THORN in Sri Lanka

www.thorn-initiative.org.uk www.uksrilankatrauma.org.uk

Project Proposal: To develop the THORN Training Programme in Sri Lanka

What is the THORN Training Programme? The THORN Training Programme has become the model in the UK around which training for mental health professionals working with individuals with a diagnosis of severe mental illness is based. As a model of best practice for working with people with severe mental illness, THORN has been in existence for over twenty years. The THORN Training Programme owes its beginnings to The Sir Jules Thorn Charitable Trust, which was established in 1964 by Sir Jules Thorn. The THORN Nurse Initiative (THORN Training Programme) was one of the Sir Jules Thorn Charitable Trusts Special Projects. In 1991 the Trustees committed funds in excess of 500,000 to what was then termed the Project for Psychiatric Nursing, and later became the THORN Nurse Training Initiative and more recently, The THORN Training Programme. The funding was to provide a new training programme in the preparation of Community Psychiatric Nurses to provide care for people who had serious mental illness. Why Sri-Lanka? Sri Lankas reputation as a provider of health services to its people is a good one. Yet Sri Lanka lags behind in one crucial area - that of mental health. More than three decades of conflict and the effects of the Tsunami have had a strong impact on the mental well-being of the Sri Lankan population, especially on its most deprived sectors. Sri Lanka has one of the highest suicide rates in the world and misuse of alcohol is frequent, especially in areas affected by disaster. It has been estimated that 70,000 Sri Lankans suffer from schizophrenia and this figure is expected to rise with the increase in the number of young adults. Access to mental health services is extremely limited and grossly disproportionate from one area of the country to another. Insufficient attention has been given to the mental health sector, and, at times, it is even forgotten.

One of the biggest developments in Mental Health in Sri Lanka has been the governments approval of the Mental Health Policy in 2005. This policy, prioritizes among other things, the development of community-based mental health services and the decentralization of services involving the downsizing of big mental hospitals with the provision of local mental health facilities.

Mental Health Capacity Building in Sri Lanka A number of groups and organisations have set up to address the training needs that arise with efforts to improve provision of mental health facilities. UK-Sri Lanka Trauma Group is made up of mental health professionals and others interested in trauma related and general mental health matters in Sri Lanka. Current membership includes psychologists, psychiatrists, medical practitioners, nurses, trainees and students as well as individuals interested in mental health work. The UK-Sri Lanka Trauma Group is supported by the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Kings College London. It also has links with the University of East London and other NHS Trusts.

The UK-Sri Lanka Trauma Groups activities are primarily aimed at capacity building in Sri Lanka through training of frontline workers. This training is carried out in three levels: level I for volunteers and those with minimal skills, level II for individuals who are working in the mental health field but may not have a profession and level III for mental health professionals and other health professionals. Samutthana is a Sri Lankan based charity set up by the UK-Sri Lanka Trauma Group. One of the essential work-streams of Samutthana is general mental health capacity building. This includes contributions to psychiatry training, clinical psychology training and mental health nursing training. In the UK, THORN has become synonymous with best practice for the care and treatment of people with a diagnosis of severe mental illness and psychosocial interventions. Having been in existence for over twenty years, the THORN Training Programme offers a proven and established model around which training for health professionals can be effectively based.

Adapting THORN to the Sri Lankan context For training to receive THORN validation the teachers on the course must be THORN graduates and the curriculum must embrace:

1. Working collaboratively with service users and carers/families

2. A biopsychosical philosophy 3. Practitioner therapeutic optimism 4. Strengths ethos, in content and language 5. Recovery focus 6. Social Inclusion: for the individual, family and community 7. The Vulnerability-stress model and a Normalising Rationale 8. Multidisciplinary/agency working, learning and teaching 9. Clinical case management 10. Clinical Supervision THORN training programmes, generally, follow a generic curriculum and developments in the literature have been assimilated with an emphasis upon family intervention, cognitive behavioural therapy and a consideration of the role of trauma in psychosis. THORN Training in Sri Lanka will need to be adapted to suit the specific cultural context and needs of local communities. It will need to be appropriate to local cultural beliefs and practices and should take on board the current behaviour of the people of the country in seeking help for mental health and wellbeing. Indeed, working collaboratively with service users and carers/families is essential for any course to be THORN accredited. Within the UK, THORN qualifications, accredited by a range of academic institutions have ranged from courses offering 20-40 undergraduate credits to diplomas, postgraduate diplomas, BSc courses and MSc courses. This range and flexibility offers additional advantage to academic institutions in Sri Lanka, wishing to accredit THORN training programmes according to their own objectives. Next Steps The first step will be a joint meeting between members of the THORN steering group and the UK-Sri Lanka Trauma Group to discuss this project idea. The plan is for this meeting to be held in the early part of 2013.

For further information contact: Email: MAAldridge@hotmail.co.uk Tel: 07817 143198 Matthew Aldridge BA(Hons) BSc (Hons) THORN DipHE RMN