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Second year psychiatry resident, Jaclyn Chua, DO, takes you through a day in the life of a Stony Brook psychiatry resident while sharing how Stony Brook offers it all: a rigorous integrative clinical program, the opportunity to do research.

The Humanitarian Side of Psychiatry

The humanitarian side of psychiatry could be considered to be a lot more fascinating and rewarding than humanitarian work in other fields.

According to Kaanthan Jawahar, a final year medical student who wrote an article on mental health in humanitarian emergencies: mental illness is the most common non-communicable ‘disease’. But when compounded with the stressors of disasters and conflicts, the baseline level of mental illness in the locality usually rises considerably. Jawahar states that this causes people with a pre-existing illness to be subjected to higher levels of stress.

The International Medical Corps (IMC)

The IMC is one of the largest non-profit humanitarian aid organizations in the world. They focus their efforts on disaster relief health care, training and development programs. They currently operate in more than 25 countries and are working on integrating mental health into their community-based primary health care.

The IMC argue that too much emphasis has been placed on the more ‘fashionable’ mental disorders, such as post-traumatic stress disorder. According to Peter Medway, the director of the International Medical Corps (IMC), there is also a largely Western focus when delivering treatment. Peter Medway argues that psychiatric health care needs to be location and context specific to achieve the most appropriate outcome.

Mental health seems to be a largely forgotten area in humanitarian aid missions, says Jawahar. Where it is addressed, it usually takes second place to other aid packages, which tend to be viewed as ‘more important’. Local practices, customs and many presentations of mental illness are often ignored.

This raises further questions about psychiatric diagnostic labels – can DSM-IV/ICD-10 criteria be effectively applied to extreme situations like those experienced in conflict and disaster zones?

The IMC is different. They deploy their mental health care services by using local knowledge to treat symptoms. They train the host country’s health care workers, so that when the IMC leave the disaster zone, there is a sustainable infrastructure for continuing care. Here´s more information on the IMC´s mental illness work.

The Effectiveness of Humanitarian Psychiatric Interventions

It appears that little work has been done by researchers to determine the efficacy of the most commonly used interventions in this field.

In October 2011, a group of doctors and academics, including Dr. Wietse Tol, Dr. Corrado Barbui, Ananda Glappatti, MSc, and Dr. Anne Golaz published a review of mental health and psychosocial support in humanitarian settings.

The review linked practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. They studied practice by reviewing reports of mental health and psychosocial support activities between 2007 and 2010; funding by analysis of the financial tracking service and the creditor reporting system between 2007 and 2009); and interventions by systematic review and meta-analysis.

In 160 reports, the five most commonly reported mental health and psychosocial support activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%).

Most interventions took place and were funded by organizations outside of the national mental health and protection service systems. The group used thirty-two controlled studies of interventions, 13 of which were randomized controlled trials (RCTs) that met the criteria for meta-analysis.

Two studies showed promising effects with regard to strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis because its definition varied too much across studies.

In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects after several interventions (psychotherapy and psychosocial supports). Meta-analysis of four RCTs failed to show an effect on the symptoms of children with PTSD (–0·36, −0·83 to 0·10), but a beneficial effect was caused by interventions (group psychotherapy, school-based support, and other psychosocial support) for internalizing symptoms (six RCTs; SMD −0·24, −0·40 to −0·09). Overall, the research and evidence reviewed focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little scrutiny.

An Expert in Humanitarian Mental Health Programs

Peter Locke studied humanitarian psychiatry and the politics of post-traumatic stress in Sarajevo, Bosnia-Herzegovina, under his mentor João Biehl. His PhD dissertation focused on how small psychosocial support organizations and their beneficiaries have survived, searched for resources, and adapted to the many challenges of everyday life after times of war and conflict.

Through his extensive fieldwork, Locke discovered how survivors’ experiences of psychological distress were shaped equally by the socioeconomic and political challenges of the present as by the traumatic events of the recent past.

“One role of anthropological research, I saw, was to open up the idea of trauma—to show all these other determinants that shape people’s mental health symptoms after a war,” explains Locke.

After finishing his doctorate, Locke worked as a postdoctoral fellow and then as a lecturer at Princeton, to develop a global health program for the institution.

For three years, he led undergraduate global health students to Sierra Leone every summer, to pursue research internships in collaboration with the medical humanitarian NGO Wellbody Alliance.

Locke and his students observed the deep poverty and limited public health infrastructure firsthand, as well as the deep distrust left by the fragmented aid projects of the colonial and postcolonial eras.

“The students, understandably, would come in with a lot of idealism about the possibilities of medical humanitarianism and their own immediate contributions,” said Locke. “I learned how important it is to help students transform natural disillusionment into a potentially lifelong commitment to the field.”

Locke’s position as Assistant Professor of Instruction at Northwestern University allows him to devote much of his time to building and delivering global health courses for undergraduates, including seminars on international public health, medical humanitarianism and war and public health.

Locke is also looking to develop a new undergraduate summer research program based in Bosnia in 2016. Students will have the opportunity to explore public health and mental health challenges in the aftermath of a war and the fall of Yugoslavia’s socialist political and economic order on the program.

Other Resources

For an interesting webinar on the subject of the role of psychiatrists in humanitarian settings, check out the webinar link on this page.

And for some interesting reading, check out this book on US Army Psychiatry in the Vietnam War.

Help With Getting onto a Residency Program

This fascinating field wouldn´t be the same without passionate physicians to bring new discoveries to light and perform much-needed humanitarian work in some of the poorest areas of the world. If you´d like to access this field but you need some help with your personal statement of purpose, you know where to find us.

Statements of Excellence for Residency & Fellowship Positions on Behalf of Applicants in Psychiatry

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