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Global Behavioral Health

  • A group of Liberian health professionals participate in a Center-supported training program that accredits them as mental health clinicians. The Carter Center works with the government of Liberia and other local and international partners to strengthen public mental health. (Photo: The Carter Center)

The Mental Health Program is guided by the Carter Center’s belief that access to health is a human right and that mental health is necessary for overall health. The Global Behavioral Health Initiative is actively engaged in the global mental health revolution, a collective effort to decrease stigma and improve access to mental health services and supports. This work enables low- and middle-income countries, such as Liberia, to enhance overall health, reduce inequities, and achieve the United Nations Sustainable Development Goals (SDGs).

The Global Behavioral Health Initiative is focused on:

• Ensuring a sustainable, quality, and accessible behavioral health system in Liberia through comprehensive support and technical assistance.

• Capturing knowledge and lessons learned in Liberia to help other countries navigate their behavioral health needs and adapt and implement best practices.

• Exploring the intersection of behavioral health and other global health and development priorities, such as the role that mental health support can play for people affected by neglected tropical diseases (NTDs).

Current Efforts in Global Behavioral Health

  • Working with the government of Liberia, The Carter Center has helped create a corps of over 340 locally trained and credentialed mental health clinicians who work in all 15 counties in the country; 120 of those clinicians specialize in child and adolescent mental health care. (Photo: The Carter Center)

Strengthening Liberia’s Behavioral Health System

The Carter Center’s Mental Health Program in Liberia aims to strengthen and sustain a public mental health system in partnership with the government of Liberia and local stakeholders. Activities in Liberia support the program’s strategic goals, including:

Workforce Sustainability

Supporting the development of a self-sustaining system for training, credentialing, and continuing education in behavioral health managed by Liberian institutions.

Human Rights and Inclusion

Helping demonstrate improved social inclusion and advancement of rights of people with behavioral health disorders to obtain needed services and supports.

Law and Policy

Providing technical assistance to fully realize the country’s Mental Health Law by developing, implementing, and enforcing relevant statutes, regulations, policies, and budget allocations.

+Key Initiatives

The Mental Health Program in Liberia is engaged in a number ofseveral initiatives to strengthen the behavioral health system and promote quality, accessible mental health services for all Liberians.

  • Training a mental health workforce and building capacity of key partners to embed training in schools of nursing, maintain rigorous credentialing processes, and ensure classification of mental health clinicians in the national civil service system.
    • The Carter Center and Deanna K. Isaacson School of Midwifery are currently training the seventh cohort of child and adolescent mental health clinicians (CAMHCs). The training brings the total number of CAMHCs to 140 and brings Liberia closer to achieving the current National Mental Health Strategy goal of 160 CAMHCs across the country by 2021.
  • Integrating mental health into other health and development priorities, including maternal mental health, neglected tropical disease management, school-based mental health, and early childhood development, with adapted tools and trainings.
    • With support from Open Society Foundations, The Carter Center is driving the adaptation, training, and implementation of Thinking Healthy Liberia, a WHO-endorsed manual for perinatal mental health.
    • The Carter Center and the Liberian Ministry of Education are working to scale up early childhood interventions in schools, supported in planning by the Bernard Van Leer Foundation.
  • Reducing stigma associated with mental illnesses by training journalists, religious/traditional healers, law enforcement, and service users and their families on anti-stigma knowledge, attitudes, and practices.
    • Working with the Mental Health Reporters Network, the first mental health reporting organization in Liberia, The Carter Center trains journalists on how to combat stigma and misinformation through accurate and sensitive reporting on mental health. This initiative leverages the insights and network of the Rosalynn Carter Fellowships for Mental Health Journalism program and decades of the Center’s experience conducting anti-stigma dialogues with faith/traditional leaders, caregivers, and communities in Liberia.
    • Training law enforcement and mental health clinicians in crisis intervention team (CIT) programs. The Mental Health Program in Liberia has been working with the Liberia National Police to educate law enforcement and mental health clinicians on de-escalation and build alliances between the law enforcement and mental health communities in order to improve community response to mental health crises.
  • Building capacity of civil society organizations such as the Liberian Center for Outcomes Research in Mental Health (LiCORMH) and strengthening advocacy efforts of user-led groups.
    • The Carter Center assists LiCORMH, established as an independent research organization in 2009 by The Carter Center, The John F. Kennedy Medical Center, and the Ministry of Health. The mission of LiCORMH is to advance quality mental health services and supports through research.
    • Anti-stigma efforts have led to the development of the nation’s first mental health consumer advocacy group, Cultivation for Users' Hope (CFUH), established and led by users of mental health services. The Carter Center supports CFUH to advance the social inclusion and integration of mental health service users through sustained advocacy and effective community engagement. CFUH is the Liberian leader for the global Speak Your Mind campaign.
  • Assisting the government of Liberia to establish, implement, and enforce policies and plans for mental health financing and service provision. These have included the 2016-2021 National Mental Health Policy and Strategic Plan, the mental health component of the Essential Medicines List, and standards for Mental Health Nursing.
    • The Carter Center is currently conducting a mental health financing assessment, working with United for Global Mental Health and the government of Liberia.
  • Ensuring supply of needed psychotropic medications in partnership with MAP International and providing adequate training in psychopharmacology and clinical management of substance use disorders to mental health clinicians and pharmacists.
    • The Carter Center and MAP International have a five-year agreement to support the delivery of psychotropic medications to Liberia until 2024. 

