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Liberia’s Landmark Commitment to Mental Health Inspires Carter Center Program



November 7th, 2012
by Shelly Terrazas

The Carter Center, in partnership with the Liberian government and foundations, including Focusing Philanthropy and the John P. Hussman Foundation, is helping post-conflict Liberia dramatically expand mental health services with the goal of reaching 70 percent of its population.

The Carter Center is a not-for-profit organization founded by former U.S. President Jimmy Carter and his wife, Rosalynn, that works to further peace and health worldwide.

The third class of twenty-four locally trained and credentialed mental health clinicians in Liberia takes the country’s new Mental Health Clinician Oath during graduation ceremonies held in Bong County, Liberia, in August 2012. Photo Credit: The Carter Center/J. Cooper.

Anthony experienced one of the most dangerous things possible in the small West African country of Liberia—he had a seizure. (Anthony, not a real person, is an amalgamation of several people with epilepsy whom graduates of the Carter Center’s training program have seen.)

Anthony, age sixteen, has had regular seizures since he was a small child. In Liberia, epilepsy, a neurobiological disease, is not only considered a mental illness, it is thought to be contagious—not to mention a punishment for past misdeeds.

Anthony’s father is embarrassed by his son’s disease and the shame it has brought to the family. Anthony has no friends and is even taunted by his siblings. He regularly is injured while seizing—falling off his motor bike, for instance—since few are willing to assist him for fear that the illness is contagious. School is no sanctuary—Anthony is shunned when he goes there.

Anthony feels he is a burden to his family despite being smart, strong, and capable of holding a job.

The sad truth is that Liberians like Anthony historically have had few options for controlling their epilepsy. Traditional healers’ herbs have little effect, and health workers at local clinics have little knowledge of this condition. Few Liberian health professionals in this nation of 3.8 million people are trained in neurobiological diseases or mental illnesses. Until recently, citizens with these disorders had literally nowhere to turn for treatment.

And epilepsy isn’t the only mental health issue plaguing Liberia. Approximately 6 percent of the disease burden in Liberia is mental illness, like many other countries around the world. However, unlike many other countries, Liberia also has a high level of trauma resulting from the civil war, which ended in 2003. One study estimates that as much as 40 percent of the population suffers from post-traumatic stress disorder caused by war atrocities like gender-based violence.

Liberia needs help for its citizens—and it needs help fast.

To address this challenge, the Liberian government invited the Carter Center to help rebuild the country’s mental health services destroyed during the war. Launched in 2010, with initial support from donors including Focusing Philanthropy and the John P. Hussman Foundation, the center’s program also will help integrate mental health services in a sustainable way into the primary health care system.

Together with the Liberia Ministry of Health and Social Welfare, these organizations all recognized that addressing this need, both from social and economic perspectives, was paramount in helping Liberia rebuild after the war. The costs of not caring for people with mental illnesses—who if left without treatment often cannot work or care for their families—are tremendous. In Liberia, as in many parts of the world, even the most serious mental illnesses can be effectively and affordably treated, and most patients can resume functioning as contributing members of society.

For someone like Anthony, the medications used to treat epileptic seizures and keep them at bay cost pennies per dose. But it had been difficult to find a trained mental health professional who could accurately diagnose, treat, and monitor a patient with epilepsy. Because of the Carter Center’s program (funded by external funders and some funds from the center itself), this is changing.

To address the lack of mental health services in Liberia, the Carter Center’s program has three main goals: (1) train a sustainable and credentialed workforce of local mental health clinicians, including 150 specialized nurses and physician assistants who will work within the primary health care system to provide mental health services; (2) assist the Liberia Ministry of Health and Social Welfare in establishing and implementing its national Mental Health Policy, including dramatically increasing coverage to reach 70 percent of the population; and (3) create anti-stigma campaigns nationwide to improve public understanding of mental illnesses and help dispel myths about their origins and treatments.

Now, at the start of its third year, the Carter Center’s program is making headway. As of now, sixty-three trained and credentialed mental health clinicians operate in fourteen of the country’s fifteen counties—all have received a specialized, free, six-month training in diagnosing and treating the top-six mental health problems seen in Liberia.

The first national legislation for the protection of those with mental and physical disabilities has been drafted, and the bill is making its way through the Liberian legislative process.

And two national anti-stigma campaigns are under way—including dramatic skits on dispelling myths around mental illnesses, which are being performed in communities across the country to initiate group dialogue.

As a result, more families of people with mental illnesses are learning how to care for their loved ones and how to use the systems that already are in place or are coming on line with Carter Center support. It is hoped that with increased community support, the stigma and misperceptions that caused Anthony to be shunned at school and by his family may be reduced, and he will no longer be left alone or unaided when he has another seizure.

With the help of the funding organizations and the Carter Center, today Liberia is serving as a model for other countries in training mental health specialists and integrating them into the primary care system. The country also is forging national systems to protect its most vulnerable citizens, while bringing communities together to face the shared goal of better health.

Challenges in adequately caring for those with mental health needs still remain, but together with its partners, Liberia certainly is on the right track to building a healthier future and building hope for so many who had none before.

Related resources:

Carter Center, Rosalynn Carter Symposium on Mental Health Policy, “Beyond Stigma: Advancing the Social Inclusion of People with Mental Illness,” November 1–2.

Carter Center, “Meet Margaret Ballah: On the Frontlines of Mental Health Care in Liberia,” June 11.

Paige Rohe of the Carter Center, “Georgia Institute of Technology Professor ‘Computes for Good’ with Carter Center’s Mental Health Project in Liberia,” October 17, 2011.

 

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