2nd year psych resident - how to get involved in global mental health

[milan95]

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huge passion of mine but sadly my program is lacking in opportunities. Any suggestions on how I can get involved?

 

[Sushirolls]

Finish your training.
Look up the countries that are top 20 for least amount of psychiatrists.
Move there.
Practice there and learn the local language and customs.

 

[Candidate2017]

As I understand it, rich countries with a shortage of psychiatrists are about building a panel of 50-100 rich patients, while poor countries with a shortage of psychiatrists are about seeing 150 patients/day and no-nonsense paternalism ("take your meds, bye!"). You could recreate both experiences in the U.S., but for malpractice issues in the latter.

Also, little to no notes in either scenario. I would love to experience that part.

 

[Merovinge]

As I understand it, rich countries with a shortage of psychiatrists are about building a panel of 50-100 rich patients, while poor countries with a shortage of psychiatrists are about seeing 150 patients/day and no-nonsense paternalism ("take your meds, bye!"). You could recreate both experiences in the U.S., but for malpractice issues in the latter.

Also, little to no notes in either scenario. I would love to experience that part.

Gosh from what I have heard about the practice in China (one of my co-residents was a first gen from China), it sounds absolutely wild. They do get to use a lot of clozapine which I can appreciate, but holy moly I don't think any US trained psychiatrist even fluent in the language and customs could wrap their head around a day in the life there. Seeing 150/day sounds about right.

 

[mistafab]

What does global psychiatry even mean?

Be more specific about what you're looking for and you'll get more helpful answers.

 

[Stagg737]

So maybe an unpopular opinion, but unless you're either from that country and are a native speaker with solid cultural competency or you're planning on moving somewhere permanently, psychiatry is a bad field for global medicine. I say this as someone who has done some global medicine before becoming a psychiatry as well as someone who works in a city where we have large populations of people from multiple different global areas with very different and unique cultures, some of which only speak dialects that not even seasoned translators understand. I've seen people from some of these cultures for years and there are still significant barriers between their norms and US norms or even the legal systems at time.

Great example was in med school I saw a patient who was admitted after family reported she wasn't really taking care of herself and one person said she was hallucinating. Per the translators, she was saying she could hear her "ancestors" voices speaking about her "from above" and we started her on an SGA. Turns out on day 4-5 we got a translator who spoke that dialect and the terms for "ancestors" and "grandparents" were almost identical and the other translators just thought it was the patient's accent. Found out from family that her grandparents lived in the apartment above her and she could hear them talking about her. Wasn't psychotic at all, turns out just mildly depressed because of some social adjustments I can't recall that family didn't think she should feel sad about d/t their culture. Fortunately it turned out fine, but she was started on antipsychotics that could have caused major side effects and likely would have been continued on them if the right translator hadn't been present.

I've seen far worse on global trips which I won't get into, but this isn't like surgery or medicine where you can confirm diagnoses with labs, tests, and physical exams. It requires an understanding of the mind in context of culture and strong communication which is often not realistic when looking at shorter periods of weeks to months of work.

 

[comp1]

I tend to strongly agree that amongst all medical specialties, psychiatry is the worst for global medicine. I COULD see it, possibly, if you have an amazingly personal close tie to a given culture or if where you trained is extraordinarily similar to where you practice, ie UK trained going to Australia, but even then, it's going to be a much bigger challenge than other specialties. Culture is like the air we breathe, it's not something that you are often even aware of and honestly, treating mental illness is probably not an ideal place to be learning it for the patient or provider.

 

[Stagg737]

I tend to strongly agree that amongst all medical specialties, psychiatry is the worst for global medicine. I COULD see it, possibly, if you have an amazingly personal close tie to a given culture or if where you trained is extraordinarily similar to where you practice, ie UK trained going to Australia, but even then, it's going to be a much bigger challenge than other specialties. Culture is like the air we breathe, it's not something that you are often even aware of and honestly, treating mental illness is probably not an ideal place to be learning it for the patient or provider.

I'd go even more basic and say if you're not fluent in the patient's language or have a translator who is experienced specifically in translating for psych patients it's going to cause problems. I see this all the time on consults with translators because I know Spanish well enough to know when the translators suck or are good. I gave an example above. I agree that culture is important to really dig in and make a longitudinal difference, but imo you can't even start to get the basics down (correct diagnoses) if you don't understand and speak the language.