To ensure the sustainability of these services and supports, the Mental Health Program in Liberia works with Liberian institutions and stakeholders including people with lived mental health experience; the Ministry of Health; the Ministry of Education; the Ministry of Gender, Children, and Social Protection; The John F. Kennedy Medical Center; County Health Teams; The Liberian Board of Nursing and Midwifery; Phebe School of Nursing; Deanna K. Isaacson School of Midwifery; The University of Liberia; The Liberia National Police Academy; The Liberia National Physician’s Assistants Association; Liberia Nurses Associations; Liberia Parent-Teacher Association; and other valued partners in the field.

+Mental Health Program Responds to COVID-19 in Liberia

The Carter Center Mental Health Program in Liberia is drawing on wisdom gained during the Ebola outbreak of 2014-15. As a trusted member of Liberia’s Incident Management System (IMS) that manages the country’s response, the program provides technical assistance to the country’s COVID-19 response. The program collaborates with the government on strategies aimed at reducing acute stress or exacerbated mental health problems associated with containment measures, such as lockdowns and quarantines in affected counties. Further, it supports mental health professionals in their provision of a range of mental health and psychosocial services (MHPSS), provides administrative support to the MHPSS pillar, and ensures integration of MHPSS services across the response pillars. The Mental Health Program in Liberia has been working on the response pillar headed by the Ministry of Gender, Children, and Social Protection, the line ministry leading welfare and response efforts, and on the IMS to ensure that mental health and psychosocial support are included in all aspects of the response.

+Impact

The Carter Center has engaged multiple sectors in the provision of mental and psychosocial support. Across the health, education and social service sectors, professionals have attained competencies in mental health clinical care, mental health identification and referral, neuroscience, anti-stigma activities, crisis intervention, and much more. The growing number of multi-sectoral mental health advocates and champions, as well as mental health infrastructure and resources, can be seen below:  

Program alumni continue to make a lasting impact in their communities, establishing new services, fighting stigma and misinformation, sharing knowledge resources, and facilitating healing dialogues. Some alumni are educators who return to classrooms to ensure the next generation of primary care workers will be better prepared to deliver mental health care. Others lead policy and strategy development, head up health care institutions such as the Liberian Ministry of Health and SOS Health Center Villages, and are on the vanguard of emergency response. As with the Ebola outbreak, mental health clinicians and mhGAP-ig trained providers are on the frontlines of Liberia’s COVID-19 response.

Addressing Mental Health in Haiti

  • The Carter Center's Mental Health Program, working closely with the Center’s Hispaniola Initiative aimed at the elimination of malaria and LF, is assessing the efficacy of an integrated mental health and NTD intervention in Haiti. (Photo: The Carter Center/ L. Desir)

The mental health of persons with Neglected Tropical Diseases (NTDs) has been referred to globally as the most neglected of neglected diseases. Haiti is one of only four lymphatic filariasis -endemic countries in the Americas. Despite successful mass drug administration efforts through the National Program to Eliminate Lymphatic Filariasis, 14% of districts still identify over 1,500 patients with LF, and few institutions have the capacity to provide adequate management and care for this population.

Many persons with LF experience stigma and social disconnectedness, impeding their ability to work, pursue education, and contribute to society. Thus, the World Health Organization recommends that individuals with LF “should also have access to psychological and social support to assist their reintegration into society and economic life.” However, there is little research to identify models of care that would effectively address the comorbidity of NTDs and mental health conditions.

The Mental Health Program, working closely with the Carter Center’s Hispaniola Initiative aimed at the elimination of malaria and LF, is assessing the efficacy of an integrated mental health and NTD intervention in Haiti. With funding from the Coalition for Operational Research on NTDs (COR-NTD), the program is testing the evidence-based Chronic Disease Self-Management (CDSM) model among a population of persons with LF as an intervention for addressing symptoms of mental illness. This model has been implemented in various parts of the world and has been shown to improve symptoms of depression while improving health efficacy among people living with chronic diseases.