

ASIA/PACIFIC
The World Association of Social Psychiatry was founded
in 1964 under the leadership of Joshua Bierer (UK) who
was the founder President. The 1st World Congress was
held in 1964 in London. This is third time, India is hosting
the WASP Congress, having earlier hosted the 13th
Congress at New Delhi in 1992 and the 17th Congress at
Agra in 2001. This is heartening news! If the 19th century
belonged to descriptive psychopathology, the 20th century
to psychological and physical treatments, the 21st century
is widely regarded to be belonging to Social Psychiatry. As
we meet at New Delhi some of the themes upper most in
our minds will be fighting against social exclusion, stigma,
coercion and wide spread neglect of mental health in many
parts of the world.
XXII World Congress of Social Psychiatry is being held at
New Delhi, India from 30th November-4th December 2016.
The Congress is being organised by the Indian Association
for Social Psychiatry. Professor Tom Craig, President, World
Association of Social Psychiatry is the Congress President
and Professor Roy Abraham Kallivayalil is the Chair,
Scientific Committee. The theme of the Congress at New
Delhi, “Social Psychiatry in a Rapidly Changing World” is
contemporary and relevant. The
Congress is being co-sponsored by
the World Psychiatric Association
and the Indian Psychiatric Society.
The venue for the conference,
Hotel the Ashok, symbolizes the
traditional grandeur and hospitality
of the historic capital of India. The
scientific programme includes a
theme symposium, 75 symposiums,
14 workshops, 12 plenary lectures,
more than 100 free papers and
about 300 poster presentations. The
Congress will also have a young
psychiatrist programme and a quiz
for postgraduate residents.
The confirmed speakers include
Professors WASP President
Tom Craig, President-Elect
22ND
WORLD CONGRESS OF SOCIAL PSYCHIATRY
NOVEMBER 30 - DECEMBER 4, 2016
NEW DELHI, INDIA
by Prof Roy Abraham Kallivayalil
Chairman, Indian Medical Association
National Committee for Mental Health
Rakesh K. Chadda
Chair, Organizing Committee
drrakeshchadda@gmail.com
Roy Abraham Kallivayalil (India), Norman Sartorius
(Switzerland), Laurance Kirmayer (Canada), Eliot Sorel
(USA), Dinesh Bhugra (UK), José Miguel Caldas de Almeida
(Portugal), Tsutomu Sakuta (Japan), Driss Moussaoui
(Morrocco), Stephen Scott (UK), Helen Killaspy (UK), Helen
Herrman (Australia), Vijoy Varma (India), R Srinvasa Murthy
(India), Vikram Patel (India) and Mohan Issac (Australia).The
Congress is likely to be attended by more than 1000 delegates
from more than 35 countries.
Delhi has a very pleasant weather during early December.
It is a vibrant, affordable, colorful and friendly city with
thousands of years of culture and history. The city is well
connected by International and Domestic flights and boasts of
a wide range of hotels, including 5 star and budget hotels to
suit the requirement of each delegate. We have also arranged
for a variety of pre and post congress tours for the delegates,
who would like to visits the places of tourist attraction. The
Taj Mahal, one of the 7 wonders of the world is just 2 hours
journey from Delhi.
Further details can be accessed at www.wasp2016.com
Hearty welcome!

8
WHERE IS THE FAMILY IN GLOBAL
MENTAL HEALTH?
byVincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPA
Chief of Child and Adolescent Psychiatry
Montreal University Institute of Mental Health
Professor of Psychiatry, University of Montreal
In a bold editorial, cultural psychiatrist Arthur Kleinman
argued for a rebalancing of academic psychiatry, citing
global mental health (GMH) as an emerging priority:
“Global health is now squarely on the agenda of students,
researchers and funders.” (Kleinman, 2012, p. 421).
Community, psychosocial, and cultural aspects, as well as
“social, moral and economic” factors are duly mentioned.
Nowhere do the words family and relationship appear.
I recently posed the question, “What is GMH?” (Di
Nicola, 2016). A major volume in this emerging field of-
fers this definition as a starting point:
Global health is an area for study, research and
practice that places a priority on improving health
and achieving equity in health for all people world-
wide. Global mental health is the application of these
principles to the domain of mental ill-health. (Patel,
et al., 2014)
While we debate the best way to capture just what it is
we want toaccomplish with GMH, I want to ask: Where
is the family in GMH? Child and adolescent psychiatrists
are already taking GMH seriously and taking stock of its
import (see Joshi, et al., 2016). In Eliot Sorel’s volume,
21st Century Global Mental Health (2012), I examined
the family, psychosocial, and cultural determinants of
health (Di Nicola, 2012). These are critical and essential
aspects that demand study and inclusion in any compre-
hensive view of health. We cannot have a truly global
movement for mental health without acknowledging the
problems in our current models of health and illness that
shape our models of health care delivery without includ-
ing local health cultures and healing traditions.
