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Background
Global mental health inequalities are increasingly pressing. 1 By 2030, depression will become the world's leading cause of disease burden. 2 Around 80% of people with severe mental disorders in low-income and middle-income countries (LMICs) receive no treatment. 3 To bridge the gap between need and provision, WHO developed the mental health gap action programme intervention guide (mhGAP-IG). 4 Despite widespread uptake, relatively few published studies have assessed its effectiveness in health education. 5
In parallel, high-income countries (HICs) face a psychiatry recruitment crisis. In 2016, just 67% of UK core psychiatry training posts were filled. 6 Stigma 7 and cultural beliefs can influence medical student perceptions of psychiatry. 8 9 Medical student attitudes and career choices may be influenced by different educational approaches. 10
High-quality global health education is limited worldwide. 11 Sustainable, mutually beneficial, long-term institutional partnerships between HICs and LMICs can address this problem and improve health bilaterally. 12 Advances in global health 13 and psychiatry education 14 require innovative, low-cost technologies and partnership approaches.
University budget cuts 15 compound challenges in global health education. E-learning has attracted growing attention for its affordability, accessibility 16 and capacity-building potential in LMICs 17 but may be of low quality. 18 The benefits of e-learning may be enhanced when combined with peer teaching, 19 20 especially when learning outcomes and language are shared. 21 Problem-based learning (PBL), where students solve clinical problems as a group, improves knowledge, critical reasoning and social skills. 22 However, PBL research outside HICs is rare. 23 Telemedicine offers one way to overcome the infrastructure requirements that limit face-to-face PBL 18 but is underused in global mental health. 24
King's Somaliland Partnership (KSP), formed in 2000, is a health link between universities and hospitals of King's Health Partners in London and Somaliland, a self-declared autonomous region in northern Somalia. KSP supports medical school mental health curriculum development, 25 using Medicine Africa, a platform that delivers real-time, clinically focused education, at low bandwidth. 26
'Aqoon', meaning 'knowledge' in Somali, is KSP's online global mental health peer-to-peer e-learning partnership between medical students in London and Somaliland. 27 Established in 2009, participants report improved attitudes to psychiatry, factual knowledge and cross-cultural understanding. 28 Challenges to successful peer educational partnership include variable motivation and...