Psychiatric-psychotherapeutic outpatient facility for Vietnamese migrants living in Germany

Priv.-Doz. Dr. med. Thi-Minh-Tam Ta, senior consultant physician, specialist in psychiatry and psychotherapy, Head of the Outpatient Clinic for Vietnamese migrants, co-head of Global Mental Health Branch

Dr. med. Eric Hahn, senior physician, specialist in psychiatry and psychotherapy, Head of Schizophrenia and co-head of the Global Mental Health branch

B. Sc. Thanh Loan Do, psychological student assistant

M. Sc. Ngoc Linh Hong Nguyen, psychologist and psychotherapist in training

Thanh Lan Lam, physician

Le Trang Nguyen, psychological student assistant

Hien Giang Do, psychological student assistant

After contacting us and arranging an appointment by e-mail or telephone, a native-speaking specialist for psychiatry and psychotherapy (Priv.-Doz. Dr. Thi Minh Tam Ta) and psychological assistants with Vietnamese language skills will be available as contact persons. A multi-professional and culturally sensitized medical and psychological team offers outpatient and, if necessary, inpatient psychiatric and psychotherapeutic treatments. Our services include psychosocial counseling and a detailed native-language, culturally sensitive diagnosis and treatment of all psychiatric disorders in an outpatient or inpatient setting. In addition to pharmacological therapies, psychotherapeutic consultations and group therapies are offered, which are methodologically based on cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) as well as mindfulness-based interventions (MBI). In addition, for patients with post-traumatic stress disorder, trauma therapy can be provided.

Furthermore, psychiatric consultation and liaison services are offered for the whole of Germany, if also required via telemedicine. Moreover, patients with somatization and chronic pain disorders can receive targeted psychological pain therapy in individual or group sessions. Regular skill training groups complement outpatient group therapies.

Since April 2020, we have also been offering online consultations. (Link to online consultations)

Vietnamese migrations to Germany are historically linked to the political divisions and reunifications of both countries and (even after the fall of the Wall) resulted in constellations that are unique in the world, especially in Berlin. Currently, almost 90,000 Vietnamese citizens and 168,000 people with a Vietnamese migration background live in Germany. According to official sources, at least 25,000 people with a Vietnamese migration background live in Berlin.

After a two-year planning phase, the Clinic for Psychiatry and Psychotherapy of Charité Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF) opened Germany’s first outpatient psychiatric clinic for Vietnamese migrants in 2010. In particular, people with limited German language skills and reservations about the German mental health care system benefit from this offer. A multi-professional and culturally sensitive team of staff has been offering outpatient and inpatient psychiatric and psychotherapeutic treatment and assists with the integration into the psychosocial care system of Berlin.

Following a further planning phase and in cooperation with the Department of Psychiatry, Psychotherapy and Psychosomatics at Königin Elisabeth Herzberge Protestant Hospital (KEH), another community-based psychiatric outpatient clinic for Vietnamese migrants was opened in 2012 as part of general psychiatric care and as a contribution to intercultural opening for the districts of Lichtenberg and Marzahn-Hellersdorf (Head: Dr. Ronald Burian). In the following years a culture- and language-sensitive team consisting, among others, of Vietnamese social workers, who also work as language and culture mediators, and Vietnamese nurses, as well as a bilingual specialized day-clinic.

Based on an outpatient and inpatient psychiatric and psychotherapeutic care structure, in a further step and cooperation with the Berlin-based Association for Intercultural Work (Verein für interkulturelle Arbeit, VIA e.V., project management: Mrs Nozomi Spennemann), a network to promote the mental health of Vietnamese migrants with low-threshold access to complementary psychosocial facilities has been advanced since mid-2013. As part of the regular networking and outreach community work, a continuous bilingual exchange can take place, with more than 20 network meetings already having taken place with a high level of participation by migrant agents.

A bilingual website of this network was launched in 2018. Since 2020 the project “WE TALK ABOUT IT! MENTAL ILLNESS IN VIETNAMESE BERLIN” (“WIR REDEN DRÜBER! PSYCHISCHE ERKRANKUNGEN IM VIETNAMESISCHEN BERLIN “) within the framework of the “Network for Mental Health of Vietnamese Migrants” (“Netzwerk für seelische Gesundheit von vietnamesischen Migrant*innen “) has initiated further activities for the prevention of mental illness, in particular the establishment of self-help groups. In addition, this project provides bilingual support for public relations, especially social media. The contact for this project is Ms Hang Hoang (hang.hoang@via-in-berlin.de).

