VP&S Programs in Global Health

The mission of the Programs in Global Health is to harness and focus the expertise and assets of the medical school, in partnership with global leaders and relevant programs of Columbia University, to improve human health worldwide by training global health leaders, building capacity through interdisciplinary education and training programs, and addressing unmet global health needs through research and application.

WHO Collaborating Centre for Global Mental Health

Columbia University’s World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health (Columbia WHO CC), formerly the Columbia Global Mental Health Program, is based in Columbia University’s Department of Psychiatry, Vagelos College of Physicians and Surgeons. Dr. Kathleen M. Pike serves as the Director of the Columbia WHO Collaborating Centre.

The Columbia WHO CC supports WHO’s mission to reduce the burden associated with mental health and substance use disorders and promote mental health worldwide through the following ways:

  1. To support WHO in advancing its research aimed at enhancing the identification, classification and treatment of mental disorders worldwide by providing scientific and technical support for research development, data infrastructure, and dissemination of research findings.
  2. At the request of WHO, develop training resources and materials on prevention, identification, diagnosis, and treatment of mental health and behavioural disorders across a range of settings and contexts.

Staff at the Columbia WHO CC and its affiliates deliver postgraduate educational programs that prepare clinicians and researchers to advance the field of global mental health, develop training programs that build capacity for research and clinical care in low- and middle-income countries, conduct basic and applied research with global relevance, advance community awareness and understanding of mental illness, and advocate for human rights of people with mental illness.

 

 

ICD-11 Development, Training, and Implementation

The Columbia WHO CC has been a leader in advancing the development and implementation of the Mental, Behavioural or Neurodevelopmental Disorders chapter of the 11th edition of the International Classification of Disease (ICD-11). Dr. Geoffrey Reed leads the activities related to ICD-11 development, implementation, and training, working with Dr. Kathleen Pike and Dr. Tahilia Rebello. Other members of the global mental health community at Columbia serve as research collaborators along with a network of clinical researchers and institutions from around the globe.

Background and Research Strategies

A clinically useful and culturally informed system of diagnosis is essential to advance mental health globally. Without a common lexicon, stakeholders cannot accurately describe clinical disorders, document effective interventions, or report public health data. During the development of the ICD-11, the Columbia WHO CC collaborated in the design and implementation of global field studies to test and evaluate the clinical utility, reliability, validity, and global applicability of the ICD-11 Clinical Descriptions and Diagnostic Requirements (CDDR) for Mental, Behavioural or Neurodevelopmental Disorders. The Columbia WHO CC also served as the Data Coordinating Center for the ICD-11 field studies.

Over the course of a decade, field studies were conducted through the Global Clinical Practice Network (GCPN), an online network of more than 16,000 mental health practitioners representing more than 160 countries that is hosted by the Columbia WHO CC. GCPN members participated in field studies to assess the accuracy, consistency, and clinical utility of ICD-11 diagnostic guidelines. Each study was conducted in at least three and as many as six languages. As a result of this collaboration, GCPN has grown to become the largest, most international, multilingual, and multidisciplinary practice-based research network ever established.

Clinic-based studies were conducted through the network of collaborating International Field Study Centers (IFSC) appointed by WHO. Located in 14 countries around the world, representing all WHO global regions, the IFSCs participated in field studies to evaluate the ICD-11 with real patients in the types of clinical settings in which the diagnostic requirements are intended to be applied. All IFSC studies were conducted in the local language of that country, in a wide range of cultural contexts.

ICD-11 Trainings

After a decade-long scientifically rigorous development process, the ICD-11 was approved by the World Health Assembly in May 2019 and went into effect on January 1, 2022.

With the release of the ICD-11, including the Clinical Descriptions and Diagnostic Requirements (CDDR) for Mental, Behavioural and Neurodevelopmental Disorders, mental health professionals must become familiar with changes introduced in the diagnostic system. The Columbia WHO CC has been active in the development of mechanisms for disseminating information about the key changes and how to implement them in clinical practice in an effective, clear, and widespread manner.

More specifically, the Columbia WHO CC is leading the development of a systematic web-based online training program aimed at providing clinicians with the knowledge and competencies required to effectively implement the ICD-11. Training units are currently being piloted and refined based on feedback from members of WHO’s Global Clinical Practice Network. Once finalized, the online training course will be made available to clinicians around the world.

