Global Mental Health | Department of Psychiatry

Following over a decade of NIH-funded mental health work conducted by department faculty members in low- and middle-income countries, the UNC Division of Global Mental Health came into existence on October 1, 2019. Our goals are to develop, test, and build the capacity to deliver contextually-appropriate and sustainable models for mental health intervention with local and global partners. Our division is a joint effort of the Department of Psychiatry and the Department of Epidemiology, in the UNC Schools of Medicine and Gillings School of Global Public Health.

Collaboration

We seek to work with individuals and organizations who aim to improve mental health outcomes globally. Collaborative research and training activities with university partners, ministries of health, non-governmental organizations and community-based networks enable us to engage diverse perspectives for complex problems.

Research: We generate and value mental health research with real world relevance and impact. Our faculty collaborate with partners locally, regionally, and globally. We work on projects developing and testing treatment and preventive interventions, system integration of mental health care, stigma reduction approaches, incorporation of mental health services into diverse community settings, and much more.

Training and Education: We aim to train and educate the next generation of global mental health leaders, practitioners, and researchers.

Dissemination and Implementation: We are committed to translating evidence-based psychiatric care to care that can be delivered in real world clinics, with a special focus on population with limited resources.

Malawi

Drs. Bradley Gaynes, Brian Pence and Samantha Meltzer-Brody. U19 SHARP (funded), D43 WARMHEART (funded), R34 PERISCOPE (funded)

The Malawian Program for Mental Health Research Training (WARMHEART) (1D43TW011794-01), sponsored by the NIH Fogarty International Center for Advanced Study in the Health Sciences. Director of the Division for Global Mental Health, Dr. Bradley Gaynes is principal investigator and Dr. Susan Girdler co-investigator. This initiative builds on the strong training track records of and successful collaborations between UNC-Chapel Hill, the Malawi College of Medicine, the Malawi Ministry of Health, and many other partners. WARMHEART will create an expert pool of mental health researchers based in Malawi who are trained as leaders and able to collaborate with other disciplines and policymakers to address the role of psychiatric illness across the lifespan in sub-Saharan Africa.

Dr. Brad Gaynes, through his NIH-funded work, played a pivotal role in the 9th Malawi Mental Health Research & Practice Development Conference in Salima, Malawi.

This international conference involved presentations by Malawian students, interns, residents, and fellows; by persons with lived experience; by social workers, other clinicians, and medical school faculty; and by researchers from Ethiopia, Ghana, South Africa, Scotland, England, the Netherlands, and the US. This meeting highlighted the large number of currently funded Malawi-based DGMH grants evaluating treatment for depressed adolescents with HIV (HEADS-UP); strategies to identify and manage depressed adolescents with suicidality (SAFETY); piloting nurse-delivered community-based rehabilitation for adults with psychotic disorders (ENHANCE); testing an implementation strategy to support and enhance integration of mental health services into general medical care (ALIGN); and training psychiatry and mental health post-doctoral fellows to develop and conduct mental health research in Malawi.

Over the past year, our work in Malawi has thrived, with our evidence-based research actively shaping health policy in the region.
Dr. Brad Gaynes, Director, Division of Global Mental Health

Philippines

Tealeaf is set to scale in the Philippines. In collaboration with the University of the Philippines – Manila (UP), Dr. Christina Cruz is planning to scale Tealeaf to all 73 of the Department of Education, School District Office Manila (DepEd – Manila) public elementary schools, reaching ~20,000-50,000 students in need yearly. In 2023-2024, she completed a pilot trial of Tealeaf in 5 schools as a proof-of-concept. She is running a trial 2024-2025 of Tealeaf as a whole-school cascade model in these 5 schools to prep for scale. Future directions in the Philippines. Dr. Cruz seeks to explore whether Tealeaf or other ways to upskill school staff in mental health skills is of interest to schools in the Philippines beyond DepEd-Manila’s elementary schools. She is in Manila 2024-2025 as a Balik Scientist through the Department of Science and Technology. As faculty at the University of North Carolina at Chapel Hill, she is interested in exploring sustainable partnerships for scaling Tealeaf or other similar programs in the Philippines should there be interested locally from schools or potential partners.

Learn more about Tealeaf

In Tealeaf, we empower teachers to deliver mental health support directly to their students through changing their everyday interactions to be therapeutic. This year, we’re working on a train-the-trainer model in order to reach all of the City of Manila’s public elementary schools. We’re also speaking with the Philippine government and potential collaborators about the potential of Tealeaf to scale across the Philippines, reaching up to 8.5 million children
Dr. Christina Cruz, Assistant Professor

Cruz’s work has taken her all over the world, from UNC-Chapel Hill to India and the Philippines. She hopes to change the conversation by training teachers in low- and middle-income countries to incorporate mental health treatment into their curriculum, providing care as early as possible.

India

Dr. Christina Cruz. American Academy of Child/Adolescent Psychiatry, Thrasher Research Fund, Klingenstein Third Generation Foundation.

Arming Teachers with Mental Health Skills in India

The prevalence of youth mental health concerns has increased after COVID. Teachers are addressing this greater volume in the classroom, many doing so despite not having mental health training. Not addressing child mental health in the classroom may affect whole class academics; children in classes where teachers had mental health skills did better in academics than those whose teachers did not. Building their mental health skills may be an opportunity to meet teachers’ professional and children’s mental health.

Dr. Christina Cruz creates and studies interventions where teachers address youth mental health in the real time moment of struggle. In TEALEAF (Teachers Leading the Frontlines), elementary school teachers are trained and coached to use mental health skills Dr. Cruz designed for them, called “education as mental health therapy” (Ed-MH). Teachers first learn the basics of behavior theory to understand student motivation for behaviors and mental health. With motives known, teachers then pick Ed-MH skills to use that meet the child’s needs.

Vietnam

Drs. Bradley Gaynes and Brian Pence. R34 VITAL (funded)

The R34 in Vietnam was funded by the National Institute of Drug Abuse (NIDA). The project is called VITAL (1R34DA051933-01; Gaynes PI). It’s full title is: Adaptation of the Friendship Bench counseling intervention to improve mental health and HIV care engagement outcome among people living with HIV who inject drugs in Vietnam. This project will adapt and pilot a feasible and effective problem-solving therapy designed for low-resource settings to address common mental disorders like depression and anxiety–the Friendship Bench–in a Vietnamese population of individuals living with HIV who also have opiate use disorder.