Those of us who work with mental health issues from
a family perspective believe that seeing individuals in
isolation is limited and ignores, minimizes or discounts
the importance of relationships as both resources for
health and as risk factors for illness. Furthermore, the
work on attachment (which is theoretically important and
clinically fertile) and belonging (its counterpart in social
and cultural psychiatry addressing aspects of affiliation,
identity, and social cohesion) demonstrates that relation-
ships in general are avenues for treatment from both a
family therapy perspective and the social determinants of
health perspective (Di Nicola, 2012). This is the systems
or relational approach to health. Relational means seeing
families as the bearers of the cultures they come from
and their own unique cultures (Di Nicola, 1997, 2011).
From a family perspective, GMH appears as a regressive
step to the usual Western health categories that focus
on individuals as bearers of larger issues in the family,
community, society and culture. These larger envelopes
are addressed in the impersonal way of categories—e.g.,
child abuse, substance abuse, violence, and treatment
gaps—rather than from the relational, social and cultural
perspectives that define mental health and illness more
fully, meaningfully, and realistically.
These aspects of GMH may deepen the practitioners’
perception of public health and epidemiology and their
international organizations as being removed from clini-
cal concerns and from their meaningful relational con-
texts. Without such notions as attachment and belonging,
ignoring the most significant of human relationships
based on the family and community, GMH risks creat-
ing another disembodied field divorced from our lived
experience as communal and relational beings.
Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPA
Professor of Psychiatry, University of Montreal
Representative to the APA Assembly
Past-President of the Quebec & Eastern Canada District Branch
Newsletter Zonal Co-Editor for the Americas
References:
Di Nicola, Vincenzo. A Stranger in the Family: Culture, Families, and
Therapy. New York & London: W.W. Norton, 1997.
Di Nicola, Vincenzo. Letters to a Young Therapist: Relational Practices
for the Coming Community. New York & Dresden: Atropos Press, 2011.
Di Nicola, Vincenzo. Family, psychosocial, and cultural determinants of
health. In: Sorel, Eliot, ed., 21st Century Global Mental Health. Burling-
ton, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Di Nicola, Vincenzo. Forum: Defining global mental health and psychiatry.
Global Mental Health & Psychiatry Newsletter, January 2016, I (2): p. 11.
Joshi, Paramjit T. and Lisa Cullins, eds. Global Mental Health Issue. Child
and Adolescent Psychiatric Clinics of North America. January 2016.
Kleinman, Arthur. Editorial: Rebalancing academic psychiatry: why it
needs to happen – and soon. British Journal of Psychiatry Dec 2012, 201
(6): 421-422.
Patel, Vikram, Harry Minas, Alex Cohen, Martin J. Prince, eds. Global
Mental Health: Principles and Practice. Oxford, UK: Oxford University
Press, 2014.
Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA:
Jones & Bartlett Learning, 2012.
the AMERICAS

EUROPE
The Section of Early Career Psychiatrists (ECPs) of the World
Psychiatric Association (WPA) was created to encourage
ECPs to network, learn, research and succeed in international
collaborations.1
One of the great values of having such a section is to ensure
the autonomy of ECPs within the WPA under the umbrella
of guidance and warm advice of senior colleagues whenever
needed.
The section wishes to proceed with several collaborative
activities with ECPs associations, aiming to enhance
high standard training, and reflect the needs of ECPs in
leadership, which can eventually improve mental health
services worldwide, since usually ECPs are their backbones2
.
Likewise, using web tools, ECPs can communicate closer
with world-leading experts in psychiatry, without leaving their
countries. These key features are just a milestone of a long list
of possibilities that can be ultimately achieved together with
its members.
We warmly invite ECPs from all over the world to join the
section, focusing their contributions in whichever areas they
think are most necessary.
Hussien Elkholy (Egypt), Florian Riese (Switzerland), Felipe Picon
(Brazil), Mariana Pinto da Costa (Portugal), Takashi Nakamae
(Japan), Prashanth Puspanathan (Australia)
References:
(1) Fiorillo A, Pinto da Costa M, Nakamae T, Puspanathan P, Riese F, Picon F, Elkholy H. Associations of early career psychiatrists
worldwide: history, role, and future perspectives. Middle East Current Psychiatry (2016), 23:3–9.
(2) Fiorillo A, Brambhatt P, Elkholy, H, Lattova Z, Picon F.Activities of the WPA Early Career Psychiatrists Council:
the Action Plan is in progress. World Psychiatry, (2011) 10(2), 159.
