RAND Study Recommends Extensive Mental Health Training for Health Providers in Conflict-Affected Countries

Extensive training in mental health services can better prepare primary healthcare providers to treat people traumatized by widespread violence in developing nations, according to a new RAND Corporation study.

The RAND study makes recommendations to better train healthcare providers – doctors, nurses, and lay health workers – serving in nations torn by collective violence and lacking enough mental health professionals. There is a presumption that trauma victims in such countries often turn first to their primary healthcare providers for all forms of medical care, including care for mental health problems.

Collective forms of violence are defined by the World Health Organization as war, terrorism, violent political conflicts within or between states, genocide, torture and human rights abuses.

“Many poor countries and regions in the world suffer from ongoing conflict and have few resources to treat survivors who are traumatized,” said Dr. David Eisenman, a RAND researcher and assistant professor of medicine at UCLA, who is the lead author of the study.

“This is the first study to provide guidelines for adequately preparing local health workers to care for victims of this violence who are prone to mental health problems including stress, depression, and coping with the loss of family members,” Eisenman said.

The RAND Health study, which appears in the February edition of the Journal of Traumatic Stress, is the result of a partnership between RAND and the International Society for Traumatic Stress Studies (ISTSS).

In 2002, the ISTSS Task Force on Trauma Training partnered with RAND to form a working group of mental health professionals, practitioners, research scientists and global health policymakers. The group convened an international panel to outline general guidelines for training professional and lay health workers located in conflict-affected areas, particularly in developing countries.

Recommendations presented in the study are the result of research and clinical practices of mental health, with an emphasis on providing mental health applications that are effective and sustainable. Researchers caution that effective training depends not only on interactions between the local health workers, but also with local governments, communities and nongovernmental organizations.

The study identified areas that should be addressed before, during, and after providing mental health care training including:

• Collaborating with local officials and providers on specific training needs, available resources and developing training activities.
• Utilizing evidence-based teaching methods to help healthcare workers identify symptoms of mental illness, establish trust with patients, and properly treat mental disorders.
• Integrating trauma training within the country's existing healthcare services, which can include enlisting the support of traditional healers or folk medicine providers.
• Advocating a human rights framework, in which providers identify and document violations.

The study also emphasizes a need to hold mental health training programs accountable by monitoring their progress and outcomes. Researchers focused only on care for adult trauma victims, because training for pediatric and adolescent mental health care requires its own focused expertise.

Funding for the study was provided by RAND from donations and funds earned on contracts, and by the International Society for Traumatic Stress Studies and the Jerome Frankel Foundation.

Other authors study were: Nadine Rayburn of RAND; Steven Weine of the University of Illinois; Bonnie Green of Georgetown University Medical Center; Joop de Jong and Peter Ventevogel of Healthnet TPO; Allen Keller of the Bellevue/New York University Program for Survivors of Torture; and Ferid Agani with the University of Prishtina.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.