Fighting Disease: Liberia
The psychological impact of more than a decade of civil conflict, which ended in 2003, has contributed to a mental health crisis in Liberia that has been intensified by misconceptions, stigma, and the resulting discrimination surrounding mental illnesses; lack of mental health care training for health professionals; and inadequate supplies of necessary medications. The Ebola crisis further exacerbated these needs.
In 2010, building upon nearly two decades of fostering peace and democracy in Liberia, the Carter Center Mental Health Program launched a five-year initiative to help create a sustainable mental health system in Liberia. The initiative has centered upon training a sustainable mental health workforce, assisting Liberia's Ministry of Health in implementing the national mental health policy and plan, as well as reducing the stigma surrounding mental illnesses and empowering family caregivers.
Training a Sustainable Mental Health Workforce and Responding to Ebola
From 2010 through 2015, The Carter Center and its partners trained and graduated 166 mental health clinicians in eight groups. The Center's partnership with Liberia's Ministry of Health and the Liberian Board of Nursing and Midwifery also has resulted in an accreditation exam for graduating mental health clinicians. These accredited clinicians now work throughout the country in all sectors of health service delivery, and at least one mental health clinician works in each of Liberia's 15 counties.
Since 2010, program alumni have made a lasting impact in their communities by establishing new services at the ground level. Clinicians have opened 10 clinical practices in prison systems, trained nurse midwives to screen for maternal depression, treated refugees from the Ivory Coast conflict, supported the nation's first mental health consumer organization, worked in Ebola treatment units, and provided psychosocial support to individuals and families affected by the Ebola virus. Some alumni also are educators who return to classrooms to ensure the next generation of primary care workers will be better prepared to deliver mental health care.
Assisting with Implementation of National Mental Health Policy
The Carter Center has provided significant policy support to Liberia's Ministry of Health and its mental health agenda. The program was instrumental in facilitating the drafting of a bill for national mental health act legislation. The bill protects and promotes the human rights of individuals living with mental illnesses and provides a policy platform for future work.
With support from Liberian partners, The Carter Center continues to advocate for the bill's passage. Furthermore, The Carter Center responded to calls from the Ministry of Health in the National Mental Health Plan and helped to establish the Liberian Center for Outcomes Research in Mental Health (LiCORMH). LiCORMH is an independent research body focused on the translation of effective interventions into routine mental health care practice, clinical epidemiology, and community-based participatory research and evaluation.
To reduce the stigma associated with mental illnesses and empower family caregivers, The Carter Center has conducted a wide range of anti-stigma training courses. Between 2010 and 2015, The Carter Center conducted trainings for nearly 200 pharmacists, journalists, and law enforcement officers, as well as faith/traditional leaders, users, and caregivers, on anti-stigma knowledge, attitudes, and practices. Anti-stigma efforts have led to the development of the nation's first consumer advocacy group. This group, called Cultivation for Users' Hope, has worked with The Carter Center in training and educating journalists, pharmacists, law enforcement officers, and mental health clinicians about the rights and experiences of people living with mental illnesses.
Current and Next Steps
In 2015, The Carter Center began implementing a three-year initiative to address the psychological effects of Liberia's Ebola crisis and to promote psychosocial health in the country. The project, Supporting Psychosocial Health and Resilience in Liberia, is funded by Japan through the Japanese Social Development Fund, a trust fund administered by the World Bank, and is expected to reach approximately 18,000 beneficiaries in two counties: Montserrado, where the capital Monrovia is located, and Margibi.
Building on its success from 2010 to 2015, The Carter Center will focus on strengthening the capacity of the Liberian institutions assuming responsibility for ongoing training, policy, and anti-stigma efforts during the coming three years. By the end of 2018, The Carter Center will have facilitated the integration of post-basic mental health training into Liberia's national curriculum for nursing schools, and transitioned the training of a specialized mental health workforce to Liberia's Ministry of Health.