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| AWARD PAPER/ORATION |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 36-41 |
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Novel Approaches to Community-Based Psychoeducation to Improve Mental Health Awareness in Diverse Settings
Atasha Jordan1, Kristin Nguyen2, Maria Bernadett Carandang3, Wydad Hikmat4
1 Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
2 Department of Psychiatry, University of California, San Francisco, California, USA
3 Batangas Medical Center, Batangas, Philippines
4 Kelaa Sraghna Psychiatric Hospital, Ministry of Health, Morocco
| Date of Submission | 10-Mar-2023 |
| Date of Acceptance | 11-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Atasha Jordan
3535 Market Street, 2nd Floor, Philadelphia, Pennsylvania 19104
USA
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_10_23
Background/Objectives: The authors are early career psychiatrists practicing worldwide who aim to increase access to mental health care and reduce associated stigma by utilizing culturally informed psychoeducation-based programs tailored for nontraditional communities. Methods: The authors chose four distinct communities to provide mental health psychoeducation, including churches in Philadelphia, a fandom group in the Philippines, nonpsychiatric healthcare workers in Nepal, and families of patients in Morocco. Results: Dr. Atasha Jordan founded the Christian Mental Health Initiative to improve mental health outcomes of Christians in the US and the Caribbean; in a pilot study (n = 29), the research team used Mental Health First Aid to increase mental health care literacy and mental health care utilization in Black Churches. Dr. Bernadett Carandang co-created Hallyu Wednesdays, an online fandom-based mental health group that meets weekly to explore mental health topics through Korean media and provide online safe spaces for their community. Dr. Kristin Nguyen, as part of the Health, Equity, Action, Leadership (HEAL) global mental health fellowship program, co-created psychoeducational videos on burnout and ways to mitigate it for the staff of a hospital in rural Nepal that can be disseminated to other Nepali healthcare workers. Dr. Wydad Hikmat implemented a family psychoeducation program, Profamille, for caregivers and families of patients with psychosis, leading to improved mood and coping strategies for patients. Conclusions: All four psychoeducational interventions used innovative approaches to addressing mental health challenges and promoting mental wellness among diverse populations worldwide.
Keywords: Community capacity building, community-based psychoeducation, cultural psychiatry, innovations in psychoeducation, mental health awareness, social psychiatry
How to cite this article:
Jordan A, Nguyen K, Carandang MB, Hikmat W. Novel Approaches to Community-Based Psychoeducation to Improve Mental Health Awareness in Diverse Settings. World Soc Psychiatry 2023;5:36-41 |
How to cite this URL:
Jordan A, Nguyen K, Carandang MB, Hikmat W. Novel Approaches to Community-Based Psychoeducation to Improve Mental Health Awareness in Diverse Settings. World Soc Psychiatry [serial online] 2023 [cited 2023 May 29];5:36-41. Available from: https://www.worldsocpsychiatry.org/text.asp?2023/5/1/36/374611 |
| Introduction | |  |
Mental illnesses are among the leading causes of disease burden worldwide, with no recent evidence of reduction.[1] Pervasive stigma is the most cited barrier to mental health care, regardless of socioeconomic status. It affects care-seeking behavior, community support, capacity building and resource allocation, and disease prevention.[2],[3],[4],[5] Systematic reviews have inconclusive findings regarding effective stigma prevention programs. However, psychoeducation focused-interventions[2],[3] and partnering with nontraditional communities show potential.[4],[5],[6]
Families, faith-based communities, community mental health advocates, and mental health providers are the examples of nontraditional communities in community-based participatory research. With this model, participation from doctors, patients, advocates, and other stakeholders help researchers understand their study populations.[7] As shown in [Figure 1],[8] the multiple concentric circles of ecodevelopment have nontraditional social groups that have dynamic effects on stakeholders. By identifying unique communities within the eco-developmental model with the potential for psychosocial intervention, the authors created culturally-informed psychoeducation-based programs tailored for each community.
The communities selected for this article are as follows:
Religious groups
Christian Mental Health Initiative (CMHI) is a nonprofit organization in Pennsylvania, United States of America (USA) that provides faith-based, capacity-building psychoeducation programming to meet the mental health needs of Christian communities.
Fandom
The Hallyu Wednesdays (HW) mental health group is an online fandom-based community that conducts psychoeducation programs delivered in the context of Korean media.
