Innovation summary

Liberia is recovering from a civil conflict that lasted from 1989-2003 and a recent Ebola crisis (2014-2015), both of which contributed to the burden of mental ill health.  Before the establishment of the mental health program in remote Maryland County, the closest mental health treatment available required a trip to the capital Monrovia, which can take several days by road.

The program described here provides mental healthcare at two clinics: JJ Dossen Hospital and Pleebo Health Center, the only regional hospital and health centers in southeast Liberia that contain clinics exclusively for mental health. JJ Dossen is the referral hospital and Pleebo Health Center is the largest health center in Maryland. The mental health team also supports and trains clinicians across the county and provides individualized care to over 50 homeless patients in the cities of Harper and Pleebo. The program works closely with law enforcement, the local prisons, and community health teams to bring treatment to homeless patients and others who would not normally have access. Together with its partners, the mental health program also generates social awareness campaigns to reduce the stigma surrounding mental illness in the region.

Impact summary

  • Over 600 patients treated and 4500 clinic visits from May 2015 to September 2017
  • 7 mental health clinicians and 2 mental health community health workers trained and 15 mhGAP-trained clinicians
  • 24 homeless patients on treatment, 27 reunited with family/support as of November 2017 and 21 patients on treatment at Harper prison as of June 2017

“Good mental health is your right, seek mental health services here.”

- Large sign at the entrance to JJ Dossen Hospital in Harper, Liberia

Innovation details

Partners In Health’s commitment to long-term interventions and health system strengthening is reflected in the mental health team’s activities in Liberia.  The team focuses on advocacy and stigma reduction associated with mental illness as well as providing treatment and improving pathways to care with grassroots, community-based programming.  Two mental health clinics in Maryland County provide services for mental health conditions like depression and psychosis, as well as neurological disorders such as epilepsy.  Outside of the clinics, the team works extensively with homeless patients to build rapport, provide treatment and social assistance, and help them reintegrate with families and communities.

Partners In Health (PIH) established the mental health team to work alongside the Ministry of Health’s initiatives in 2014.  At the time, diagnostic patterns did not accurately reflect the burden of mental illness in the region, with epilepsy and psychotic disorders consisting of the majority of diagnoses.  With one psychiatrist in the country, fewer than 147 mental health clinicians with six months of training, and 131 primary care clinicians with supplementary mental health training through the WHO’s mhGAP training, our program fills the need for additional mental health services. Additionally, the team spends substantial time working with homeless patients in Harper and Pleebo, the two largest cities in Maryland County. Clinicians and community health workers provide individualized care by identifying patients who are often suffering from severe mental illnesses and working to build rapport before initiating treatment. They follow up as often as on a daily basis providing medication, food, clothes, and hygiene as needed. Importantly, the team also works with patients’ families and communities to reduce stigma by discussing the realities of mental illness, what to expect from treatment, and how to best provide support.

Patient Identification and Treatment Administration

Since the establishment of the program, PIH has worked together with the Ministry of Health to significantly improve diagnostic patterns, and initiation and adherence to treatment.  Training has allowed the clinics to identify and reach patients with a host of conditions including anxiety, depression and PTSD, as well as substance use and conduct disorders in addition to the more commonly diagnosed conditions like epilepsy and psychotic disorders. For our homeless patients, treatment administration means spending time getting to know each person and establishing a relationship based on trust. This process usually consists of our clinicians and community health workers sitting and conversing with potential patients, sometimes over the course of many days, to understand their circumstances and explain the course of treatment.

Psychosocial Support

The team works together to provide psychosocial counseling and support to reduce stigma connected to mental illness and epilepsy.  Clinicians work with patients, families, and caretakers to normalize mental health conditions and break down common misconceptions.  Our motto of “no health without mental health” exemplifies our strategy to endorse mental healthcare as a fundamental aspect of overall wellness. Since the initiation of the program, this support has helped 27 of our formerly homeless patients reunite with their families and reintegrate into their communities.