EARLY CAREER PSYCHIATRISTS WORLDWIDE
by Mariana Pinto de Costa, MD
Mariana Pinto da Costa
International Coordinator of the BrainDrain study
Psychiatry Trainee, Hospital de Magalhães Lemos, Porto,
Portugal
Contact: mariana.pintodacosta@gmail.com

10
Low Intensity CBT (LI CBT) is an umbrella term for a
set of problem specific interventions1
. Waseem El Sarraj,
psychological wellbeing practitioner has trained in LI CBT
within the United Kingdom National Health Service model
known as ‘Improving Access to Psychological Therapies’
(IAPT). Having worked as a LICBT therapist he found that
the UK general public were by in large very unfamiliar
with this model of linking thoughts, feelings and behaviors.
For example one of the LI CBT interventions known as Be-
havioral Activation, is at its core about getting ‘deactivated’
patients to recognize how their low mood can negatively
color their view of the world, themselves and the future,
as well as decrease motivation, leading to a reduction in
the pursuit of activities and goals that may bring pleasure2
.
Having found a high degree of patient satisfaction with this
approach in the UK it seemed reasonable for the Palestin-
ian Medical Education Initiative (PMED) to explore its
salience to a Gaza population.
In an effort to learn more about the usefulness of CBT and
within a broader mandate of introducing mental health to
primary care staff the PMED arranged a workshop with 15
primary care health workers (nurses, doctors and psycholo-
gists) in the Gaza Strip. PMED had planned to visit Gaza
in March 2016 but found obtaining permission to enter
problematic. PMED was forced to conduct the training via
Skype from Amman, Jordan. There were no technical dif-
ficulties and the training was conducted without problem.
There were three parts to the workshop: an introduction
to the IAPT service model in the UK, the assessment and
treatment of depression, and the assessment and treatment
of generalized anxiety disorder. Participants were attentive
and curious throughout the training and the trainer sought
regular verbal feedback from the group, and was able to
ascertain that the group had a solid understanding of CBT
principles and where LI CBT interventions sit in the gambit
of evidence based mental health interventions.
At the end of the session the group was engaged in an hour-
long discussion on the validity of LI CBT for a Gaza popula-
tion. The first objection raised was how effective such simple
interventions would be to a population experiencing chronic
effects of occupation and war. The second objection was that
LOW INTENSITY COGNITIVE
BEHAVIORAL THERAPY
by Dr.Wasseem El Sarraj, London, UK
PsychologicalWell Being Practitioner
National Health Service
and Michael Morse MD, MPA
the community already has ways to cope such as religion,
civic engagement and tight social bonds. However, it was
noted that religion is a ‘double edged sword’ as it can lead
some people to seek out religious healing which in many
cases is ineffective for mental illness.
Despite these objections the workshop group liked the sim-
plicity of the CBT model and how insight into mood can
be gleaned from linking thoughts, feelings and behaviors.
Participants were in agreement that LI CBT would likely
not be harmful. When asked about delivering the psycho-
education participants agreed that social media would be a
helpful way to reach large parts of the Gaza population.
Overall, the workshop represents a first step to exploring
the usefulness of LI CBT for a Gaza population. Further
work will require the testing of interventions whilst ad-
dressing the need to situate interventions within the context
of war and occupation. As well as being mindful of the
sources of resilience found not in the individual but in the
community and wider society.
Dr. Wasseem El Sarraj, London, UK
Senior Director, Palestinian Medical Education Initiative
Psychological Wellbeing Practitioner, National Health
Service, England
Michael Morse MD,MPA
Executive Director, Palestinian Medical Education
Initiative
Director, Program in Global Community Mental Health,
Department of Psychiatry, George Washington University
Dr. Morse is training in Child and Adolescent Psychiatry
Fellowship- CNMC, Washington DC
The Palestinian Medical Education Initiative (PMED) is a nonprofit
which supports the people of Palestine through international partner-
ships in medical education and health service program development.
www.pmedonline.org
References:
(1) Roth, A. Pilling, S. 2008. Using an evidence based methodology
to identify the competences required to deliver effective cognitive
and behavioral therapy for depression and anxiety disorders.
Behavioral and Cognitive Psychotherapy, 36, 129-147
(2) Hopko, D., Lejuez, C., Ruggiaro, K. & Eifert, G. (2003).
Contemporary behavioural activation treatments for depression:
procedures, principles and progress. Clinical Psychology Review,
23, 699-717.l
Dr. Michael Morse Wasseem El Sarraj
E A R L Y C A R E E R R E P O R T S F R O M A C R O S S T H E W O R L D

I am an early career psychiatrist who has been fortunate to work
in three different countries with different cultures and varying
socio-economic backgrounds; these three are India, Singapore
and USA. One major common personal factor was that in all
the three countries I practiced in public setting hospitals. It can
be argued whether manifestations and management of different
common mental illnesses vary across nationalities or cultures.
