UCLA psychiatry residents rotating at Tintswalo Hospital will work with local staff and practitioners to help strengthen mental health delivery in rural South Africa. While South Africa is struggling to treat medical problems including HIV/AIDS, TB, other communicable illnesses as well as complications from smoking, there remains a large need of mental healthcare practitioners and treatment of psychiatric conditions. Research suggests that 16.5% of adults have suffered from a mental disorder in preceding year and that the access to mental health providers remain dismal. In fact, in 2015, the overall staff/population ratio per 100,000 population for psychiatrists was 0.4 (range of 0.1 - 0.8), and can be substantially lower in rural areas. Given this, there remains a substantial and critical need for primary care physicians to understand how to provide basic psychiatric care, and how to determine when referrals are necessary for more complex cases.

For approximately 3-4 weeks, UCLA psychiatry residents will work daily in the outpatient psychiatry clinic and inpatient psychiatry unit with Dr. Belinda McIntosh, a general practitioner who provides psychiatric care along with nurse practitioners and physician assistants. Residents will evaluate and treat patients with psychiatric illnesses in a rural community setting, applying the current interventions (cultural, pharmacological in a resource-limited setting, or otherwise) that the clinic has been utilizing to treat the patients. The residents will also help train health assistant students, health assistants, medical students, and nurses to evaluate psychiatric disorders that are commonly seen in the local population, including mood disorders, psychotic disorders, substance use disorders, psychiatric complications of illness such as HIV/AIDS, and post traumatic disorders. Residents will become familiar with the WHO Essential Medications and regional formulary medications. Residents will work with under direct supervision of primary care practitioners and specialists.

Weekly supervision will be provided throughout the elective by recent Associate Director of Residency Education, Dr. Jonathan Heldt, as well as additional CGP faculty, via video tele-conferencing. Supervision will include discussion of clinical cases as well as systems-level interventions/quality improvement and training initiatives that will help address sustainability and impact of GMH work. Residents are expected to participate in scholarly work related to this experience, as well as participate in a short GMH curriculum course that involves didactics, journal club, and formal supervision. Given that practicing psychiatry in South Africa presents numerous barriers including access to medication and treatment and understanding of the cultural perspective on mental illness, the residents will rely on feedback and instruction from local staff and health care providers to ensure that they are delivering evidenced based care with cultural humility. The long-term goals of this experience are to train residents that will continue to work in community-based and/or global mental health settings (academic, research, non-profit, governmental, clinical, etc.) where mental health care access is limited in the context of a profound cultural stigma of mental health.