Global Behavioral Health Engagement: Building Partnerships and Enhancing Readiness

photo of  Cmdr. Michelle Tsai (third from left), Psychological Health Center of Excellence subject matter expert, with other participants at the 2018 Behavioral Health Subject Matter Expert Exchange engagement in Nepal. (Courtesy photo)
Cmdr. Michelle Tsai (third from left), Psychological Health Center of Excellence subject matter expert, with other participants at the 2018 Behavioral Health Subject Matter Expert Exchange engagement in Nepal. (Courtesy photo)
By U.S. Public Health Service Cmdr. Michelle Tsai, RPh, PsyD
May 21, 2018

Global Behavioral Health Engagement

We generally think of the Department of Defense (DoD) as a government agency that provides military forces to protect and defend the security of our country, and many of us don’t think much of the connection between global health and DoD. In fact, DoD has a long standing history of participation in many global health engagement initiatives to support global stability and security via enhancing the health system capabilities of partner nations; however, few of these initiatives focus on behavioral health.

There is a growing focus within DoD on global behavioral health engagement as we recognize the potential impact of mental health on readiness of warfighters worldwide. Since 2011, the Psychological Health Center of Excellence (PHCoE), as the DoD sponsor of the International Initiative for Mental Health Leadership Military Issues Work Group, has worked across the globe to share operational, accessible practices for the delivery of mental health and addiction services along with United Kingdom, Australia, Germany, Netherlands, Denmark, Canada, and New Zealand military collaborative partners. In 2017, PHCoE was invited to join the U.S. Army Regional Health Command-Pacific (RHC-P) Global Health Engagement Team to develop a behavioral health functional area playbook. The behavioral health playbook is a strategic planning document used to assess current status related to behavioral health care capacity in any given nation, and helps global partners work together in a structured way over several years to strengthen collaboration and enhance service capabilities. 

PHCoE recently participated in a four-day Behavioral Health Subject Matter Expert Exchange (BH SMEE) engagement in Nepal with the Nepalese Army, Nepalese Armed Police Force, and selected Nepalese health care professionals, along with the U.S. Pacific Command.  The key to a successful mission in Nepal began with careful preparation and planning where we:

  • Prepared a list of questions for the Nepalese Army key planners for a pre-planning conference (e.g., what is potential audience participating in the exchange and their training background, what are the available resources for individuals with psychiatric conditions, and are there policies or doctrines addressing mental health conditions)

  • Reviewed country-specific materials from the U.S. State Department

  • Identified cultural considerations (e.g., attitudes towards mental health, barriers to mental health care and stigma)

  • Coordinated logistics (e.g., accessibility of internet/AV capability of the partner nation and transportation)

  • Identified challenges that might interfere with the BH SMEE and developed courses of action to mitigate the challenges (e.g., a language barrier and presentation topics)

Upon arrival in Nepal in April, clinical and operational experiences were shared with our Nepalese counterparts, including my perspectives as a former Army behavioral health officer embedded in a U.S. Army brigade combat team and a U.S. Public Health Service officer. DoD efforts to reduce stigma in the U. S military were discussed as was integration of mobile applications in behavioral health care. I learned the Nepalese share similar challenges regarding stigma and barriers to behavioral health care, and they have more mobile phones than people in the country (1.3 to 1 ratio). Information regarding the psychiatry patient profile in the Nepalese Army and their perspectives on suicide was learned and a discussion ensued regarding the management of patients with anxiety and depression in the Nepalese Armed Police Force, alcohol and substance use problems, child and adolescent psychiatry in Nepal, use of psychotropic drugs, and United Nations missions.

Most importantly, professional relationships with our Nepalese counterparts were established and I experienced the richness and diversity of the Nepali culture. The exchange provided lasting lessons about the value of global behavioral health engagement and how collaboration can help to enhance military readiness through knowledge exchange and strengthened relationships for both DoD and partner nations.

Resources for DoD Global Health Engagement

Cmdr. Michelle Tsai is a U.S. Public Health Service Officer, and currently serves as the chief of the prevention and early intervention section at the Psychological Health Center of Excellence.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


  • excellent.

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