My earliest experience in psychiatry was in my home country
in India as an Intern (fresh from medical school) and as a house
officer. Psychiatric illness still has a lot of stigma in some societ-
ies and in India it is simply huge but attempts are being made
by various psychiatry societies and the government to alter this
perception and consider mental illness as akin to any physical
disease and seek proper therapy without being bound by baseless
and ignorant concepts about psychiatric illnesses. Looking back,
I see that talking to the patient in his language can be a big ad-
vantage (compared to when I worked in Singapore). There were
significant administrative and cultural differences in working
styles and facilities available in all 3 countries which directly or
indirectly definitely affected patient care.
In India families are generally involved in patient care as
families are very closely knit .The major obvious advantage of
this is the patient most of the times receives good family sup-
port and has strong a fallback system. A minor disadvantage
from this positive family support system that I noticed was that
patient autonomy in making decisions was sacrificed at times,
although in my view the advantages of huge family support
outweigh this tremendously. Another striking point I noticed
was families would always add a spiritual or a religious angle to
their loved one’s mental illness. Not uncommonly the families
would seek help of spiritual or religious affiliates. The patient
would also bring in their faith in dealing with the stress of their
mental illness; prayers, spiritual teachers and at-times medita-
tion. Psychiatry Consultations are often sought, especially by the
rich, for minor issues often confusing the role of psychiatrist as a
counselor rather than a physician. On television channels many
psychiatrists are seen discussing psychological issues; the role of
them as counselors remains ill defined. Recently substance abuse
has also become a major problem in some states of India and
addiction psychiatry is gaining great attention and scientific data
support that prevalence of drug abuse and addiction has already
become epidemic in certain states .
My work as Medical Officer in a leading and largest public psy-
chiatric hospital in Singapore was a great learning experience.
Singapore has been voted as one of the most efficient models
of socialized medicine in the world. The administrative govern-
ing style in Singapore is meticulous and it is so also in medical
services. In Singapore most patients speak in Chinese and I was
at times utilizing help of a translator. I realized that the language
barrier can causes difficulties in establishing a rapport but at
the end of the day what matters is physician empathy, experi-
ence and knowledge. These help in establishing rapport and
satisfaction of obtaining patient and patient's family's trust. The
language barriers may cause its frustrations both to the patient
and the physician but experienced psychiatrist has to take all
this in stride and be able to provide the best services that he is
capable of. Like India, Singapore also is fighting in dealing with
stigma of mental illnesses. As noted earlier the very effective
work ethics and high set standards in place in their culture has
taken its toll as high stress related mental illnesses. Singapore has
expanded psychiatric care to children which is also of very high
quality. The spectrum of mental illnesses was also very similar
to what I encountered in India but with varying prevalence and
similarly cultural influences seemed to play a role also in dealing
with stressors from mental illnesses. Substance abuse (especially
illicit drugs) is not as prevalent in Singapore arguably due to very
strict laws and punishments.
In U.S. where I am working as a attending Psychiatrist after
completing my residency from a state hospital and am currently
working in the same institution. Here along with mental illnesses
substance abuse is more prevalent as compared to Singapore.
The socioeconomic factors are seen to play hugely in prevalence
of mental illnesses. Forensic psychiatry is much more involved
as compared to public state psychiatric settings in India. In the
U.S. apart from medications, other treatment modalities are also
used in public hospitals. The treatment strategies include various
therapies-individual and groups, music, art and dance therapy.
The current treatment goal in most state hospitals is to rehabili-
tate the individual in care back to the community. Compared to
India individuals from the lower socio comic status are provided
with much better access to psychiatric care and more compre-
hensive services. But the billing and insurance procedures in
both private and public sector health care institutions are surely,
perhaps unavoidably, much more complicated than India or
Singapore.
Finally realizing that though all 3 countries present with different
cultures and human experiences but the biggest commonalty is
that all human beings are the "same" at the end of the day. Each
person as a patient has similar concerns of well -being, similar
ambitions and similar problems-well-being remains the most
vital. Languages and faces may differ and vary but the “depres-
sion" remains depression and "pain" of the mental illnesses
remains pain- easily seen and the same everywhere.
References:
(1) Strategy for the management of substance use disorders in the State
of Punjab: Developing a structural model of state-level de-addiction
services in the health sector (the “Punjab model”) Indian J Psychiatry.
2015 Jan-Mar; 57(1): 9–20. doi: 10.4103/0019-5545.148509
(2) World Health Organization Assesses the World’s Health Systems
http://www.who.int/whr/2000/media_centre/press_release/en/
PSYCHIATRIC EXPERIENCES
Rajeev Sharma, MD
District of Columbia Department of Behavioral Health
Washington, DC
E A R L Y C A R E E R R E P O R T S F R O M A C R O S S T H E W O R L D

12
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