PALOP (Paises Africanos de Lingua Oficial Portuguesa) Mental Health (MH) Implementation Research Training Program. Globally, mental disorders remain 3 of the top 10 contributors to years lived with disability among those over age 15. This is even more so in low- and middle-income countries (LMICs) such as Mozambique;over 75% of those with mental disorders in LMICs receive no care despite substantial disability, and where treatment is provided, it is rarely based on evidence-based practices and human rights violations occur frequently. The Lancet Global MH Series (2007) concluded that "funding should be given to research that develops and assesses interventions that can be delivered by people who are not MH professionals (task- shifting), and... assesses how health systems can scale up such interventions across all routine-care settings." Sadly, international research collaborations focused on MH in LMICs are limited and no Fogarty or NIH training programs in MH implementation research are yet available in any LMICs. Partnering with Universidade Eduardo Mondlane (UEM) and in alliance with Universidade Federal de Sao Paulo (UNIFESP) and the Vanderbilt Institute for Global Health (VIGH), we propose a program in Mozambique with a North-South and South-South collaboration that will train the next generation of PALOP MH implementation scientists in a 2- year fellowship. The program will have two foci: A) Deployment-focused interventions research: With community collaboration, fellows will learn adaptation and field-testing of tried and true interventions that address access, valid assessment, effective prevention and treatment;and B) Intervention dissemination, implementation and services research: Examining how care can be scaled-up within Mozambique's newly expanding system of MH care. Mozambique is an ideal setting given its new strategic plan for MH care developed by our partner UEM with the Ministry of Health (also collaborators) and the recent implementation of an innovative training program for psychiatric technicians to deliver non-specialist care. The program's components will be: 1) mentorship;2) didactics in research design, statistics, and grant writing;3) interventions research training;4) participation in design, execution and analysis of research and submission of scientific papers/proposals;5) hands-on research experience in task-shifting, stepped-care and access-enhancing strategies through design/implementation of pilot projects;6) instruction in responsible conduct of research;7) presentation at scientific meetings;and 8) interchange with New York State Psychiatric (NYSPI)/Columbia University and UNIFESP faculty and distinguished researchers in the field. Mozambique can be a model to other PALOP and sub-Saharan African countries as well as other low-resource settings, including the US. This program will leverage 8 existing fellowships at NYSPI, including a T32 Global MH implementation fellowship, and scholarships from UNIFESP to cultivate a rich learning environment that will immerse fellows in a milieu focused on fostering MH locally, regionally, and globally.
A Mental Health Implementation Research Training Program will prepare scientists to develop effective and feasible mental health interventions that are adapted to a specific culture and context, making more efficient use of less specialized human resources available in various low-resource systems of care. In Mozambique, an expanding mental health service infrastructure will require evidence-based interventions capable of reaching those often excluded from care. As a clear leader in the Portuguese speaking African countries (PALOP - Paises Africanos de Lingua Oficial Portuguesa), Mozambique can be a model to other PALOP and sub-Saharan African countries as well as other to low-resource settings, including the US, and thus help decrease the global mental health treatment gap.