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.
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.
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.
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.