Nonpsychiatric healthcare workers
The Health, Equity, Action, Leadership (HEAL) global mental health fellowship program in Nepal developed the visual methods of teaching burnout to improve nonpsychiatric health-care workers' competencies in addressing the condition.
Family
The Profamille program in Morocco tapped patients' families for active participation in the treatment and long-term care and utilized group therapies to improve coverage of health-care delivery.
Empowering Faith-Based Communities with Mental Health Knowledge in Philadelphia, Pennsylvania, USA
Atasha A. Jordan, MD, MBA
| Mental Health Knowledge and Training in Black American Churches | | |
According to the Pew Research Center, almost 80% of Black Americans – roughly 30 million people – identify as Christian.[9] Black Christians often seek counsel from church leaders rather than mental health clinicians in times of psychological distress.[10] Many church leaders are trained in seminary to support their members' spiritual development, but seminary and theology programs that include mental health training are in the minority.[11] There are mental health materials such as the American Psychiatric Association's Mental Health: A Guide for Faith Leaders.[12] However, there are no standardized means of training faith leaders about mental health in the United States.
| Addressing Gaps in Mental Health Knowledge and Resource Utilization in Philadelphia's Black Churches | | |
The CMHI is a social psychiatry-oriented nonprofit organization based in Pennsylvania in the USA. CMHI serves a research and community-based mission to improve the mental health outcomes of Christians in the United States and the Caribbean. The CMHI research team recognized that data indicate that higher religiosity could be associated with the lower use of traditional mental health services among African-American.[13] Thus, the research team created a pilot study to assess the impact of Mental Health First Aid (MHFA) on the mental health knowledge, behaviors, and attitudes of leaders and attendees at two predominantly Black churches in Philadelphia, Pennsylvania.
MHFA is a globally recognized, evidenced-based mental health training offering participants a 3-year certification as a Mental Health First Aider after 8 h of manual training.[14] This psychoeducational intervention has been well-studied in diverse populations, including the military, secondary education, and first responders.[15] However, as of this writing, there is only one published study on the use of MHFA in the church.[16] The CMHI research team seeks to understand the impact of MHFA on the mental health knowledge, behaviors, and attitudes of Black church leaders and members in Philadelphia. The team recruited members and leaders from Brethren/Gospel Hall churches to participate in the MHFA training. Participants also completed pre and postintervention surveys about mental health knowledge, behaviors, and attitudes. Postintervention data collection is still underway, and the CMHI research team aims to publish the results of this pilot when data collection and analyses conclude. Based on the efficacy studies of MHFA in other vocational and minoritized populations, the researchers hypothesize that participants in this CMHI MHFA pilot study − Black church leaders and members − will report increased self-reported knowledge of mental illness and an increased self-reported likelihood to refer other community members to mental health resources.
Ultimately, this MHFA pilot aims to empower Philadelphian Black church leaders and members to address the mental health needs in their communities. Moving forward, the CMHI research team will conduct semi-structured interviews with participants to assess implementation facilitators and barriers in the ongoing utilization of MHFA in Black churches in the United States.
Fandom-based Approach to Mental Health: The Hallyu Wednesdays Experience
Maria Bernadett P. Carandang, MD, DSBPP
| Fandoms-A Transcendent Social Unit | | |
Fandoms are social groups created through an affinity for a pop-culture object with whom members have a strong parasocial connection.[17] Existing both online and off, fandom communities have widespread reach and have become a coping resource mechanism for many of their members.[18] Members are noted to be highly emotionally connected to their fandom, with participation evolving throughout their life course.[19],[20],[21]
During the pandemic, the Internet became a readily available-if not the primary-resource for social connectivity, gaming, posting, and other activities that can mitigate feelings of low self-esteem and poor life satisfaction in the outside world.[22] With social media's interest-based algorithm and structures, digital fandom consumption has become a stronger coping resource.[23] Concurrently, mental health-care delivery and resources rely heavily on digital platforms. As such, fandoms, especially those with a strong online presence, can be harnessed for mental wellness by using them as a vehicle for psychoeducation. Fandoms can be a safe space for self-exploration and a venue for community fellowship – if directed intentionally. This fandom-based approach to mental health can transcend beyond physical boundaries and is only limited by current technology.
| Fandoms as Safe-Spaces | | |
This theory of a fandom-based approach to mental health was applied to HW, a mental health group in the Philippines. Despite the relatively lessened stigma resulting from the Mental Health Law and the pronounced psychological impact of the pandemic, a gap remained in the psychoeducation of the general community. Having the 11th largest digital population as of January 2022 makes Filipinos ideal for interventions based on social media.[24] Hence, HW developed a social media-based community that creates and curates different fandom content (i.e., memes, fan covers, and fan-made merchandise) with the intention of promoting mental health concepts.
