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Training of trainers vital

by Dr. Nalaka Mendis

On the occasion of the World Mental Health Day I am very happy to share with you the very deep sense of satisfaction that we at the National Council for Mental Health (Sahanaya) feel at a very important development in mental health care in Sri Lanka.

I refer to the successful launch of a project, which was conceived more than six years ago and developed with the help of a large number of people to address some of the emerging mental health problems of individuals, families and communities in Sri Lanka.

The National Council launched its latest development activity with the establishment of the "Sahanaya Institute of Mental Health" at a tranquil setting in Bolgoda, Gorakana to provide training in mental health care. This carefully designed Institute complete with lecture halls, discussion rooms, information and communication center, recreational areas, residential facilities and many other essential modern facilities will service forty residents and seventy day trainees at a time.

The library and the information center of the Institute are in the process of being developed. Key personnel have been recruited and further recruitment and development of staff are under way. The project costing sixty five million rupees was funded by public donations and contributions from the corporate sector and other agencies including the President's Fund.

The activities of the center was initiated on July 26 with an academic session attended by a large number of local and foreign mental health professionals including Dr. Michael Shooter the immediate past President of the Royal College of Psychiatrists and Dr. Angelo Barbato the President of the World Association for Psychosocial Rehabilitation.

The main aim of Sahanaya is to train a wide range of personnel, including doctors, non medical mental health professionals, primary health care workers, teachers, social welfare officers, community leaders, care givers and religious leaders in mental health care.

The training is intended to impart the necessary competencies to identify, care, support and refer to appropriate services when necessary for those suffering from distress, disability and effects of disaster. In addition the center plans to develop a mental health information and education center for the public.

Approach of Sahanaya Institute

Sahanaya Institute plans to develop innovative service models to respond to the emerging needs of people with mental health problems. In this respect the Institute will address the full range of mental health issues including the needs of those with mental health problems, capacity building, institutional mechanisms necessary to respond to needs, mobilisation of resources and developing partnerships in a globalising world. The Sahanaya Institute intends to implement projects of national importance and these are expected to benefit a cross section of the society.

Clearly such projects could not be funded only by charitable donations of benefactors. Therefore in order to sustain such projects (those producing public goods) an attempt will be made to mobilise funds from the government or other donor agencies. Funds for services for the individuals and private agencies will have to be borne by them. Sahanaya plans to establish a trust fund to subsidise the costs of the future programs.

Psychosocial Care Project

The first project of the new Institute was initiated a few weeks ago and is aimed at enhancing the capacity of workers of the general health and other human services as well as the system at the district level to respond to psychosocial needs of the community.

The activities of the project include a. Training of personnel including primary health care workers, teachers, social welfare officers, community leaders in mental health and psychosocial care at the Sahanaya Institute at Gorakana. b. Facilitating and supporting continuously the activities of the above group in the field through the District Resource Centre, which has been established for the purpose.

It is important to understand the rationale for the development of this project. The traditional health and mental health services do not meet most of the needs of a large number of people experiencing distress, disability and disaster, which amounts to over ten percent of the general population.

This group includes those suffering from the effects of trauma, distress, mental illness and disability, dependence producing substances such as alcohol, deprivation, poverty, violence and social strife. The burden resulting from these conditions to the individual, family and the society are enormous.

General workers such as primary health care workers, teachers, social workers and other community workers in their daily routine come across people with such problems.

It is well known that the interventions of generic workers and communities could minimise these psychosocial problems in individuals in many ways.

Recognising people with such problems, advising them, referring them to appropriate special services, facilitating the development of new services, providing social care, and family support are some of the interventions that the generic workers could carry out. Unfortunately the generic workers, though possessing the potential for such interventions, do not necessarily have the required skills and the institutional facilities.

This project intends to address some of the above inadequacies of the system. The project has the blessings of the Health, Education, Social Welfare and Public Administration ministries and is supported at provincial and district level administration.

Activities and implementation of project

One component of the project is "training of trainers" and this activity termed Child and Family Resilience Project is a result of a partnership between Sahanaya, public agencies, expert groups and a funding agency.

The professional expertise for training in this project comes from The Israel Trauma Coalition in collaboration with the Israel Ministry of Health, UJA Federation of New York and Ben Gurion University of Israel. Trauma related psychosocial issues are the major emphasis of this program.

The project was initiated on September 12. Most participants came from the Kalutara district with a few from south and eastern provinces.

The prospective trainees have been selected by their superior officers on the understanding that these workers will be given the opportunity to make use of the skills gained during training to train a further group of workers and provide services.

Already nearly 250 trainees (doctors, nurses, teachers, social workers, police and others), have been exposed to the five-day orientation course. Apart from classroom teaching trainees have been given an opportunity of hands on training.

Following the orientation course a group of 100 will be selected as "expert trainers in psychosocial care" for a further period of intensive training. After successful training this group will be given basic teaching materials and funds to conduct new training programs for a new group of trainees in their work place.

The second component of the project is the establishment of the District Resource Centre at Kalutara, which will facilitate the activities of these special trainers who graduate from the project by providing continuing training and coordinating district services.

A centre has already been established in Kalutara on premises donated by the Bodhi Trust and is manned by two professionals. This centre in addition to coordinating the selection of candidates for the training programme will monitor and facilitate post training activities.

The Jewish Distribution Committee of New York funds the educational component of the project and the relevant Ministries and Sahanaya fund other components. World Health Organisation has supported a number of activities related to the project.

Sahanaya Institute, the result of a collaborative effort The credit of this initiative goes to all those who have been associated with Sahanaya as well as many others for giving the necessary inspiration, support and assistance to make this project a reality.

A special appreciation goes to former President of Sahanaya late Dr. Jayantha Kelegama who served Sahanaya with great commitment and dedication for over a decade. Mr. Ken Balendra who worked very hard to make this project a reality by mobilising funds and making a substantial personal contribution deserves our gratitude. Dr. Tara de Mel has supported our activities at crucial moments.

Professors Itzhak Levav and Mooli Lahad from Israel worked very closely with me to initiate and develop this project following the tsunami. The fact that Sahanaya, since its inception in 1982, has been able to contribute a great deal towards the development of mental health is an indication of the dedication and hard work of all those who have been associated with this organisation.

I am confident that the Sahanaya Institute of Mental Health and the National Council for Mental Health (Sahanaya) together will be able to successfully work towards achieving their common objectives of developing mental health in Sri Lanka.

The writer Dr. Nalaka Mendis is the Professor of Psychiatry University of Colombo, President of the National Council for Mental Health and Director Sahanaya Institute of Mental Health.

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