Comment 328 www.thelancet.com/psychiatry Vol 1 October 2014 Published Online July 29, 2014 http://dx.doi.org/10.1016/ S2215-0366(14)70274-3 Teaching global mental health at home and abroad Although much has been published in the USA, and elsewhere, about global health rotations for medical students, including consensus guidelines, 1 few papers have addressed global mental health education, and those that do focus largely on post-graduate training. 2,3 This Comment examines the lessons learned from present global health training models and recommends ways to improve educational experiences about global mental health. A typical global health programme at a US medical school comprises a didactic portion and an international rotation. Students travel to other countries, usually in Africa, Latin America, or South Asia 4 and participate in clinical service delivery. Cultural immersion is expected to introduce unique health perspectives and equip students for modern day practice. Yet before we can develop effective education for global mental health, five questions require consideration. First, what determines expertise? Sending students from high- income countries to countries with low and middle income perpetuates perceptions that global health is foreign aid, and that only developed countries have the expertise to solve problems in the world’s poorest societies. 5 Didactics about the global burden of diseases and the social determinants of health offer the knowledge base, but do not assure competence in low income and poorly resourced settings. Second, where will the student fit? The exact role—medical student, junior practitioner, or health educator—is unclear. Definition of the students’ responsibilities and roles while on away rotations is difficult because existing medical training, heavy on inpatient technological medicine, does not prepare students for work in low-income settings. Third, how will the student benefit? Although the rotation is expected to benefit the student, the experience gleaned from international rotations is often not the exchange of knowledge and skills with local practitioners, but so-called survival in settings with limited resources. Fourth, how to ensure quality of care? Supervision is a major challenge. 6 Although some trainees enjoy greater flexibility and responsibility in resource-strained settings, this should not equate with tolerance for lower quality care. Students should gain competency in domestic settings before adapting their skills for global practice. Last, what are the benefits to the host country? Ensuring shared benefit between trainees and host countries is an important challenge in global health education. Although evidence supports the value of international rotations for trainees, far less comparable data exists detailing the experience of host institutions. 7 Training models informed by exchange of expertise will more probably yield mutual learning, and be responsive to the needs of the host country. 8 Worldwide, medical students learn mental health- care as applied to individual patients, through the development of skills in diagnosis, medication management, and occasionally restricted exposure to psychotherapy. Students rarely engage in population- based approaches, such as screening for mental health disorders in primary-care settings, and employing treatment algorithms to manage multiple patients. 9 At Yale Medical School (CT, USA), the authors are piloting a programme in which medical students are trained to function as community mental health workers in a low-resource primary-care setting with a large uninsured Latino population. The programme moves away from prescribing as the only method of care, towards deployment of specific, evidence-based, and often underused skills (eg, psychoeducation). Curriculum development was guided by the question; “What skills are needed to perform well in this setting?” rather than “What should medical students learn or do to become junior psychiatrists?” Educational manuals developed by non-governmental organisations (Basic Andres Barkil-Oteo