STRENGTHENING HUMAN RESOURCES
THROUGH DEVELOPMENT OF CANDIDATE
CORE COMPETENCIES FOR MENTAL,
NEUROLOGICAL, AND SUBSTANCE USE
DISORDERS IN SUB-SAHARAN AFRICA

WORKSHOP SUMMARY

A Collaboration of the Forum on Neuroscience and Nervous System Disorders
and the African Science Academy Development Initiative

Diana E. Pankevich, Theresa M. Wizemann,
Patricia A. Cuff, and Bruce M. Altevogt,
Rapporteurs

Board on Health Sciences Policy

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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STRENGTHENING HUMAN RESOURCES THROUGH DEVELOPMENT OF CANDIDATE CORE COMPETENCIES FOR MENTAL, NEUROLOGICAL, AND SUBSTANCE USE DISORDERS IN SUB-SAHARAN AFRICA WORKSHOP SUMMARY A Collaboration of the Forum on Neuroscience and Nervous System Disorders and the African Science Academy Development Initiative Diana E. Pankevich, Theresa M. Wizemann, Patricia A. Cuff, and Bruce M. Altevogt, Rapporteurs Board on Health Sciences Policy

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The workshop that is the subject of this summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This project was supported by contracts between the National Academy of Sciences and the Alzheimer’s Association; CeNeRx Biopharma; the Department of Health and Human Services’ National Institutes of Health (NIH, Contract No. N01-OD-4-2139) through the National Eye Institute, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Institute on Aging, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and NIH Blueprint for Neuroscience Research; Department of Veterans Affairs; Eli Lilly and Company; Fast Forward, LLC; Foundation for the National Institutes of Health; GE Healthcare, Inc.; GlaxoSmithKline, Inc.; Johnson & Johnson Pharmaceutical Research and Development, LLC; Lundbeck Research USA; Merck Research Laboratories; The Michael J. Fox Foundation for Parkinson’s Research; the National Science Foundation (Contract No. OIA-0753701); One Mind for Research; Pfizer Inc.; the Society for Neuroscience; and Wellcome Trust. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-28606-0 International Standard Book Number-10: 0-309-28606-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Strengthening human resources through development of candidate core competencies for mental, neurological, and substance use disorders in sub-Saharan Africa: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON STRENGTHENING HUMAN RESOURCES FOR MENTAL, NEUROLOGICAL, AND SUSBTANCE USE DISORDERS IN SUB-SAHARAN AFRICA1 PAMELA Y. COLLINS (Co-Chair), The Office for Research on Disparities and Global Mental Health SEGGANE MUSISI (Co-Chair), Makerere University Medical School VIKRAM PATEL (Co-Chair), London School of Hygiene & Tropical Medicine STEVEN HYMAN, The Broad Institute SYLVIA KAAYA, Muhimbili University College of Health and Allied Sciences WALTER J. KOROSHETZ, National Institute for Neurological Disorders and Stroke ALAN I. LESHNER, American Association for the Advancement of Science DAVID NDETEI, African Mental Health Foundation ADESOLA OGUNNIYI, University of Ibadan SOLOMON RATAEMANE, University of Limpopo SHEKHAR SAXENA, World Health Organization JOHN WILLIAMS, Wellcome Trust IOM Staff BRUCE M. ALTEVOGT, Project Director PATRICIA A. CUFF, Senior Program Officer DIANA E. PANKEVICH, Program Officer ELIZABETH K. THOMAS, Senior Program Assistant (until November 2012) 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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INSTITUTE OF MEDICINE FORUM ON NEUROSCIENCE AND NERVOUS SYSTEM DISORDERS1 STEVEN HYMAN (Chair), The Broad Institute SUSAN AMARA, Society for Neuroscience MARC BARLOW, GE Healthcare, Inc. MARK BEAR, Massachusetts Institute of Technology KATJA BROSE, Neuron DANIEL BURCH, PPDi C. THOMAS CASKEY, Baylor College of Medicine TIMOTHY COETZEE, Fast Forward, LLC EMMELINE EDWARDS, NIH Neuroscience Blueprint MARTHA FARAH, University of Pennsylvania RICHARD FRANK, GE Healthcare, Inc. DANIEL GESCHWIND, University of California, Los Angeles HANK GREELY, Stanford University MYRON GUTMANN, National Science Foundation RICHARD HODES, National Institute on Aging THOMAS INSEL, National Institute of Mental Health PHILLIP IREDALE, Pfizer Global Research and Development DANIEL JAVITT, Nathan S. Kline Institute for Psychiatric Research FRANCES JENSEN, University of Pennsylvania School of Medicine STORY LANDIS, National Institute of Neurological Disorders and Stroke ALAN LESHNER, American Association for the Advancement of Science HUSSEINI MANJI, Johnson & Johnson Pharmaceutical Research and Development, Inc. DAVID MICHELSON, Merck Research Laboratories RICHARD MOHS, Lilly Research Laboratories ALEXANDER OMMAYA, U.S. Department of Veterans Affairs ATUL PANDE, GlaxoSmithKline, Inc. STEVEN PAUL, Weill Cornell Medical College TODD SHERER, The Michael J. Fox Foundation for Parkinson’s Research PAUL SIEVING, National Eye Institute JUDITH SIUCIAK, Foundation for the National Institutes of Health 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vii