Impact of COVID-19 Pandemic on Mental Health Treatment and Mental Health Professionals

In response to the COVID-19 pandemic, the Columbia WHO CC initiated an additional large-scale research study and engaged with the Global Clinical Practice Network to examine the long-term impacts of the global public health emergency on mental health professionals worldwide. With a grant from the Canadian Institutes for Health Research, the team is conducting three waves of global data collection in six languages with a focus on the impact of the pandemic on the well-being of mental health professionals, as well as the impact on mental health treatment delivery. By identifying the nuanced changes in mental health services and practitioner wellbeing during the pandemic, this research will inform the development of future infrastructure and interventions that can more appropriately support mental health professionals and individuals receiving mental health care.

Tohoku Theater Project

On March 11, 2011, Japan experienced the most devastating earthquake and tsunami in over 100 years. Communities in the Tohoku Region have made enormous progress in recovery and rebuilding. However, many communities from Tohoku, and other impacted regions in Japan, were under tremendous stress as a result of loss of family and sense of community, loss of community infrastructure, and of livelihood. As the burden of recovery wore on, the psychological cost became more apparent.

 

Background

As the time since the disaster increased, the needs of the impacted communities in Japan were shifting, and mental health concerns presented a serious priority that required attention. Attending to emotional health and well-being was complicated by the fact that communities were displaced, services were disrupted, and many individuals found it difficult to seek help because of stigma and concerns about placing more burden on an already-taxed system.

Project Overview

Visual and performance arts have a long tradition of being used to engage communities, capture important social issues, and promote wellbeing. In consideration of the profound impact that the 2011 disaster had across all aspects of human experience, this project aimed to use theater to create safe environments for open dialogue about the difficult issues facing communities from Tohoku. We developed and delivered the program in partnership with local organizations and theater groups to tailor the intervention to the particular needs of the participating community groups. In all cases the program was designed to support communities, promote resilience and coping, and address psychological needs of members from the community. The theater program is based on a unique and participatory methodology developed by Outside the Wire, a social impact company that uses theater and a variety of other media to address pressing public health and social issues. The Tohoku Theater Project represented the first time that this methodology was utilized in Japan.

Project Aims

This program aimed to: 1) build community capacity and resilience; 2) engender empathy and enhance understanding of mental health needs; and 3) help individuals pursue appropriate community services as needed. After each performance, audience members were connected to appropriate information and resources, empowering them to take action steps based on their new understanding of the core issues explored by each play. An impact assessment of the program was conducted.

Outcomes

A total of 143 participants engaged in guided discussions after the performances. Positive feedback was received from participants about the cultural-relevancy of the performances, and participants also reported gaining a greater understanding of their own emotional experiences, increased empathy for others, greater desire to support others, and greater understanding of the variation in experiences post-disaster. As participants engaged in discussing grief, misunderstanding, displacement, and post-disaster family and social relationships, some individuals also noted a shift in their perspectives on “talking out” one’s concerns as a way of healing in community. Furthermore, while acknowledging that there are limitations in coordinated mental health care in Japan and some reluctance to seek mental health care, participants were assisted in making connections to local, regional, and national mental health resources.

In 2021, the team’s research documenting the impact of The Tohoku Theater Project was published in Psychiatric Services. The full article can be found here. The Tohoku Theater Project can serve to inform future strategies and interventions that engage the arts to build community dialogue and promote psychological healing in response to global health crises.

Collaborating Team

  • Tsuyoshi Akiyama, NTT Medical Center Tokyo
  • Evelyn Bromet, Stony Book University
  • Bryan Doerries, Outside the Wire
  • Naoko Horikoshi, Fukushima Medical College
  • Phyllis Kaufman, Outside the Wire
  • Norito Kawakami, Tokyo University
  • Mami Kayama, St Luke University
  • Kathleen Pike, Columbia University
  • Tahilia Rebello, Columbia University
  • Hirooki Yabe, Fukushima Medical College
  • Lawrence Yang, Columbia University (formerly, current: New York University)
  • Seiji Yasumura, Fukushima Medical College

Contact Information

For more information on the Tohoku Theater Program, please contact Dr. Tahilia Rebello at [email protected].