Community Involvement

A close partnership with the community health team provides treatment and social support to over 50 homeless patients suffering from primarily psychotic disorders.  Our community health workers reach out to patients daily to ensure they receive medication, food, and hygiene. The team has successfully reunited patients with their families and communities and has made strides in reducing the stigma that is frequently a barrier to care for patients with severe conditions.  The team also provides services to the local prison in Harper to provide treatment to inmates and to counsel prison staff on managing stress and maintaining good mental health.

Professional Development

The mental health team regularly facilitates refresher training for mental health clinicians and primary care clinicians trained in the mhGAP program. By collaborating with Ministry of Health clinicians, the team hopes to implement a task-sharing model to increase the identification and expand pathways to care for patients.

For more PIH innovations on MHIN, please visit the PIH organisation profile

Key drivers


Partnerships with district-level, county-level and central Ministry of Health teams prioritize mental health as an essential part of overall healthcare.

Clinical Support

Primary care clinicians trained in mhGAP help identify and treat patients in the parts of the county that have limited access to mental health specialists.


Coordinating with the PIH community health team ensures that homeless patients receive care through the involvement of our community health workers, who provide support on grassroots level.


Medication Supply Chain

Inconsistent supply of medication limits the treatment options available to patients.

Human resources

There is a shortage of mental health professionals training and operating in Liberia and limited prioritization of mental healthcare treatment in the health system.

Rural Communities

Remote location of Maryland County presents challenges to the availability of clinicians.


There is continued stigma towards patients and clinicians working in mental health care. 


Community Awareness

Our program endeavors to expand our current community engagement model to areas of particularly high risk, such as extremely remote communities and communities with high risk activities like mining.  Patients in these places are often highly stigmatized, vulnerable, and hard to reach. The aim to increase service delivery as well as engage in discussions with community leaders about reducing stigma and optimizing pathways to care.

Social Assistance

The next step is to extend social support to the most vulnerable patients, especially refugees, children, the elderly, and those living in abusive environments. They also plan to introduce job training for their patients who have made significant improvements.

Expanded Professional Support

To strengthen local involvement and ownership of health initiative, PIH hopes to increase the number and scope of trainings they offer around the county.  By expanding training and developing a protocol for consistent supervision, they can not only identify treatment gaps and facilitate collaboration between clinicians at various levels of the health system, but also increase the overall quality of care for patients.

Data Collection and Management

PIH would like to optimize their data collection and reporting standards to better recognize patient outcomes and evaluate their impact. With concrete quantitative information, they plan to target donors and funding opportunities to further expand our programming.

Evaluation methods

The mental health team is in the process of updating PIH's monitoring and evaluation methods. They are switching from a paper-based system to an Electronic Medical Record (EMR) system that will capture diagnostic and treatment information for all patient visits to both the mental health and non-communicable disease clinic at JJ Dossen Hospital.  The information from the EMR will help them track patient outcomes by tracking visits and capturing changes in mental status using the PHQ-9 questionnaire as an indicator. 

Cost of implementation

They plan to have data regarding the cost-effectiveness of their intervention in the near future.

Impact details

As of September 2017, they have treated more than 600 patients at two different mental health clinics in Maryland County.  They have the capabilities to treat patients with a gamut of mental disorders, including common disorders like anxiety and depression, childhood disorders like ADHD and conduct disorder, psychotic disorders like bipolar disorder and schizophrenia, and various other conditions.

As of September 2017, their mental health community health workers follow 24 patients and provide treatment on a daily basis. The team provided a refresher training in 2017 for 15 mhGAP-trained clinicians from across the county. A recent research study in collaboration with the mental health team will result in three upcoming publications focused on mental health in Maryland County.


  1. Vigo D. (2016). Report on disease burden of mental illness across Partners In Health sites. PIH, Boston, US.
  2. Kruk ME, et al. (July 1, 2010). Availability of essential health services in post-conflict Liberia. Bulletin of the World Health Organization, 88(7): 527-534.
  3. Gwaikolo WS, Kohrt BA, Cooper JL. (July 27 2017). Health system preparedness for integration of mental health services in rural Liberia. BMC Health Serv Res, 17: 508.
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