Mental disorders comprise three of the top 10 contributors to years lived with disability globally among those aged 15 years and over. The contribution is more pronounced in low- and middle-income countries (LMICs). 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 still occur frequently. In 2007, the Lancet Global Mental Health Series concluded that funding should be given to research that develops and assesses interventions that can be delivered by people who are not mental health professionals (task-shifting), and that assesses how health systems can scale up such interventions across all routine-care settings. In the US, global health research has become one of five NIH priorities and global mental health research is now an explicit NIMH priority. Despite recent calls for action and recognition as a high priority, international research collaborations focused on mental disorders in LMICs is limited. Further, formal NIH postgraduate training programs in GMH clinical research are not available. In partnership with Brazil, Nigeria and countries in Central Asia, this proposed program will provide training to the next generation of GMH scientists and will have a two-fold focus. The first is deployment-focused interventions research, such that fellows will learn to develop interventions geared towards deployment in resource poor areas. With community collaboration, fellows will be trained on adaptation and field-testing of tried and true interventions that directly address recognition, assessment, prevention and treatment. The second focus is intervention dissemination, implementation and services research, with fellows learning to examine how mental health prevention, assessment and treatment interventions can be translated for utilization in specific LMIC settings. The Global Mental Health (GMH) Research Training program will include eight components: (1) mentorship; (2) didactic courses in clinical research design, statistics, special topics, grant writing; (3) specialized training in GMH; (4) participation in research, including design, execution and analysis of studies and submission of scientific papers, reviews and proposals; (5) hands-on research experience in task-shifting and other access- enhancing strategies through design and implementation of their own pilot projects; (6) instruction in the responsible conduct of research; (7) presentation at scientific meetings; and (8) interchange with Columbia faculty, our Global partners, and distinguished researchers in the field. This program will leverage existing programs and facilities at Columbia University and international sites to provide a rich learning environment so that fellows are steeped in a milieu focused on the scientific endeavor of promoting mental health locally and worldwide. Because underserved populations are sadly abundant in the US, this training program will also teach young investigators the necessary skills to implement research protocols that can lead to the closing of the mental health care delivery gap in this country as well.
People in Low and Middle Income Countries do not receive proper mental health care. This Global Mental Health Research Fellowship will train scientists to enhance access and implementation of effective and feasible mental health interventions that are adapted to each country's culture and context, making more efficient use of less specialized human resources available in various systems of care., U.S. repercussions too are of import, given the lack of services available in low resource areas in our country.
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