The APS Grant for Intercultural and/or International Projects of up to $10,000 supports innovative projects that have an intercultural and/or international focus, particularly in countries where psychology is an emerging discipline. Doug Scott MAPS was awarded the APS Grant in 2009 to facilitate training for psychologists at the National Center Against Violence in Ulaanbaatar, Mongolia. A key aspect of the grant was to use half of the funding to enable Mongolian psychologist Ms Khongorzul ("Zola") Amarsaana to spend six weeks in Melbourne to learn how the APS operates and assist in the establishment of the Mongolian Psychological Society. In addition to this goal, Zola was to gain new skills so she could return to Mongolia and provide training for mental health staff at the National Center Against Violence.

Mongolia is a nation of 2.9 million people which experienced a democratic revolution in early 1990 after the breakdown of communist countries in Eastern Europe. Ulaanbaatar, the capital and largest city, is home to about 38 per cent of the population. Another 30 per cent of Mongolia’s population are nomadic or semi-nomadic and subsist from breeding lifestock (goats, sheep, yaks, horses and camels) as herders. 

How did you come to be involved with facilitating training in Mongolia? What was your role?

Doug: At the end of 2008 I was invited by the National Center Against Violence (NCAV) in Mongolia to run training for psychologists and other mental health clinicians on suicide prevention, trauma counselling, ethics in counselling and self-care. The invitation came as the result of the training work I had conducted in Melbourne regarding trauma and suicide prevention and the interest in these specific topics from the NCAV. I went over to Ulaanbaatar in June 2009 to conduct this training. Due to the success of the training, I was invited back the following year. At this point I applied for the APS Intercultural Grant to assist with funding the training and to commence the establishment of the Mongolian Psychological Society with the support of existing contacts I had made on my first visit. With funding from the APS Grant, I returned to Mongolia in 2010 to facilitate further training of staff at the NCAV in the assessment and treatment of depression and suicide prevention.

Zola: I met Doug when I was studying in Melbourne in 2008 and, having heard about the variety of training programs he had previously facilitated, I thought he would be interested in Mongolia given the natural disasters both countries experience. I knew Doug had been involved in supporting people after the Black Saturday bushfires in Victoria. I was very excited to be part of Doug’s application for the APS Intercultural Grant in 2009. The overall objective was to build capacity among Mongolian psychologists and for me to have a field visit to Australia to learn from the Australian experience of establishing a professional organisation for psychologists. In Mongolia there are approximately 200 psychologists for whom we would like to start organising peer support and professional development, and also explore research into mental health issues across Mongolia.

What are some immediate and longer-term mental health and wellbeing issues confronting the people of Mongolia?

Zola: For the past decade almost every winter Mongolia has faced a harsh winter, with temperatures reaching as low as -50 Celsius, and during summer rural areas have experienced drought with temperatures beyond 40 Celsius. Due to this extreme weather, rural communities lose their livelihood year after year. Suicide among herders as well as people in urban areas has increased. In my opinion, the increase in people's distress and depression is due to social and economic unrest, and climate change. Mongolia lacks mental health services to address these community demands. In addition to this, Mongolia is a patriarchal culture and family violence, sexual abuse and people trafficking is prevalent. The National Center Against Violence is the only organisation in the country which works with the victims of violence and cannot always meet the demand. Therefore, we continuously need to support professionals who are working in the field.

Doug: Suicide prevention and trauma counselling were
two of the main areas of discussion on both of my visits to Ulaanbaatar. Also, many psychosocial problems have emerged since 1998 with the series of "dzud" (extremely prolonged winters). Dr Altanzul Narmandakh, a Mongolian psychiatrist, provided the 2007 figures presented below.

Prevalence rates
Suicide – 17 per 100,000 population
Schizophrenia – 0.97 per 1,000 population
Alcohol abuse – 13.6 per 100 population (ratio of males to females is 4:1)

Psychiatric services
Beds – 2.4 per 100,000 population
Psychiatrists – 3.3 per 100,000 population
Nurses – 4.4 per 100,000 population
Psychologists – 6.0 per 100,000 population
Social workers – 3.0 per 100,000 population

It appears there is a greater need for community-based mental health services in Mongolia, with specialist services for youth and children’s mental health and an emphasis on non-medical treatments such as counselling and community outreach.

