Aim: The main aim of the Child and Adolescent Overseas Working Party has been to support the
development of services in low-income countries through enhancing their training capacity. This is
congruent with the British Council’s policy of Higher Education.
Link: The paper shares an experience of translating such a policy into practice.
Method: The experience of implementing a British Council Higher Education Link in Child and Adolescent
Psychiatry between the two Universities in Varanasi and Leicester is shared.
Implication: In spite of various difficulties, all parties concerned learnt some valuable lessons and found it
to be a worthwhile ventur

Bretherton, Karen

Dogra, Nisha

Dwivedi, Kedar Nath

Frake, Clay

Sharma, Indira

English

Cognitive Sciences ePrint Archive

Original Article                               JIACAM Vol. 1, No. 1, Article 8
Policy into practice: an experience of Higher Education
Link in Child and Adolescent Psychiatry
 Kedar Nath Dwivedi1, Nisha Dogra2, Indira Sharma3, 
Karen Bretherton4 and Clay Frake5
Child Adolescent and Family Services, 8 Notre Dame Mews, 
Northampton NN1 2BG, UK.
ABSTRACT
Aim: The main aim of the Child and Adolescent Overseas Working Party has been to support the
development of services in low-income countries through enhancing their training capacity. This is
congruent with the British Council’s policy of Higher Education. 
Link: The paper shares an experience of translating such a policy into practice. 
Method: The experience of implementing a British Council Higher Education Link in Child and Adolescent
Psychiatry between the two Universities in Varanasi and Leicester is shared.
Implication: In spite of various difficulties, all parties concerned learnt some valuable lessons and found it
to be a worthwhile venture.
Key words: Link, Child, Adolescent, Psychiatry
Introduction
The Royal College of Psychiatrists had received numerous requests from low-income
countries to help with basic skills training in various aspects of psychiatry. The College
therefore, set up an Overseas Working Group (Royal College of Psychiatrists, 2001). Its
recommendations included setting up of an Overseas Working Group in Child and
Adolescent Psychiatry in response to the urgent need for training in child and adolescent
mental health. The College set this up in July 2001 and the end of 2004 expects a formal
report.
Putting the recommendations into practice
Whilst there are clear recommendations, there is often little financial support available to
translate policy into meaningful practice. Thus, a variety of approaches have been
considered to move things forward. One of these has been to seek support from the
British Council via a Higher Link in Child and Adolescent Psychiatry.
Aim
The main aim of the Working Party has been to support the development of services in
low-income countries. In order to achieve the above aim, several tasks were identified by
the Working Party, including the following: 
1. to identify key people and networks associated with Child Adolescent and Mental 
Health Services (CAMHS) in various countries and contact them in order to assess
their training needs and co-construct training programmes that can be cascaded
further, and
2. to closely liaise and work with other associations already interested in this field.
The organisations
The University Hospital in Varanasi caters for the needs of several provinces, such as,
Eastern Uttar Pradesh, Bihar, part of Madhya Pradesh and Nepal, and attracts patients
largely from lower middle and poor sections of the society. As regards child and
adolescent mental health, there is tremendous enthusiasm and interest and also a need for
further training and experience. Therefore, the main aim of this Link has been to develop
short courses in child and adolescent mental health at the Institute of Medical Sciences,
Varanasi through:
•    Training of staff in basic child and adolescent mental health work
•    Supporting trained staff in training others, specially primary care workers and 
peripheral mental health workers 
•    Locally developing courses for undergraduate and postgraduate training 
•    Fostering a mutually supportive relationship between the two Institutes so that 
culturally sensitive child mental health services for diverse populations can evolve at
both ends. 
The University of Leicester has experience in training in child mental health and working
with overseas institutions to develop training.
The aims of the Working Party and of the Link were congruent. The individual Link also
had an aim of trying to ensure sustainability beyond the project.
Specific issues for British Council funding
The British Council emphasises alleviating poverty and addressing gender issues. This
Link serves this purpose as the university hospital caters largely to poor & lower middle
class population. The Link should help the poor and unprivileged section of the society by
improving the mental health of children and alleviating the suffering of the affected
families and improving their quality of life. 
The Link also aims to ensure that the project will particularly benefit females. This is
likely to happen at different levels, for example, an opportunity for the professional
women to improve their academic and clinical performance in the area of child mental
health. Training will also consider gender issues in the development of mental health
problems and service delivery to girls. The mothers of the children with psychiatric
problems treated by the centre will be alleviated of their suffering and will be able to
perform better. A significant proportion of the children and young people attending the
Centre are females. Offering help to them would improve their chances of experiencing
more fulfilling womanhood.
One of the potential problems may be the difficulty faced while attempting to empower
women, in case it raises conflict with some of the local cultural practices.
Another potential difficulty is in relation to staff availability from UK, given that the staff
time is not paid for and depends mainly on the goodwill of the employing Trusts and a
wider recognition by them.  However, the employers may be able to appreciate the fact