An up-to-date list of Vietnamese facilities and services in Berlin can also be found here:

www.netzwerk-vietpsygesundheit.de/vi/tai-lieu/

www.netzwerk-vietpsygesundheit.de/vi/

From the very beginning of the clinical planning phase, the main objective was to provide scientific support for the development of psychosocial care for the previously difficult to reach group of Vietnamese migrants.

This applies to both accompanying health care research and interdisciplinary psychiatric-anthropological research within the framework of the Collaborative Research Centre CRC 1171 “Affective Societies”, which will be briefly described below.

(2015-2019) CRC 1171 A02 – First funding period: Affective efforts of migration

South and North Vietnamese life-worlds in separated and reunified Berlin

In the focus of our anthropological-psychiatric project are ageing first-generation migrants from former North and South Vietnam. The diverse reasons for migration as well as the particular ways of migration to the FRG and GDR, respectively, were quite distinct for both groups of migrants, that is ‘boat people’ and ‘contract workers,’ with each scenario entailing diverse emotional and affective challenges. Using interdisciplinary approaches and methodology, we examine the affective efforts of coping with emotional crises in daily life. Additionally, we want to explore the various contexts that are, in fact, managed with the help of psychiatric-psychotherapeutic professionals. Thereby, our project contributes to the CRC’s general interest in the shaping of transcultural emotion repertoires. Furthermore, our project is characterized by our conceptualization of migrants as actors who actively shape their lifeworlds by drawing from different resources and coping strategies such as psychiatric-psychotherapeutic help and transforming care structures.

www.sfb-affective-societies.de/en/teilprojekte/A/A02/laufzeit1/index.html

(2019-2023) CRC 1171 A02 – Second funding period:

Affects and Processes of Institutionalization in Vietnamese Carescapes of Berlin

Project A02 explores the affects and processes of institutionalization in heterogeneous Vietnamese care settings in Berlin. We investigate how experiences of migration and societal participation shape the perceptions and expectations of different actors in changing institutions. We also take into focus the “costs of caring” which arise from practices of personal, therapeutic, and professional care, as well as civic engagement. The project provides theoretical contributions on affects and emotions in relation to migration-sensitive carescapes, to the possibilities of societal participation of migrants in the health care-sector and processes of internal social differentiation in institutionalized fields of informal and formal professional care-providing and care-giving within social security and public mental health systems.

https://www.sfb-affective-societies.de/en/teilprojekte/A/A02/index.html

Selected References:

www.sfb-affective-societies.de/teilprojekte/A/A02/pub_A02/index.html

Integration into the Global Mental Health branch at Charité, CBF

The Global Mental Health department aims to investigate and improve the psychiatric care of patients with a refugee or migrant background by developing new types of care structures and innovative treatments. Specialized outpatient services are available for Vietnamese and Arabic speaking patients, with psychiatric and psychological staff educated and trained in their respective host countries. Moreover, attitudes towards mental disorders are being researched and compared internationally in order to design culturally sensitive treatments. Global Mental Health forms an interdisciplinary research, treatment, participation and international cooperation platform as an integral part of the Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, jointly headed by Prof. Dr. Malek Bajbouj, Priv.-Doz. Dr. Thi Minh Tam Ta and Dr. Eric Hahn.

https://psychiatrie.charite.de/en/research/global_mental_health/

Upscaling of a clinic partnership, Partners strengthen health - Establishing a clinic partnership network in North Vietnam (2017-2019 and 2020-2023)

Starting in 2016, as part our international collaboration, several induction trips of the project participants and joint courses were carried out in cooperation with the Department of Psychiatry of Hanoi Medical University in the National Institute of Mental Health Vietnam at Bach Mai Hospital Hanoi. Subsequently, a sustainable bilateral collaboration between the Departments of Psychiatry of both nationwide-leading Medical Universities in Berlin and Hanoi (led by Prof. Dr. Nguyen, Van Tuan, en.hmu.edu.vn/news/default.aspx) was established within the framework of a clinic partnership of the first funding phase (2017-2019; BMZ, GIZ). From the very beginning, this partnership was designed to be long-lasting and on an equal footing. Personal contacts, Vietnamese language skills and country-specific knowledge of German and Vietnamese stakeholders at Charité as well as a regular exchange in the areas of teaching and training, clinical practice, care and science form the basis of the partnership. Together with the Vietnamese partners (HMU, NIMH-VN, MoH), the need for further development of mental health care was defined even beyond the first funding phase. These future objectives are: 1. continuous medical education and training (CME) in the fields of psychiatric care and psychosocial support, 2. the development of evidence-based treatments, including digital strategies, especially in the context of community-based psychiatric care, and 3. strengthening networks of professional groups in psychiatric hospitals associated with the HMU in several provinces of Vietnam.

