Home > Publications > 4 Zanmi Lasante Severe et al General Practitioners

Brief presenter biography: Dr. Jennifer Severe graduated from Medical School at the University d’Etat d’Haiti. As a generalist physician, she worked with Partners In Health for four years managing the HIV program in Haiti’s Central Plateau and started PIH’s projects in Elias Piña, Dominican Republic before joining the Zanmi Lasante mental health team. She has worked on various quality improvements initiatives and various researches projects, including an NIMH-funded school-based research to implement mental-health interventions in schools in Haiti’s Central Plateau.

TITLE OF PRESENTATION:

General practitioners as mental health providers in Haiti’s Central Plateau and Artibonite Departments 

PRESENTERS:

Jennifer Severe, MD; Reginald Fils-Aime, MD; David J. Grelotti, MD

Presenter: Jennifer Severe, MD

Professional Title: Physician, Mental Health Team, Zanmi Lasante, Haiti; Dr. Mario Pagenel Fellow in Global Mental Health Delivery, Partners In Health

Organization: Zanmi Lasante (Haiti)

Complete Mailing Address:2 Grandoit, Delmas 75, Port-au-Prince, Haiti

Email Address:jsevere@pih.org

Phone Number:

Haiti: +509-38157447

US: 857-205-9110

Brief presenter biography:Dr. Jennifer Severe graduated from Medical School at the University d’Etat d’Haiti. As a generalist physician, she worked with Partners In Health for four years managing the HIV program in Haiti’s Central Plateau and started PIH’s projects in Elias Piña, Dominican Republic before joining the Zanmi Lasante mental health team. She has worked on various quality improvements initiatives and various researches projects, including an NIMH-funded school-based research to implement mental-health interventions in schools in Haiti’s Central Plateau.

Additional Presenters

2) Reginald Fils-Aime, MD

Professional Title: Medical Director, Mental Health Clinical Team, Mirebalais Hospital, Mirebalais, Haiti; Dr. Mario Pagenel Fellow in Global Mental Health Delivery, Partners In Health

Organization: Zanmi Lasante (Haiti)                                                                      Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti

Email Address: rj.filsaime@gmail.com                                                                       Phone Number:

Haiti: +509-37017431                                                                                                                      US: 617-835-1892                                                                                                                      Brief presenter biography: Dr. Joseph Reginald Fils-Aime graduated from medical school at the Universite d’Etat d’Haiti. He initially worked at Zanmi Lasante since 2009 as a general practitioner, then as the manager of the Multi-drug Resistant Tuberculosis Program at Cange. Currently he is the Medical Director of the mental health program at Zanmi Lasante. 

3) David J. Grelotti, MD
Professional Title: Clinical and Research Psychiatrist and Research Fellow
Organization: Partners In Health and Harvard School of Public Health
Complete Mailing Address: Partners In Health, 888 Commonwealth Ave, 3rd Floor, Boston, MA 02215
Email Address: dgrelotti@pih.org
Phone Number: 617-998-8922
Brief Presenter Biography: Dr. Grelotti completed medical school at The Johns Hopkins University School of Medicine and residency training in adult psychiatry and child and adolescent psychiatry at Harvard Medical School. He was the first Pagenel Fellow in Haiti at Partners In Health and Harvard Medical School and provided near full-time support to the Zanmi Lasante mental health team between July 2011 and June 2012 in Haiti’s Central Plateau and Lower Artibonite. Now splitting time between Partners In Health and the Harvard School of Public Health, Dr. Grelotti conducts global mental health research and continues to support mental health capacity building at Zanmi Lasante and Partners In Health Lesotho.

MODE OF PRESENTATION

Panel presentation:  Friday June 07, 2013 (45- to 50-minute long)

ABSTRACT

Background:

Following the 2010 earthquake it was recognized by ZL that Haitian physicians receive little training in mental health service provision, and that there is a lack of specialized providers for mental health care. The importance of training generalist physicians to manage mental disorders in collaboration with other providers—psychologists, social workers, nurses, and community health workers—was also recognized. Health providers who have not previously had roles in mental health care provision have been engaged to evaluate and care for a large number of patients with complex, acute and chronic psychiatric conditions in Haiti’s Central Plateau and Artibonite Regions, serving a catchment area of approximately 1.5 million people.

Methods:

Following the 2010 earthquake a number of physicians at ZL were initially trained in the identification and management of mental disorders and their treatment. Over time it was recognized that a small cadre of generalist physicians with more experience in mental health service provision would benefit the health care system as a whole. To facilitate the development of mental health services in a sustainable way, ZL developed a model effectively harnessing the capacity of general physicians functioning as specialized psychiatric providers within the context of a multi-disciplinary team. These physicians carry the responsibility for evaluating patients presented to the hospital and clinic, mobile clinic visits, collaborative care with psychologists and others care providers, psychopharmacology for mental disorders, management of epilepsy, and the training of other physicians. They have received ongoing supervision from foreign specialists, either in person or remotely by phone and by email.

Results:

These trained generalist physicians function as effective and valuable members of a multidisciplinary mental health program at ZL. They have taken a central role not only in the provision of vital mental health services, but also in program management, quality improvement and teaching efforts. Mental health care provision has been integrated as well into family practice residency training of generalist physicians at several ZL hospital sites. The role and training of generalist physicians in mental health care is now being more fully articulated though the development of well-defined curricula for physician training and practice. The supervision model has been effective in improving the knowledge of the generalist physicians working in the mental health team.

Conclusions:

Generalist physicians are effective in providing a range of mental health services as part of a multidisciplinary team. Having generalist physicians in such roles not only fills a critical service delivery gap, but it also helps to reduce stigma regarding mental disorders within the medical system. This intervention benefited from and nurtured an invaluable collaboration with foreign educational institutions and close supervisions and trainings both on site and remotely.

BRIEF DESCRIPTION OF SESSION

In Haiti’s Central Plateau and Artibonite Departments Zanmi Lasante has mobilized general practitioners as mental health providers as part of a collaborative system of care that includes psychologists, social workers, nurses and community health workers. Generalist health providers have been engaged to evaluate and care for a large number of patients with complex, acute and chronic psychiatric conditions, including through psychopharmacology for severe mental disorders, management of epilepsy, and the training of other physicians.

LEARNING OBJECTIVES

1) Generalists physicians can serve as essential providers in task-sharing and the development of sustainable, community-based mental health systems of care in Haiti

2) Generalist physicians’ remote trainings and supervision are as effective as on-site for mental health care provision

3) Having generalist physicians who provide essential and effective mental health services serves to reduce stigma toward mental disorders within the medical system.

TARGET AUDIENCE

 

Mental Health Providers
Medical Providers
Educators/School Administrators
Paraprofessionals
Policymakers/Legislators

Legal/Juvenile Justice Personnel
Administrators
Students
Faith-Based Organizations
Community Leaders
General Public

Other

KNOWLEDGE LEVEL: Introductory (useful for professionals/students new to this field, or non-mental health professionals)

AUDIO VISUAL EQUIPMENT: LCD Projector/Computer