Shin Daimyo on Innovating for Global Mental Health

Shin Daimyo is a kinetic presence at Partners In Health. The 28-year-old program manager for the mental health program bounces through our Boston office daily, weaving clinical and programmatic insights with gut-busting one-liners. He’s as good-humored as he is dedicated to expanding mental health services in the countries where we work.

From tackling health issues on the Obama campaign to developing clinical protocols for mental health services in Haiti, Daimyo’s work has always focused on delivering high-quality health care to vulnerable populations. But he’s the first to admit that the path toward making his passion a reality has been tough to navigate at times. Recently, Daimyo authored a chapter in Do Good Well: Your Guide to Leadership, Action and Social Innovation, a book that noted New York Times columnist Nick Kristof dubbed “a practical field guide for young people wanting to change the world.”

We caught up with Daimyo to discuss what doing good well means in the world of mental health and to learn more about how PIH is innovating simple and scalable models of care for mental health in low-resource settings.

Q: Hey, Shin! Thanks for taking the time to chat. So why don’t you start by explaining to readers what you do on a day-to-day basis at PIH?

Thanks for having me! As the program manager for mental health, I’m responsible for the overall management of our programs in Haiti and Rwanda, and I also provide support to burgeoning clinical work and research in Mexico and Lesotho. On any given day, I'll be meeting to develop clinical protocols for depression; talking with a potential partner to provide clinical supervision to our psychologists, social workers, and physicians; and developing indicators to track mental health patient outcomes, among other tasks. I work with a great team of people who bridge a range of disciplines and nationalities.

One project our team has been working on is building a long-term strategy for epilepsy care that can be scaled up across resource-poor settings. An underlying goal of all our programs is to expand the capacity of local clinicians to deal with the high rate of mental and neurologic disorders. Recently, our partners in Haiti at Zanmi Lasante received a large grant from Grand Challenges Canada to develop a community-based model of mental health care and expand and bolster mental health services at all our health centers and hospitals in Haiti. In collaboration with Harvard Medical School, we also manage the Dr. Mario Pagenel Fellowship, which sends senior psychiatrists to Haiti and Rwanda so they can provide clinical and programmatic supervision to local staff.

Q: When many people think of health issues in the developing world, they often think of infectious diseases such as HIV/AIDS or tuberculosis. Are you seeing a shift toward greater awareness of mental health in low-resource countries?

That’s a complicated question, and I think it’s important to look at it from the perspective of local governments and development partners, such as bilateral organizations and foundations. We are starting to see a shift among low-income countries in terms of their prioritization of mental health, especially as more and more countries develop mental health laws and policies. This is most clearly seen with our work in Haiti and Rwanda. The Haitian government has voiced strong support for our Grand Challenges Canada project to scale up services over the next three years at our joint sites. Our plan is to present a roadmap for delivering similar services in the rest of the country.

In Rwanda, the Ministry of Health has done an incredible job of decentralizing and scaling up mental health services at public facilities, and it continues to invest its own resources to provide mental health care to its population. Inshuti Mu Buzima, PIH’s Rwanda sister organization, works closely with the government to provide technical support. It’s a wonderful model.

As a whole, however, there isn’t enough investment, both politically and financially, for mental health. That’s why funding from donors such as Grand Challenges Canada is so important. It signifies a nascent shift in thinking and prioritization of mental health services that can be sustainable and impactful. We strive not only to provide incredible care to the most vulnerable populations, but to also advocate for increased political and financial commitments to mental health. 

Q: So how did you come to be involved with Do Good Well, and what was your contribution to the book?

Nina Vasan, a lead author of the book, is a good friend and past colleague. We met in 2006 while I was working at the World Health Organization in Geneva in the department of mental health policy and service development. We had many conversations about nonprofits, leadership, movement building, and social change, and were surprised about how many lessons and beliefs were common to our experiences. She ended up recruiting me to the Obama campaign soon after, where we formed a formidable team in key battleground states. We have stayed in touch since then, supporting each other as we furthered our careers in social change. Nina reached out to me about a year ago to help write a chapter.

Q: And what did you decide to write about?

My chapter focuses on how you refine your passions and define your goals, and how to take concrete steps toward a sustainable career in social change.

I empathize with being really passionate about wanting to make a difference, but having no idea or direction on how to get there. I started as a business major in college then changed to psychology. I coordinated alternative spring breaks focused on poverty, the environment, and cross-cultural issues, and I worked with children with serious emotional disabilities. From there I worked in student affairs, applied to three graduate programs in different fields, and did a whole lot of research on at-risk youth. Then I moved on to quality improvement and management work in four hospitals in Lesotho, acted as director for President Obama’s health care work in Florida, and co-founded a student-run global health journal at Boston University School of Public Health, where I earned my master’s degree.

I’m not saying this to brag about all the avenues I’ve been down. The entire time, working for the most vulnerable populations has been my core motivation. But it took a very long time for me to hone in on how I wanted to make my passions a reality, a career. I truly see my role at PIH as the realization of my passions, and my hope is that the chapter helps others do the same.

Q: Noted New York Times columnist Nick Kristof called Do Good Well “a practical field guide for young people wanting to change the world.” And a theme throughout is this notion of social innovation. How is social innovation unfolding in the world of mental health?

People often associate innovation with some sort of new, fancy technology, which is sometimes the case. Other times, however, innovation is just doing something simple in somewhere it has never been done. We live in a world of finite resources, and consequently we must pursue creative ideas that have the greatest benefit to the most number of people.

Back when PIH first started, many people believed HIV drugs couldn’t be effectively provided to people in low-resource settings or in isolated rural areas. When PIH proved this wrong by deploying a simple, targeted strategy founded on community health workers (CHWs), we were innovating, and it worked. Now we’re demonstrating the same thing with mental health. High-quality, community-focused, evidence-based mental health services that are culturally appropriate can and should be provided in low-resource settings. That in itself is something the world is still trying to believe and realize.

Q: In previous conversations, you’ve mentioned the effectiveness of mobile mental health clinics. What are they and are they capable of providing long-term care that some patients struggling with, say, depression or schizophrenia may need?

Imagine a multidisciplinary team of psychologists, nurses, physicians, and social workers packed into an SUV driving to the most remote part of Haiti to provide care. This team meets up with a CHW, who they are in constant communication with, and goes out in the community to screen for mental disorders and provide initial treatment. The CHWs play a key role: Because they are embedded in the community, they can refer individuals to the mobile team when they arrive.

Now imagine this is done on a monthly basis while the CHW stays in the local village to provide follow-up care and appropriate referrals when necessary. This is a long-term model for care, and it’s terrific.

Q: Are there any technological innovations emerging for mental health at our sites?

We are currently developing a mobile health, or mHealth, pilot where our CHWs will utilize cell phones to track, screen, and refer patients from the community to health centers and mobile clinics. The phones will likely have a decision support model— a tool that helps CHWs make clinical and referral decisions based on the types of symptoms the patient has—to effectively support and improve clinical care in the community-based model. It’s still a young project with lots of potential, so stay tuned for more information in the coming months.