How did the APS Grant for International and/or Intercultural Projects assist you in your work in Mongolia?

Doug: The APS Grant enabled me to return to Mongolia a second time to build on earlier training for our psychologist colleagues over there. It also enabled Zola to visit Australia in order to consolidate links and learn about how to establish the Mongolian Psychological Society (MPS). Forging links with key government and non-government representatives to explore the promotion of mental health care in Mongolia was inspiring. The MPS will focus on professional development and membership initially. It would be great if Australian psychologists could continue providing training for Mongolian clinicians, such as the valuable work Dr Marion Oke has contributed since the mid 1990s.

Zola: As well as me personally, the beneficiaries of the APS Grant range from mental health professionals to local communities in Mongolia. The Grant provided the opportunity for Mongolian psychologists to have up-to-date training from Doug on various topics such as depression, suicide prevention and self- care. The impact of this Grant is enormous, as I believe all the psychologists who participated in the training are practising what they have learnt. For example, my colleagues from the National Center Against Violence always use their new skills, and whenever we have discussions we refer back to the training. The training therefore has certainly benefited the wider Mongolian community, and psychologists deliver skilled services to their various clients such as victims of domestic violence and sexual abuse.

What kinds of personal qualities and professional skills were most valuable to you during that time?

Doug: The most important qualities are to be open-minded, with a preparedness to embrace another culture and a willingness to work flexibly and respectfully within it despite little familiarity. A key personal quality is being willing to give new things a go, whether this is drinking mare’s milk or gaining an understanding of the former Soviet psychiatric system. My Mongolian colleagues commented that many consultants from the West have visited Mongolia since 1991 and have brought their own ‘brand’ of mental health services without considering specific cultural markers and the historical context. I found it incredibly valuable to learn as much as I could before I arrived in Ulaanbaatar.

Zola:
Having previously studied at Monash University helped me to get along with Australian people and understand the culture. Professionally, this made it easier to understand the systems within the APS and other organisations.

What has the experience meant for you as a person and as a psychologist?

Doug: It has been an incredible learning experience for me both professionally and personally. We tend to get rather stifled with the very comfortable world that we enjoy in Melbourne, often unaware that most people in the world don’t have access to education, good health and mental health services. Mongolia is such a vibrant place, with an amazing history and rich cultural practices, and has been successfully developing since 1991. I thoroughly enjoyed working with psychologists in Mongolia who were so keen to develop their skills and learn from the mental health services we have in Australia. I found it liberating being able to work with a group that spoke passionately about their clinical work without being bogged down by the bureaucratic processes that govern the psychology profession in Australia. The APS Grant has allowed me to grow as a person and develop as a psychologist. The Buddhist traditions in Mongolia have also left their mark and I have become far more mindful of the world around me.

Zola: This field trip has opened my eyes and widened my horizons. Every meeting I had with different psychologists, counsellors and mental health professionals reinforced how much we need to do and learn in Mongolia. It also helped me to see differences between cultures and institutions, and be reminded of how Mongolian communities endure many hardships in everyday life and lack mental health services. It really strengthened my resolve to stand more solidly for Mongolian grassroots communities. The experience and knowledge gained from my visit to the APS will contribute to establishing a professional network of psychologists across Mongolia.

Is there a take-home message for us as psychologists here in Australia, and as global citizens?

Doug: I think the take home message is not to be too cautious about diving in and embracing work in developing countries. I sense we have far more to learn about the human condition than we have to impart. I would encourage psychologists from Australia to look at how they can share their skill sets (especially in educational, health and community psychology) with colleagues in developing countries. I would like to thank the APS for providing me with this great opportunity to pursue further work in Mongolia and especially thank Heather Gridley for facilitating this.

Zola: Perhaps in the future the APS or other professional organisations should have a staff exchange program where Australian psychologists or mental health professionals share their experiences with professionals in developing countries through country visits for up to a month or so. Professionals from developing countries have extensive experience in different areas, and psychologists from both developed and developing countries have much to learn from each other.