that the staff will bring back learning that would be useful for the service.
Sharing experiences 
The key principle behind the approach was that of sharing experiences and
contextualising them. The project is based on a principle of collaboration, rather than the
UK team assuming the role of expert. The aim is to share what we do and to ask how
much of it is relevant or useful to them: a collaborative partnership as used in family
therapy. 
The visits
During the first year of the Link [2003] two members of the Varanasi multidisciplinary
team [a postgraduate trainee and a Social Worker] visited Northampton CAMH Service
and attended the Midland Course in Group Work with Children and Adolescents. A
senior teacher visited Northampton, London and Leicester and examined various training
programmes in child and adolescent mental health. A teaching team from UK visited
Varanasi and ran a multidisciplinary course on Basic Child & Adolescent Mental Health
(including learning disability) as well as training for trainers in child and adolescent
mental health. The Indian Medical Council also supported the course. During the second
year [2004], three members of the Varanasi multi-disciplinary team visited UK. An UK
team visited Varanasi during the second year to run a multi-disciplinary course. A senior
teacher from India would be visiting UK during the third year. Also, similar activities will
take place during the third year.
Lessons learned
During the seminar in Varanasi the delegates (psychiatrists, psychologists, social workers,
private practitioners and some NGOs) experienced a new approach as regards learning
and teaching. This involved experiential, interactive and small group methods. In the
beginning, there was considerable resistance to this approach, but as the course
progressed they began to value it more and more. By the end of the course, most
delegates were enthused by this approach and it is hoped that at least some of them would
be able to plan and deliver short courses in peripheral centers. It is perhaps somewhat
surprising that innovative and interactive teaching practices were perceived as useful as
the contents of the course.
Visitors from Varanasi took a great deal from their visits to UK in terms of service
planning and delivery, assessment and management approaches, multi-disciplinary
working and specialised training programmes. They gained significantly from seeing
other systems at work and learning how professionals manage with resources even more
constrained than the ones in the UK in so many ways. 
From the perspective of the UK team, it became apparent that it would be useful for the
visitors from UK to have an introductory session of observing clinical practice in India as
this would help improve their understanding of the local working practices and
conditions. A detailed critique of the training has been prepared (Dogra et al, 2005) to
enable reflection of the teaching and for the UK visitors to consider what they gained
from the experience.
Policies tend to cover general principles however; actual practice involves the messiness
of specific and practical details. The common aim of both the Working Party and the Link
has been to help the local staff develop a course. Although by the end of first year, there
is no sign of a concrete course having developed, there is however, a solid foundation
taking shape for such a course to evolve during the next two years of the Link. The UK
visiting team abandoned the idea of pushing for the development of a course during the
first year, as the local team did not seem ready for it. 
In conclusion, there is great enthusiasm and commitment to supporting recommendations
such as made by the Royal College on re-training in child mental health. However, there
are key obstacles that have to be overcome. Marrying the aims of the college and the aims
of funding bodies can raise potential conflict. However, the rewards for service
development and for individuals can be significant. The UK teams have been exposed to
realities of a different nature, which provides opportunities for reflection on their own
practice. The Indian team had an opportunity to consider furthering its teaching and
training programmes and exploring ways of developing child and adolescent mental
health services for the deprived areas and for children generally.
Declaration of interest
KN Dwivedi is the Honorary Secretary of the Overseas Working Party and the UK Co-
ordinator for the Link. I. Sharma is the India Co-ordinator and other authors also
contributed to the seminar.
References
Dogra, N., Frake, C., Bretherton, K., Dwivedi, K. and Sharma, I. (2005) Training
CAMHS professionals in developing countries: an Indian case study. Child and
Adolescent Mental Health (Under publication).
Royal College of Psychiatrists (2001) Report of the overseas working group. Council
Report CR93. London: Royal College of Psychiatrists.
Address for correspondence:
1. Honorary Director, International Institute of Child and Adolescent Mental Health and
Consultant  Child  and Adolescent  Psychiatrist,  8 Notre Dame Mews, Northampton
NN1 2BG, UK. E-mail: Kedar.Dwivedi@ngh.nhs.uk
2. Senior  Lecturer  &  Honorary  Consultant  in  Child  and  Adolescent  Psychiatry,
Greenwood Institute of Child Health, Westcotes Drive, Leicester LE3  0QU, UK.
3. Professor  of  Psychiatry,  Department  of  Psychiatry,  Institute  of  Medical  Sciences,
BHU, Varanasi, India.
4. Consultant  in  Child  Learning  Disability,  Westcotes  House,  Westcotes  Drive,
Leicester LE3  0QU.
5. Clay Frake, Senior Clinical Nurse and Family Therapist, Westcotes House, Westcotes
Drive, Leicester LE3  0QU.


Consultant in Child Learning Disability, Westcotes House, Westcotes Drive,

Senior Clinical Nurse and Family Therapist, Westcotes House, Westcotes Drive,

Training CAMHS professionals in developing countries: an Indian case study. Child and Adolescent Mental Health (Under publication). Royal College of Psychiatrists

Policy into practice: an experience of Higher Education Link in Child and Adolescent Psychiatry

Policy into practice: an experience of Higher Education Link in Child and Adolescent Psychiatry

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