Highly effective PR and a regular exchange of information between all project partners via e-mail, video calls, shared project management software such as Microsoft Teams, ongoing care-oriented research projects and mutual visits by project partners accompanies the clinic partnership. Since 2019, a DAAD PAGEL university cooperation between HMU and Charité has been established, which expands the opportunities for long-term bilateral collaboration between the two leading university clinics.

Since 2020 we have been able to expand the clinic partnership to a network mainly in the northern provinces of Vietnam. In addition to the Department of Psychiatry of HMU and the National Institute of Mental Health (NIMH), this network includes other clinics such as the Hanoi Mental Hospital, My Duc Psychiatric Hospital, and provincial psychiatric clinics in Cam Pha, Son La Nghe An in Central Vietnam. The network thus supports 20% of the psychiatric staff in Vietnam and provides care for over 50,000 psychiatric patients in a service area of about 20 million Vietnamese residents.

Partnerships for the health sector in developing countries - PAGEL 2019-2022

The university collaboration “PAGEL Partnerships for the Health Sector in Developing Countries” of the German Academic Exchange Service (DAAD) between Charité Universitätsmedizin and Hanoi Medical University is funded by the Federal Ministry for Economic Cooperation and Development (BMZ). It is led and coordinated by Priv.-Doz- Dr. med Thi Minh Tam Ta, Dr. med. Eric Hahn and Dr. Kerem Böge.

This collaboration aims to promote high-performing cosmopolitan universities in Germany and Vietnam through exchange and teaching in the field of mental health. In 2020, a Memorandum of Understanding between Charité Universitätsmedizin Berlin and Hanoi Medical University was signed by the Dean of Charité (Prof. Pries) and the President of HMU (Prof. Ta). This MoU enables greater scientific collaboration and academic exchange between the two universities.

Building a Vietnamese cohort for genomics research on schizophrenia

In cooperation with the Laboratory for Statistical Genetics, Charité Mitte (https://psychiatrie-psychotherapie.charite.de/en/metas/person_detail/person/address_detail/ripke-1/) and the Berlin Psychosis Study and Bridge-S Study headed by Prof. S. Ripke, we are jointly recruiting a new cohort for genomics research on schizophrenia to identify genetic and psychosocial risks in people of Vietnamese ethnicity. These efforts will serve the ethnic diversification of GWAS studies with in-depth phenotypic characterization.

CYPression study “Influence of peripheral cytochrome P450 activity 2C19 on the clinical manifestation in depression: a combined functional and genetic study in two distinct ethnic groups”.

In addition to psychotherapy, there are a number of possible characteristics to be considered in the psychopharmacological treatment for people with a migration background: e.g. negative attitudes towards psychopharmacology, oversensitization to side effects and increased perception of side effects, with a lack of medication adherence. Objectively, side effects such as agitation are more common, especially with SSRI (Cipralex, which is metabolized by CYP 2C19). The often additional intake of traditional “Asian” drugs is an important feature of psychopharmacotherapy in Vietnamese patients. The interplay between culture and ethnicity as well as genetic factors, environmental factors, including lifestyle and its influence on clinical responsiveness and side effects of psychopharmacotherapy in the treatment of people with a migration background must be taken into account. Cytochrome P450 enzymes, especially CYP 1A2, -2B6, -2C9, -2C19, -2D6 and -3A4, are involved in metabolizing over 90% of all drugs used in psychiatry.  The study in cooperation with the neurobiological laboratory of our clinic (headed by Dr. J. Hellmann-Regel) will investigate the link between cytochrome P450 2C19 enzyme activity and the development of depression in both Vietnamese patients and German patients as part of a grant from the Clinician Scientist Programme of the BIH for Priv.-Doz. Dr. Thi Minh Tam Ta.

Ms Nguyen, Thi Hoa, a psychiatrist from HMU, a DAAD scholarship holder and doctoral student within the PAGEL university cooperation and hospital partnership between Charité and Hanoi Medical University is also involved in the project.

See publications:

www.sfb-affective-societies.de/teilprojekte/A/A02/pub_A02/index.html