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Q&A with Brandon Kohrt, MD, PhD

           
Brandon Kohrt, MD, PhD
, a global mental health expert, joined the Department of Psychiatry & Behavioral Sciences and the Duke Global Health Institute as a faculty member on July 1, 2013. We are very pleased to have Dr. Kohrt on board as he will expand upon Duke’s existing expertise in global mental health. Dr. Kohrt has worked in Nepal and Liberia, conducting global mental health research on populations affected by war-related trauma and chronic stressors of poverty, discrimination, and lack of access to healthcare and education. Learn more about his work overseas and his vision for how Duke can become a leader in global mental health below.

What is your new position at Duke?

I am assistant professor in the Duke Global Health Institute and the Department of Psychiatry and Behavioral Sciences.

Tell us about your previous work in Nepal.

I have worked in Nepal for seventeen years. The work has covered topics ranging from traditional healing for persons with mental illness to gene-environment interactions conferring risk for suicidal behavior. The most rewarding part of the work has been the long-term collaboration with Nepali researchers. I have had the privilege of working with a Nepali nongovernmental organization Transcultural Psychosocial Organization (TPO) Nepal. Researchers with whom I trained and collaborated many years ago are now running large projects and making major contributions in both clinical care and research. As I join Duke, I am excited to see how resources and expertise in psychiatry and global health can further build the capacity of these energetic and committed Nepali partners.

What made you decide to combine your doctorate in medical anthropology with clinical training in psychiatry?

The decision to study anthropology came first. However, after doing a year of cross-cultural research on mental health in Nepal, I decided that I also wanted clinical skills so that I could train health workers in Nepal to address the dire need for psychiatric services. Clinical training was crucial to improve treatment and availability of care for Nepalis experiencing high levels of both acute political trauma and ongoing structural violence.

What have you learned about global mental health challenges through your work with the Carter Center?

The work in Liberia with colleagues from The Carter Center has taught me two crucial lessons. First, strengthening government systems is indispensable for long-term sustainable change in psychiatric services. Prior to working with The Carter Center, most of my work was independent research or through the nongovernmental and humanitarian sector. It is very difficult to achieve change and sustain interventions with NGO and humanitarian organizations alone. The Carter Center works hand-in-hand with the Liberian government. I have witnessed how this approach implants psychiatric care into government systems and in national training programs in a way that will sustain services long after The Carter Center program is completed. Their philosophy has a multiplier effect that builds capacity of skilled people in government positions who then lead others in the system to change psychiatric services. The second lesson has been the involvement of persons living with mental illness and their family members. We conducted a pilot program to reduce stigma associated with mental illness in Liberia. It had minimal measurable effect. We realized the missing piece was a lack of engagement with persons living with mental illness. Now, engagement with persons living with mental illness is the cornerstone of our stigma reduction program. These two lessons already are reflected in our work in Nepal, which now has a stronger focus on government collaboration and partnerships with persons with psychosocial disabilities.

How can Duke become a leader in global mental health?

A major contribution that Duke can make is building the capacity of mental health clinician-researchers in low and middle income countries such as Nepal and Liberia. I have greatly enjoyed teaching researchers and clinicians in these countries because there is such a hunger for knowledge and new skills are immediately deployed in their work. It would be rewarding to see how current endeavors at Duke can be expanded in three areas that build capacity around the globe: virtual learning and supervision, training programs in low income countries, and educational exchanges to bring clinician-researchers from low income countries to Duke. These efforts—many of which already are happening through Duke—will make a major contribution to ending global disparities in mental health care.

Tell us a fun fact about yourself

Before transitioning to anthropology and medicine, I studied documentary filmmaking. During my research with child soldiers in Nepal, I collaborated with Robert Koenig, a friend and filmmaker, to create a documentary about child soldiers coming home after war. This was the second long-format documentary we made together. Our first was a film about a wrestling coach in Mongolia with a cultural syndrome similar to chronic fatigue syndrome. Surprisingly, there is not much of a market for documentaries about Mongolian wrestling coaches with chronic fatigue.