Sharing Mental Health Expertise at Home and Around the World

As one of Canada’s preeminent cross-cultural psychiatrists, Dr. Lisa Andermann is at the forefront of tackling global mental health challenges.

And it’s a challenge she began preparing for even before medical school.

“I was already passionate about cultural psychiatry prior to entering psychiatry residency,” says Andermann, now an Associate Professor in the University of Toronto's Department of Psychiatry. “Having done a BA in anthropology and an MPhil in social anthropology I always knew I was looking for clinical opportunities to work across cultures.” 

Today, Andermann is deeply involved with domestic and international mental health outreach programs that target underserved populations in remote locations and underdeveloped countries where mental health treatment must be approached with great cultural sensitivity. And she studies the cultural context of mental disorders and the challenges that can arise when treating mental illness in different cultures.

It's a little-known field that was highlighted recently at the Global Mental Health Conference held at U of T during Mental Health Week. 

Since completing her residency at U of T in 2001, Andermann has spent three weeks each year providing psychiatric care to residents in Baffin Island through the university’s Northern Psychiatric Outreach Program (now located at CAMH).

Over the years, she’s learned to be prepared for a variety of different situations.

“Weather is always foremost in mind when planning a trip as a cancelled flight or blizzard can wreak havoc on a tight clinic schedule when a town only has a psychiatrist visiting twice a year for one week,” says Andermann 

“Alternatively, when the weather gets nice in spring and summer, there can be many no-shows to appointments because everyone is out on the land participating in traditional activities like hunting and fishing!”

When she first started travelling to Baffin Island there were no dedicated mental health nurses and, outside Iqaluit, not a single full-time doctor. Since then, the situation has changed. Each community now has an assigned psychiatric nurse who can triage patients, assist with support and follow-up and monitor medications. 

In 2003 Andermann and two U of T colleagues traveled to Ethiopia as part of the first psychiatric teaching trip to Addis Ababa University (AAU). That experience became the foundation of the Toronto Addis Ababa Psychiatry Program (TAAPP), the flagship educational collaboration between U of T’s department of psychiatry and the department of psychiatry at Addis Ababa University (AAU) developed by U of T’s Dr. Clare Pain.

“Ethiopia had a number of excellent faculty – clinicians and researchers who were trained abroad, but there was not enough manpower for teaching, supervising and sustaining a new training program,” says Andermann. 

So her team quickly got to work assessing the existing framework and helping develop the country’s first psychiatric training program.

“One thing we immediately realized was that we would have to balance instructive teaching in the classroom with offering a variety of opportunities for clinical supervision at rounds, in the emergency room, clinics and at the bedside – services which were very much needed.”

Andermann says her team also recognized a need to introduce various new teaching styles, as AAU professors had a very instructive and formal tradition in their medical education. Getting students to sit in a circle and discuss cases in a small group, engage in role playing activities and practice interview skills was a big cultural shift, says Andermann.

Thanks to the TAAPP initiative there are now five departments of psychiatry outside the capital city of Addis Ababa, run by graduates of the program, Andermann says. 

“The country went from having less than 10 psychiatrists in a country of 80 million people to now having more than 50 and a fully operational training program for psychiatrists.”  

Before this program was implemented, only the most severely psychotic patients would ever receive treatment at the one psychiatric hospital in the country. Less severe mental illnesses such as depression and anxiety would go untreated.

Today, Andermann leads the selection committee that chooses U of T psychiatry residents to participate in four-week teaching trips at AAU.  

“The selection committee looks for residents who demonstrate an interest in teaching, an attitude of cultural humility, curiosity, and flexibility to be able to manage a four-week trip successfully,” says Andermann. “Outreach experiences such as NPOP or Baffin electives are excellent preparation for TAAPP residents as they need many of the same skills and have already had experiences with managing limited resources and working with staff psychiatrists in a very different setting than a downtown teaching hospital.” 

Andermann and her colleague Dr. Kenneth Fung are the winners of the Faculty of Medicine’s inaugural Social Responsibility Award in recognition of their leadership on issues regarding equity, social justice and social responsibility, cultural psychiatry and global mental health, promoting dialogue to reduce stigma and increasing public engagement with mental health issues.