Heidi Burns, MD

Nominated From: University of Michigan

Research Site: Ghana

Research Area: Global Mental Health, Suicide

Primary Mentor: Cheryl Moyer

Research Project

Developing, Implementing, and Evaluating Suicide Screening Tools in Ghana: Building on a year of Exploratory Research

Suicide is a significant global and public health problem that results in 800,000 deaths every year around the world. It is estimated that only 60 countries in the world have high-quality data on suicide, yet an estimated 78 percent of suicides occur in low- and middle-income countries (LMIC), where there can be significant barriers to data collection. Ghana is an LMIC where emerging evidence suggests a recent rise in suicidal behavior, but high quality data on suicide is limited. Further research is needed to improve understanding of suicide trends, treatment practices, and suicide prevention in Ghana.

The global importance of suicide is highlighted by the fact that the World Health Organization declared suicide prevention a global imperative in 2014. This imperative lead to the development of the Mental Health Gap Action Programme (mhGAP), which aims to improve mental health care access in LMIC’s by task shifting to front-line providers. Both psychiatric and non-psychiatric healthcare providers play a role in suicide screening and risk assessment to reduce the impact of suicide, particularly among front-line providers who have the highest likelihood of identifying those at risk. In some settings, it has been documented that nearly half of those who complete suicide had sought out health care in the month prior to their death, which emphasizes the important role of healthcare providers in suicide recognition through the use of screening tools.

During the 2018-2019 Fogarty Fellowship year, I was awarded a Northern Pacific Global Health Fellowship to explore attitudes towards suicide and suicide prevention amongst front-line providers caring for patients that had experienced suicide attempts at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. The project evaluated for screening trends, provider stigma, and current practices amongst front line providers. Research findings from this past year gave insight into current treatment pathways and screening trends for patients with suicidal behavior. Last year was an exciting year full of relationship building, collaborative efforts, and exploration into mental health care in Ghana. This research helped to clarify current mental health practices at KATH and has laid a foundation of understanding around how suicide has been treated and interpreted in Ghana.

With an extension grant for 2019-2020, this next year will provide the opportunity to build up research efforts within the Psychiatry Departments at KATH. This project will build on foundational knowledge from last year by creating and implementing suicide screening tools that are culturally relevant in Ghana.

Research Significance

My first Fogarty year allowed for new research findings in global mental health, which is an extremely underrepresented area of global health research. That data helps to improve understanding of suicide trends, provider attitudes towards suicide, and current front line provider practices in Ghana. This extension project provides an opportunity to build on current research findings in global mental health and suicide. This project focuses on the development, implementation, and evaluation of suicide screening and prevention protocols in a major teaching hospital in Kumasi, Ghana. Development of suicide screening tools could streamline care, which will improve safety of patients with suicide risk by identifying them earlier. It would also allow us to extend these benefits to a wider community with educational seminars at health centers and in the community. The NPGH Fogarty grant will also strengthen the burgeoning multi-disciplinary collaborations across Komfo Anokye Teaching Hospital and the University of Michigan and ensure capacity building as these skills will become embedded in researchers here in Ghana.

Advice for Potential Candidates

Relationships and mentorship matter in global health work. I was introduced to the Fogarty opportunity by a mentor who I had confided in about my interest in global mental health and it was through her guidance and encouragement that I took a chance and applied. These relationships have continued to be a main source of support as I embarked on this adventure to develop a new skill in a foreign environment. I strongly recommend taking time at the beginning of your global health work to invest in developing personal and professional relationships in your new community and embrace the culture (food, language, etc). The more time you invest in learning about the community, the easier it is to understand and work through any obstacles that may arise. Obstacles are inevitable in global health work, so try to embrace them and look at it as an opportunity to better your understanding of a new culture and community.

Publications

View on PubMed

Mentors

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