SOURCE: E. ORLIND COOPER OF DEVELOPMENTAL MEDIA INCORPORATED
People with Mental Illness or epilepsy have always been stigmatized and
discriminated as outcast in the Liberian Society. They do not get
decent employment; they are not allowed to interact with others nor do
they participate in the general decision making of their community. In
some communities, mentally ill persons do hard labor such as cleaning
the dirt, lifting a heavy load among others.
The Carter Center in Liberia runs a Mental Health Program that is making significant headways aimed at catering to the needs of the missing link in the revitalization of Liberia’s Health system following the fourteen years civil strife in Liberia. The purpose of “Mental Health Beyond Facilities (mhBeF)” is to develop and implement a sustainable, holistic community based methodology of care for people with mental disorders. The Mental Health Beyond Facilities Project (mhBeF) aims to provide a comprehensive community based mental health services package. As a pilot initiative, it is a multi-country project implemented in three post conflict nations: Uganda, Nepal and Liberia. In Liberia, the project is predominantly implemented in six (6) administrative districts in Sinoe County in the Southeast.
The Liberia’s Project Coordinator, Wilfred Gwaikolo, Jr. says that for the first time in the Country, the Project will form what is referred to as “Patients Support Group” to provide direct recovery mechanism for patients with mental illness. “Basically, this component brings together Mental Health Service Users and their Family Members and they meet regularly to provide support to one another”; adding that, “the project provides seed grant to them to identify their skills and see that they can do business or something to move forward”.
Mental Health Beyond Facilities
When asked as to why mental health beyond facilities, Mr. Gwaikolo intimated that the Carter Center and partners have realized that confining people with mental illness to the health facilities violate their basic human rights as they have illness as any other person with Malaria and other sicknesses. “The BEST way to take care of persons with Mental Disability as anybody with any other sickness like Malaria and any other sickness is within the community; they stay with their parents and then people provide support to them”. They young social worker also emphasized that the project model is designed to a success story in that people with severe mental disorders will lead symptom free, stigma free, economically productive lives.
“We’ve seen in many countries now, that if you concentrate all of your resources in Psychiatry Hospitals or Psychiatry Centers, it is very expensive and it doesn’t help people to get better in terms of their psychiatry conditions and their social conditions”; says Dr. Brandon Kohrt, a consultant of the Carter Center Mental Health Program. Dr. Kohrt noted that “The Community based treatment is the BEST way for
people’s lives to be improved at a feasible cost.”
Treatment and Care
To present, the Carter Center Mental Health Program has trained about 100 Mental Health Clinicians (MHC) around Liberia. An addition of 23 Mental Health Clinicians are currently in training as Cohort-6 at the Phebe Hospital in Suakoko, Bong County. These MHC are expected to graduate on February 28, thus making it 123 trained out of the total 150 MHC to be trained under the program. These trainings have been very intensive with Clinicians spending sufficient time understanding Mental Health Issues. Mid level health workers are also provided short term trainings to provide treatment to patients and do referrals for cases beyond their reach. Also the General Community Health Volunteers (gCHV) in the Project’s Pilot County, Sinoe, are provided basic skills to create community awareness; make referrals to the health center for treatment and work with the project’s model, Patient Support Group (PSG).
“We are training a lot of nurses PAs (who are Physician Assistants), and Midwives to be able to do basic Mental Health Care”; Dr. Kohrt further emphasized, “We are teaching them how to do diagnosis, how do you identify someone who has a psychotic disorder, or who has something called Bipolar Disorder and or people who has epilepsy”.
The trained MHCs provide medical treatment and psychosocial support to people with mental illness. Akoi Jaygbeh of the F. G. Grante Hospital in Greenville, Sinoe County, says that his Wellness Clinic at the hospital has been predominantly handling cases of “Epilepsy or may literally be referred to as falling sickness to avoid stigma” adding he feels “very good working with people with mental illness even though it is sometimes difficult”.
Dr. Kohrt and Mr. Jaygbeh both attributed the treatment challenge to the unavailability of the best medicines to treatment mental illness in the Country. “The challenge is that a lot of the best medicines for these treatments are not available so they [clinicians] are working under very difficult conditions!” exclaimed Dr. Kohrt.
Using Information Technology (IT) for MhBef
An application that works on an android mobile phone was developed to enable clinicians to upload their patient data in the clouds and is assessable at anytime and from anywhere. “With technology or IT, you have a decentralized storage of Information”; Paul Tumwine, the Project’s IT Support Officer from Uganda, expands on the significance of using IT to synchronize treatment and care to people with mental illness. “If you have a database in the cloud, then this patient information does not have to be always with this one hospital. That means this medical history can be accessed from anywhere”, the young Ugandan Specialist stressed.
Myths, Misconception, Stigma and Discrimination
As there are several myths, misperception and deep-rooted beliefs associated with the causes of mental illness in the community, it is also visible among clinicians and other health care givers. People in the entire Liberian Society have beliefs that are very stigmatic and discriminatory to people with mental illness and epilepsy. Several of the General Community Health Volunteers (gCHV) explained that generally people believe that mental illness is associated with witch craft activities or breaking the laws of voodoo. Additionally, the gCHVs pointed to the strong beliefs of epilepsy being highly contagious. “If we touch the saliva of a person with spell (a stigmatizing term) used to refer to an epileptic patient), we will catch it”; exclaimed T. Koon Dixon, a gCHV of Butaw, adding; “That is why we run far from them when they fall down (experiencing epileptic seizure).” But with the Carter Center Mental Health Training, Koon is now moving back to his community with a different perception. He and eight (8) other gCHVs leave the training with fresh knowledge to mobilize community dwellers and raise awareness and reduce the stigma and discrimination against people with mental illness. The gCHVs are otherwise known Community Resource Persons (CORPs) under the Carter Center Mental Health Program.
A unique way to break the myth and misconception was that the crafters of the project brought together all of the stakeholders to a training in Greenville during the second week of February. The gCHVs, MHCs, Midlevel Health workers, Social workers and the Users or patients mingled together, learning from one another and even eating together. This enabled a considerable shredding of the beliefs that Mental illnesses are contagious or should be treated differently from others sicknesses.
“Unfortunately, we found out that not only that stigma is high among community workers, but also with among health care workers”; Dr. Kohrt asserted, adding; “In one study, more than 40 percent of Nurses noted that epilepsy was contagious. So there are very high rates of stigma to deal with”.
Most of the patients from different parts of Sinoe County shared how improved their conditions have been since they started getting treatment. Henry Jleh [not his real name] noted that “I earlier thought that I was never going to stop falling”. The handsome and brilliant young man shared the terrible psychological pains he continues to face from friends and family even as he is recovering and there are no moments of epileptic seizure as he continuously adheres to medical advice. “With the way some of my friends and family members have started interacting with me again, I have the hope that it will soon be over”, Henry expressed optimistically.
The patients and their family members have formed the Sinoe County Support Group and Henry was elected as one of the official to steer the group to progress.