The flagship project is the Wednesday group sessions conducted through Zoom. The main goal is to create a safe space for psychoeducation, self-reflection, and community. Topics covered in the 42 sessions in 2022 included positive psychology, Jung's map of the soul, burnout, etc., Participants discussed these mental health topics through popular Korean cultural phenomena, such as songs by the popular Korean pop boy band BTS and Korean dramas. Participants were predominantly female, aged 20–65, and with different occupations. Breakout rooms were strategically placed within the sessions for individual sharing, and a group forum was done at the end to harmonize the understanding of the topic.
HW also participates in advocacy-based activities, allowing its community members to participate and sublimate. HW projects and partnerships aim to support the United Nations Sustainable Development Goals, inspired by BTS' work with UNICEF and the United Nations. Other fandom-based groups who engage in similar activities are featured on the HW social media platform, thereby encouraging positive modeling within the fandom.
With this platform, HW uses a fandom-based approach to mental health to create safe spaces for its participants, whether online or in real life.
Implementing Educational Videos and Multidisciplinary Discussions to Teach Health Care Providers in Rural Nepal about Burnout and Solutions
Kristin Nguyen, MD
| Introduction to a Rural Hospital in Nepal where Staffing Issues Lead to Burnout | | |
As part of the HEAL global mental health fellowship program, fellows can live and work in a rural town in Nepal, where they are the only psychiatrist in the hospital. This outreach hospital is a 5-h treacherous jeep ride from the capital of Kathmandu. Many Nepali staff members who work there are not from the town and are far from family. The medical residents do not have any work-hour restrictions. Three medical officers (equivalent to interns in the US system) cover the hospital – one covers the busy urgent care model clinic, one has a 24-h shift in the emergency room, and one has the day off after working the emergency room shift. When one medical officer is away for vacation or exams, the postcall day off is gone, and the medical officers go from working a 24-h shift to working all day in the clinic to the next 24-h ER shift. When asked if they were feeling burnt out, they did not understand this term, despite exhibiting classic signs and symptoms of burnout.
| Burnout is a Major Issue in Nepal | | |
Healthcare provider burnout is a major issue in Nepal, yet many healthcare workers in Nepal have not learned about this concept, its consequences, and how to manage it.[25],[26],[27],[28] Nepal already has a critical shortage of health-care providers,[29] and providers are leaving the profession or dying from suicide due to burnout.[30] The COVID pandemic has exacerbated the situation. The prevalence of burnout among doctors (72.4%), resident doctors (42.4%), and medical students (48.8%–65.9%) has been studied in Kathmandu.[25],[26],[27],[28] The World Health Organization describes three features of burnout: feeling exhausted, feeling like one's work does not make a difference, and caring less about work or other people at work.
| Implementation of Burnout Materials | | |
A proof of concept study was conducted on knowledge and attitude on burnout using pretest and posttest questionnaires, followed by educational videos on ways to ameliorate burnout. The first video educated viewers on burnout as they followed a character named Dr. K as he went about his day at the hospital. The other videos explained burnout mitigation strategies. One video led viewers through deep breathing exercises to alleviate anxiety, and the other video showcased behavioral activation to reduce the feelings of depression. All types of staff members watched the videos, including physicians, nurses, physical therapists, dentists, pharmacists, lab technologists, radiographers, health assistants, and public health officers. To increase understanding, the HEAL team translated videos into Nepali audio with English text.
The videos were supplemented with discussions and experiential learning activities, such as practicing deep breathing techniques. There was also an emphasis on how, while the learners were taught what burnout is and individual-level ways of reducing burnout, system-level changes also need to be addressed.
| Hope for the Future | | |
Finally, mental illness is still highly stigmatized in Nepal.[31] The hope is that if health-care providers have more insight into their struggles and seek help for themselves and their colleagues, they will also develop more empathy and therapeutic skills for their patients going through similar issues.
