A US PSYCHIATRY RESIDENT'S PERSPECTIVE OF TELE-PSYCHIATRY SUPERVISION OF MENTAL HEALTH PROVIDERS IN LIBERIA

Abstract

Introduction Liberia, a West African country, has a population of 4.6?million and an annual GDP per capita of $352. Liberia suffers from a devastating shortage of mental health providers with only one psychiatrist and one mental health hospital in the country. Mental health services are largely provided by nurses and midwives with a 6-month graduate training in mental health at the Carter Center. After graduation, no supervision or continued education is offered.In 2016, the Global Mental Health program at the Icahn School of Medicine at Mount Sinai started a tele-supervision program in Liberia. Nine senior psychiatry residents provided clinical supervision to 9 Liberian mental health clinicians (MHCs). Each resident had a faculty mentor to discuss cases when needed. The Icahn School of Medicine at Mount Sinai provided the teleconferencing equipment, including 9 Internet hotspots and 9 laptops. Methods A psychiatry resident's perspective with the program is discussed with focus on challenges met and rewards achieved. Results The challenges faced include:1- Wifi connection issues: Out of 16 scheduled supervision sessions, only 8 were held over 8 months course due to Wifi connection issues that were not easily resolved.2- Language (accent) barrier: due to my partner's heavy accent in English, we decided to communicate through texting on Vsee instead of direct video conferencing.3- Very limited psychiatric medication options: Only 6 medications were available in my partner's facility: Haldol, Chlorpromazine, Carbamazepine, Amitriptyline, Imipramine, and Valium.4- Deficient presentation of cases: Despite having good clinical knowledge, my partner's presentations usually missed sufficient DSM-5 diagnostic criteria as well as proper screening for relevant differential diagnoses.The primary rewards included:1- Tangible improvement in confidence in managing cases was reported by MHCs. The program received a recognition letter from the Liberian Ministry of Health.2- Gaining appreciation of the huge gap in mental health services in Liberia as an example of low-income countries. It was a gratifying experience providing assistance to a much-needed population.3- The opportunity to be innovative in treating mental illness using very limited resources. Gaining a greater degree of familiarity with older mental health medications was a major plus.4- Obtaining the skills of using tele-psychiatry as a tool to improve mental health services in low-income countries. Conclusions Despite multiple challenges, tele-psychiatry supervision is a promising strategy in training local mental health providers in low-income countries. This type of intervention offers a very rewarding training experience in psychiatry. Future research on the objective effectiveness of such programs is warranted. This research was funded by: Laptops provided by Mount Sinai School of Medicine. No other funding received