Strengthening Systems of Care in Haiti for the Long-term

The Haitian Ministry of Health (Ministère de la Santé Publique et de la Population; MSPP) has prioritized mental health as a central component of the rebuilding effort, with the ultimate goal of a national mental health plan and decentralized mental health services. PIH and its Haitian sister organization, Zanmi Lasante (ZL) and the PGMHSC have been working closely with the MSPP toward a coordinated national response, to develop within the ZL system locally feasible and lasting structures for community- and clinic-based mental health care and, over time, to establish generalizable models for systems of mental health service delivery for Haiti and its people.

Supporting Service Delivery in Haiti in Response to Acute and Chronic Disaster

Since the 2010 earthquake, PIH and ZL have worked to implement a comprehensive, Haitian-led response to mental health needs for a catchment area of more than 1.4 million people. The adverse mental health impacts of ensuing acute and profound losses were compounded by a subsequent cholera epidemic, chronic manifold social adversities, and longstanding resource gaps for mental health care. Measures taken since the earthquake have included more than tripling the size of the pre-existing mental health and psychosocial team, and the integration of mental health services with both medical and community-based psychosocial interventions. By September, 2010, the ZL mental health and psychosocial support team had offered more than 10,000 support services in Port-au-Prince spontaneous settlements alone, including psycho-education, counseling, and individual and group therapy. With the construction of a world-class teaching hospital at Mirebalais, there exists a timely opportunity to develop a model hospital-based, public-sector mental health service.

Developing Research Capacity for Mental Health Interventions for Youth in Central Haiti

Numerous cultural and social barriers undermine access to mental health care in Haiti, particularly among youth. An important foundation for addressing this in central Haiti was established with the development of the “Tout Timoun Se Moun” (“Every Child is a Person”) Program by ZL in 2006-8, through federal US funding. This psychosocial support group helps to improve communication and coping for adolescents and their HIV-positive parents living in rural Haiti. Empirically supported interventions to improve access to mental health care for youth continue to be urgently needed. The goals of this work are to develop local institutional capacity for mental health implementation research in Haiti within ZL, while also implementing and evaluating a school-based pilot program to promote access to care for Haitian youth with mental disorders.

Strengthening Mental Health Service Delivery, Infrastructure and Research Capacity in Rural Rwanda

With two psychiatrists and two neurologists for more than nine million people, hospitals and clinics in rural Rwanda are faced with a high burden of neuropsychiatric problems. The Rwandan Ministry of Health (MoH) is committed to addressing mental health problems, and innovating community-based approaches to decentralized mental health care. PIH, with its Rwandan sister organization, Inshuti Mu Buzima (IMB), supports the Rwandan MoH in its efforts to combat this burden of mental illness through preventive and clinical approaches. PIH/IMB provide technical support to district hospital and health center staff—including physicians, hospital and clinic nurses, psychologists, psychiatric nurses and social workers—at three sites in rural Rwanda. These sites mobilize large numbers of community health workers (CHW) to attend to both infectious and noncommunicable diseases, with the imminent elaboration of a CHW mental health component. This initiative builds on Rwanda’s MoH efforts to expand its successful HIV initiatives through scalable approaches to health care delivery for chronic conditions common in rural areas, including heart disease, diabetes, hypertension, hemato-oncologic and neuropsychiatric conditions. With the recent opening of a world-class teaching hospital at Butaro in northern Rwanda, there exists a timely opportunity to develop model hospital- and health center-based public-sector mental health services.