Addressing the Mental Health Crisis in Morocco: The Role of Group Therapy and Family Psychoeducation in Improving Access to Quality Care
Wydad Hikmat, MD
| Morocco's Mental Health System in Crisis | | |
Mental health professionals are scarce in Morocco, as in many other countries. According to the latest survey by the Ministry of Health, Morocco has only 219 psychiatrists in the public sector, where patients with limited resources seek medical care.[32] This ratio of 0.84 psychiatrists per 100,000 people falls far below the recommended minimum ratio of one psychiatrist per 8000 people.[33] Such a shortage of mental health professionals raises concerns about the availability and quality of mental health services.
Due to a lack of funding and resources,[32] the availability of psychiatrists and other mental health providers in Morocco is particularly difficult. This is compounded by the stigma associated with mental illness.[34] To overcome these difficulties, evidence-based practices should be implemented to improve the availability and quality of mental health services in Morocco.
| Strength in Numbers: How can Group Psychotherapy Address the Shortage of Mental Health Professionals | | |
Providing psychotherapy in group settings can be an innovative approach to tackling the shortage of mental health professionals.[35] By offering group therapy sessions, psychiatrists can treat more patients at once, making the best use of their time and resources.[36] In addition, group therapy has been shown to have numerous benefits for patients, including increased social support and a sense of community, as well as improved coping skills and overall mental well-being.[35] Some of the group and evidence-based interventions the team implemented in Morocco are family psychoeducation, cognitive-behavioral therapy, and metacognitive training for psychosis.[37]
| Family Psychoeducation: A Highly Effective Yet Under-Implemented Approach | | |
Family psychoeducation is an evidence-based practice that effectively reduces the mental illness burden on families and patients.[38],[39],[40] This modality involves educating family members about the illness, teaching coping skills, and providing emotional support. Family psychoeducation has been implemented in Morocco using Profamille, a family psychoeducation program for caregivers and families of patients with psychosis. It is the most widely used program in French-speaking countries and the only psychoeducation program globally proven effective in reducing suicide risk.[41]
Profamille was first launched in Morocco in 2012 in Casablanca with a few families.[42] Since then, it has grown in popularity, and there are currently seven active Profamille centers throughout Morocco. After 6 months of implementing Profamille, Dr. Hikmat and her team observed a statistically significant improvement in the participants' moods as measured by Center for Epidemiologic Studies Depression Scale scores. The team also observed improved knowledge and coping strategies among participants and improved patient compliance and functioning. Further details of this study will be published in an outcomes paper. Dr. Hikmat and her team aim to translate Profamille into Arabic to reach more Arabic-speaking families in Morocco and around the world.
| Conclusions | | |
The four psychoeducational interventions discussed in this paper present innovative approaches to addressing mental health challenges and promoting mental wellness among diverse populations worldwide. They include empowering faith-based communities with mental health knowledge, using fandom-based groups to create safe spaces for mental health exploration and positive modeling, alleviating burnout through educational videos and multidisciplinary discussions, and implementing group therapy and family psychoeducation interventions to tackle the shortage of mental health professionals.
The success of all these interventions highlights the importance of creating customized solutions considering each population's unique needs and contexts. Furthermore, these interventions underline that mental health challenges and the shortage of mental health professionals are global issues that require creative solutions. By harnessing the strengths and resources of communities and implementing evidence-based interventions, we can create a more equitable and accessible mental health system. Ultimately, investing in mental health is essential for the well-being of individuals and society.
The paper aims to emphasize the importance of psychiatrists globally communicating their challenges, working together to create solutions, and implementing creative, culturally sensitive, and evidence-based interventions. Furthermore, these interventions offer a positive perspective that innovative approaches to psychoeducation have the potential to successfully address mental health concerns and improve overall mental wellness worldwide.
Acknowledgments
The authors would like to thank:
- Dr. Rachel Talley, MD; Dr. Kimberly Arnold, PhD, MPH; Jennifer Jolivert, BS
- Dr. Eva Studer; Dr. Tula Gupta; Dr. Rajkumar Dangal; Dr. Bibhav Acharya; Karuna Khadka; Shailina Shrestha
- Julianna Maria E. Garcia; Jenny Lind A. Rubio, Project Steady Asia.
- Yann Hode MD, PhD, Prof. Yasser Khazaal.
Financial support and sponsorship
The study was funded by:
- APAF/SAMHSA Minority Fellowship; Penn Psychiatry Department R25 Grant
- University of California, San Francisco HEAL Global Health Fellowship
- Hallyu Wednesdays.
Conflicts of interest
There are no conflicts of interest.
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