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MARC TESSIER-LEVIGNE, The Rockefeller University WILLIAM THIES, Alzheimer’s Association NORA VOLKOW, National Institute on Drug Abuse KENNETH WARREN, National Institute on Alcohol Abuse and Alcoholism JOHN WILLIAMS, Wellcome Trust STEVIN ZORN, Lundbeck USA CHARLES ZORUMSKI, Washington University School of Medicine IOM Staff BRUCE M. ALTEVOGT, Forum Director DIANA E. PANKEVICH, Program Officer SHEENA M. POSEY, Research Associate RACHEL J. KIRKLAND, Senior Program Assistant ANDREW POPE, Director, Board on Health Sciences Policy viii

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INSTITUTE OF MEDICINE BOARD ON AFRICAN SCIENCE ACADEMY DEVELOPMENT1 ENRIQUETA BOND (Chair), Burroughs Wellcome Fund JO IVEY BOUFFORD, New York Academy of Medicine MICHAEL CLEGG, University of California, Irvine PRINCETON LYMAN, Georgetown University NARCISO MATOS, Foundation for Community Development CHEIKH MBACKÉ, Hewlett Foundation ROMAIN MURENZI, TWAS–The Academy of Sciences for the Developing World VENKATESH NARAYANAMURTI, Harvard School of Engineering and Applied Sciences IOM Staff PATRICIA A. CUFF, Liaison to the Uganda National Academy of Sciences CHRISTIAN ACEMAH, Associate Program Officer ANGELA CHRISTIAN, Program Associate JAMES BANIHASHEMI, Financial Officer PATRICK KELLEY, Director, Board on Global Health 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. ix

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Reviewers This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Jonathan Burns, University of KwaZulu-Natal Marcelo Cruz, Global Network for Research on Mental and Neurological Health Natalia Kanem, The Lloyd Best Institute of the West Indies Ana-Claire Meyer, University of California, San Francisco Angelina Kakooza Mwesige, Makerere University School of Medicine Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this work- shop summary was overseen by Donald Silberberg, The University of Pennsylvania Medical Center. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with in- xi

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xii REVIEWERS stitutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the authors and the institution.

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Contents INTRODUCTION 1 STRENGTHENING HUMAN RESOURCES 4 WHY FOCUS ON DEPRESSION, PSYCHOSIS, EPILEPSY AND ALCOHOL USE? 5 OVERVIEW OF THE 2009 JOINT IOM AND UNAS WORKSHOP 7 PROGRESS SINCE 2009 7 STATUS OF MNS DISORDERS IN SUB-SAHARAN AFRICA 10 CHALLENGES FACING MNS CARE PROVIDERS IN SSA 14 MSN DISORDER PROVIDERS 18 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS 22 THE PROCESS OF UPDATING AND INTEGRATING CORE COMPETENCIES 32 PERSPECTIVES ON NEXT STEPS 43 APPENDIXES A Summary of Candidate Core Competencies 49 B Candidate Core Competencies 81 C Provider Definitions and Relationship Roles 83 D References 89 E Workshop Agenda 91 F Working Groups 103 G Attendees 107 xiii

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