PIH: Linking Community and Facility-level Mental Health care in Liberia
To provide mental health care at a facility and community level and reduce stigma in southeast Liberia.
Community-based, health center linked, and hospital- enriched approach to resilient mental health programming.
During the Ebola outbreak of 2014 and 2015, Partners In Health (PIH) worked closely with the government to help control the disease's spread through patient accompaniment, training, and expertise to support treatment centers. In the wake of the outbreak, PIH expanded its mission to strengthen and rebuild Liberia’s health systems, using our approach that had proved successful in countries like Haiti and Rwanda. PIH Liberia launched its mental health program in 2016 in the cities of Harper and Pleebo in Maryland County to provide needed mental health care. The program collaborates closely with the Ministry of Health to integrate mental health into primary care, drive innovation through community and outpatient mental health programming, and strengthen capacity of clinical providers and community health workers (CHWs).
- Through the homelessness program, the team has reintegrated 60% of the homeless population back into the community.
- The team launched and strengthened the implementation of Psychosocial Rehabilitation (PSR) Groups using their adapted PIH PSR curriculum, incorporating vocational skills training as part of the program.
- Created and impactfully led substance use group sessions for youth and adults, increasing availability of community-based mental health services
- 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.”
- Sign at entrance to JJ Dossen Hospital in Harper, Liberia
Partners In Health Liberia 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. As there are limited specialized mental health staff, local clinicians work in a task-sharing referral-based mental health system and collaborate closely with the Ministry of Health (MOH) to integrate mental health into primary care and drive innovation. PIH’s team strengthens facility-based mental health services to address coverage gaps, conducting psychoeducation, crisis management for emergency cases, and providing comprehensive treatment and support to identified patients.
The team advocates for mental health as a human right and its integration into the primary care system at the county and national levels. Mental health clinicians and primary care staff have been trained to accurately screen, diagnose, and treat people living with mental health conditions, using the WHO mhGAP, PIH curricula, and the Common Elements Treatment Approach (CETA).
Mental health Outreach
PIH Liberia works extensively to provide care and educate community members about mental health conditions via patient-led radio broadcasts, training, and traditional/faith healer engagement to destigmatize mental health conditions. Clinicians work with patients, families, and caretakers to normalize mental health conditions and demystify treatment, emphasizing the reintegration element of PIH’s Value Chain. Among their many community outreach efforts, they launched an innovative school mental health program, improving mental health awareness and school retention for over 3,500 students, parents and teachers in seven schools.
In 2021, PIH Liberia established psychosocial rehabilitation groups with peers and caregivers of people with severe mental health conditions to help recovering patients attain an optimal level of functioning and minimize disability by increasing individuals’ capacity to live successfully in the community. They implement a Community-Based Psychosocial Rehabilitation Curriculum and Training Package (developed by a working group across PIH), which champions a human-rights-centered approach to social reintegration by placing service users at the center of decision-making. Former patients are recruited as psychosocial volunteers and have helped expand the vocational program to help vulnerable patients establish income-generating activities, such as working in the local market.
A close partnership with the community health team provides treatment and social support to patients who are homeless and suffer from severe mental health conditions. The program reunites these patients with their families and promotes rehabilitation, stigma reduction, and community reintegration.
A close partnership with the community health team provided treatment and social support to over 150 people who were homeless and suffering from severe mental health conditions. Community Health Workers (CHWs) worked alongside community members to reunite these patients with their families and promote rehabilitation, stigma reduction, and community reintegration. Learn more about the program.
The team is collaborating with CHWs and traditional healers to promote quality improvement projects that increase case detection and referral of patients with common mental health disorders. They are also enhancing the quality of data management and launched their electronic medical record system in 2020 to collect and organize patient data at the facility level.
Collaboration: PIH Liberia partners locally with district-level, county-level, and central Ministry of Health teams for care delivery and policy making to prioritize mental health as an essential aspect of healthcare.
Community Engagement: The team works extensively in the community to provide care and educate community members about mental health conditions through patient-led radio broadcasts, training, and traditional healer engagement.
Clinical Support: Clinicians and psychosocial assistants undergo extensive training in mhGAP and CETA to accurately screen, diagnose, and treat people living with mental health conditions. To strengthen the MOH workforce, the team trains clinicians on crisis de-escalation, motivational interviewing, and other key skills. They also conduct regular supportive supervision for sustained improvements to care delivery and a continuously expanding capacity for data collection.
Capacity Building: PIH Liberia is scaling up capacity building strategies for local mental health care providers by continuing to train staff in innovative adapted psychotherapy methods, such as CETA, PFA, and supervisory care pathways to enhance efficiency and quality of care.
Limited resources for mental health: Liberia faces inconsistent supply of medication, which limits the treatment options available to patients. Additionally, due to the geographic isolation of Maryland County, there is a shortage of mental health professionals training and operating, making it challenging to prioritize mental healthcare treatment in the health system.
Stigma: There is a long history of stigma towards mental health conditions, which makes it difficult to promote and implement community-based care systems. Discrimination from families and communities have historically pushed mentally ill patients into the streets, resulting in low community support for the homeless population.
Limited capacity: Despite the growth over the years, the team continues to face various technological and resource challenges in properly training both general providers and mental health professionals in new psychotherapy methods, such as CETA and psychological first aid (PFA), to address the expanding needs of the program.
Care Delivery Strengthening: PIH Liberia is integrating work into primary health care systems and strengthening collaboration between the facility and community. The team is also continuing to work on quality improvement projects via increased utility of electronic medical record systems and the continuation of CETA.
Data Management and Quality Improvement: The team’s capacity has grown tremendously, including the finalization of an electronic medical record system using OpenMRS, and the launch of CommCare to collect patient-level data at the community level. In 2020, tele-health services were piloted to provide appropriate interventions while in-person services remain limited during COVID-19.
Cost of implementation
They plan to have data regarding the cost-effectiveness of their intervention in the near future.
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.
Since July 2021,PIH Liberia has implemented Psychosocial Rehabilitation (PSR) Groups for people with severe mental health conditions.
Created and impactfully led substance use group sessions for men & women, increasing availability of community-based mental health services.
- Vigo D. (2016). Report on disease burden of mental illness across Partners In Health sites. PIH, Boston, US.
- 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. http://www.who.int/bulletin/volumes/88/7/09-071068/en/
- 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. https://www.ncbi.nlm.nih.gov/pubmed/28750617
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