THORN in Sri Lanka www.thorn-initiative.org.uk www.uksrilankatrauma.org.uk

Project Proposal: To develop the THORN Training Programme in Sri Lanka What is the THORN Training Programme?

The THORN Training Programme has become the model in the UK around which training for

mental health professionals working with individuals with a diagnosis of severe mental

illness is based. As a model of best practice for working with people with severe mental

illness, THORN has been in existence for over twenty years.

The THORN Training Programme owes its beginnings to The Sir Jules Thorn Charitable Trust,

which was established in 1964 by Sir Jules Thorn. The THORN Nurse Initiative (THORN

Training Programme) was one of the Sir Jules Thorn Charitable Trust’s Special Projects. In

1991 the Trustees committed funds in excess of £500,000 to what was then termed the

Project for Psychiatric Nursing, and later became the THORN Nurse Training Initiative and

more recently, The THORN Training Programme. The funding was to provide a new training

programme in the preparation of Community Psychiatric Nurses to provide care for people

who had serious mental illness.

Why Sri-Lanka?

Sri Lanka’s reputation as a provider of health services to its people is a good one. Yet Sri

Lanka lags behind in one crucial area - that of mental health. More than three decades of

conflict and the effects of the Tsunami have had a strong impact on the mental well-being of

the Sri Lankan population, especially on its most deprived sectors.

Sri Lanka has one of the highest suicide rates in the world and misuse of alcohol is frequent,

especially in areas affected by disaster. It has been estimated that 70,000 Sri Lankans suffer

from schizophrenia and this figure is expected to rise with the increase in the number of

young adults.

Access to mental health services is extremely limited and grossly disproportionate from one

area of the country to another. Insufficient attention has been given to the mental health

sector, and, at times, it is even forgotten.

One of the biggest developments in Mental Health in Sri Lanka has been the government’s

approval of the Mental Health Policy in 2005. This policy, prioritizes among other things, the

development of community-based mental health services and the decentralization of

services involving the downsizing of big mental hospitals with the provision of local mental

health facilities.

Mental Health Capacity Building in Sri Lanka

A number of groups and organisations have set up to address the training needs that arise

with efforts to improve provision of mental health facilities. UK-Sri Lanka Trauma Group is

made up of mental health professionals and others interested in trauma related and

general mental health matters in Sri Lanka. Current membership includes psychologists,

psychiatrists, medical practitioners, nurses, trainees and students as well as individuals

interested in mental health work. The UK-Sri Lanka Trauma Group is supported by the South

London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King’s College

London. It also has links with the University of East London and other NHS Trusts.

The UK-Sri Lanka Trauma Group’s activities are primarily aimed at “capacity building” in Sri

Lanka through training of frontline workers. This training is carried out in three levels: level

I – for volunteers and those with minimal skills, level II – for individuals who are working in

the mental health field but may not have a profession and level III – for mental health

professionals and other health professionals.

Samutthana is a Sri Lankan based charity set up by the UK-Sri Lanka Trauma Group. One of

the essential work-streams of Samutthana is general mental health capacity building. This

includes contributions to psychiatry training, clinical psychology training and mental health

nursing training.

In the UK, THORN has become synonymous with best practice for the care and treatment of

people with a diagnosis of severe mental illness and psychosocial interventions. Having been

in existence for over twenty years, the THORN Training Programme offers a proven and

established model around which training for health professionals can be effectively based.

Adapting THORN to the Sri Lankan context

For training to receive THORN validation the teachers on the course must be THORN

graduates and the curriculum must embrace:

1. Working collaboratively with service users and carers/families

2. A biopsychosical philosophy

3. Practitioner therapeutic optimism

4. Strengths ethos, in content and language

5. Recovery focus

6. Social Inclusion: for the individual, family and community

7. The Vulnerability-stress model and a Normalising Rationale

8. Multidisciplinary/agency working, learning and teaching

9. Clinical case management

10. Clinical Supervision

THORN training programmes, generally, follow a generic curriculum and developments in

the literature have been assimilated with an emphasis upon family intervention, cognitive

behavioural therapy and a consideration of the role of trauma in psychosis.

THORN Training in Sri Lanka will need to be adapted to suit the specific cultural context and

needs of local communities. It will need to be appropriate to local cultural beliefs and

practices and should take on board the current behaviour of the people of the country in

seeking help for mental health and wellbeing. Indeed, “working collaboratively with service

users and carers/families” is essential for any course to be THORN accredited.

Within the UK, THORN qualifications, accredited by a range of academic institutions have

ranged from courses offering 20-40 undergraduate credits to diplomas, postgraduate

diplomas, BSc courses and MSc courses. This range and flexibility offers additional

advantage to academic institutions in Sri Lanka, wishing to accredit THORN training

programmes according to their own objectives.

Next Steps

The first step will be a joint meeting between members of the THORN steering group and

the UK-Sri Lanka Trauma Group to discuss this project idea. The plan is for this meeting to

be held in the early part of 2013.

For further information contact:

Email: MAAldridge@hotmail.co.uk Tel: 07817 143198

Matthew Aldridge BA(Hons) BSc (Hons) THORN DipHE RMN