From Brain Drain to Brain Circulation: Initiative in Child and Adolescent Mental Health Training in India. Dr PORPAVAI KASIANNAN

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1 From Brain Drain to Brain Circulation: Initiative in Child and Adolescent Mental Health Training in India Dr PORPAVAI KASIANNAN

2 Areas of Primary Concern Magnitude of the burden of child and adolescent mental disorders is huge World-wide up to 20% of children and adolescents suffer from a disabling mental illness (WHR, 2000). Atlas: child and adolescent mental health services - WHO 2005 Countries with the largest proportion of children and adolescents are those that most lack specific CAMH policies, and lower-income, less developed countries have the fewest child and adolescent psychiatrists and other mental health professionals and the lowest availability of community mental health care. Only one out of the 100 gets some care and treatment. Around 90% of children with a mental health disorder are not currently receiving any specialist service. It is high time we reach out to 90% of the child population that is being unattended by any agency

3 Population 1.36 billion plus Prevalence of serious mental disorders 6.5% (70million) Total number of psychiatrists 3,500 to 5000 Number of psychiatrists per population 0.4 Number of psychiatric nurses per population 0.05 Number of psychologists per population 0.03 Number of social workers per population 0.03 Mental health budget 0.83% of total health budget WHO 2001

4 Population 24.6 million (2017) Around 3244 practicing psychiatrists (2016) Around 12% specialists from India (2011) More than 10 full time equivalent psychiatrists per 100,000 people

5 Brain Drain Tremendous demand for psychiatrists overseas Obstacles in setting up practice in India WPA task force 2006: Those who go overseas for training and fail to return after completing their studies; Those who go overseas for advanced training, return to work for some time after their studies and then emigrate; Those who train locally and emigrate after the completion of their programs or after working for a period of time

6 Push Factors Lack of research funding, poor research facilities, limited career structure, poor intellectual stimulation, Threats of violence and social turmoil, lack of good education for children, low remunerations, poor living conditions, Insecurities at work place, lack of clear career development paths, and lack of professional development opportunities WPA task force 2006

7 Pull Factors Targeted recruitment to fill vacancies in richer countries, Better remunerations and working conditions, Secure and conducive living conditions, Available employment opportunities, and opportunities for intellectual growth WPA task force 2006

8 Some possible solutions Brain drain to brain circulation Support for psychiatrists working in resource poor settings Barriers to overcome for emigrant psychiatrists Great examples Sangath Mental Health Action Trust Pathways Foundation Kovai

9 Pathways Foundation Kovai, Was Established in December 31, 2014 Registered as a charitable trust

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11 End of 2017-PG Certificate Course in CAMH

12 How did we go about it? Promoted the course through social media from October 2017 aiming for a minimum of 10 students We recruited 24 students Ten teachers including myself Three teachers based in India and others in Australia Initial classes in person, later via zoom Google classroom WhatsApp group

13 The course Involves twenty taught seminars on basic concepts and common issues/disorders Designed to include normal development, CAMH assessment including case formulation Questions after each class Assessments: Normal developmental observations Clinical assessment and case formulation Regular case discussions

14 Outcome 21 Students completed the course 1 dropped out 2 did not complete the course requirements 19 completed feedback forms

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16 Outcome Very good experience. learnt a lot about the psychological issues of children and the ways of effective parenting. all the teachers taught us very effectively. suggestions is clinical experience is needed for the students

17 Outcome It was a great experience, I gained more knowledge in child and adolescent mental health issues and it's causes. And also I gained more practical knowledge on how to observe the children and take a report, and the importance of past life history of the client...and the importance of interview in diagnosis. It would be glad for me, if you come with the advanced course on psychological treatment of child and adolescent mental health on detail. All our teaching staffs are excellent and gave us a splendid of information on their topics...i really enjoyed each and every class on gaining more knowledge.

18 Outcome It was a wonderful learning experience with excellent course content and dedicated teachers. Learning was an enjoyable experience here. Assignments kindled the curiosity for learning. Accreditation to university and classes on Sundays will promote the course further to postgraduate students of psychology, paediatrics, psychiatry etc. Early identification of mental illness in child and adolescence leading to the early intervention and treatment could pave way to a better quality of life with respect and dignity. This course will definitely take a further step in accepting mentally ill persons also to be part of our society protecting their rights and creating opportunities for a better life which they deserve. I assure you that I will be a part of this process. Thank you

19 Outcome The most important aspect of the course is the experience that you gain by Interacting with world Class faculty and the knowledge sharing. It has been a practise booster as I have better understanding and communication with children. Personally being a young parent, I have benefited a lot. The course has made me less judgemental and more receptive. I would recommend This course to everyone who are passionate in helping children one way or other.

20 Outcome It was a great learning experience in both professional and personal front. This course has been an eye opener to understand aspects of parenting, development of children and importance of mental health. It has definitely made a great impact on how I deal with children with problems. Dr Porpavai is so passionate about mental health and it is contagious. I am very happy for being a part of this course. It would be useful to have clinical sessions with supervision and also to witness a real time consultation of a patient by the teachers.

21 Challenges Technical issues Human resource issue Lack of clinical placements for students to practice TIME MONEY

22 Future Child and adolescent community service development More focused workshops Parent Training Program.