Liberia has a unique history of trauma that has battered her people in waves. Before a generation could recover from a brutal civil war, the Ebola virus hit them – a crisis that shook the world in its relentless ferocity.
During the 2014-15 Ebola outbreak, existing trauma was compounded by the devastating truth that infection and certain death could result from a loving touch or an act as simple as breathing.
The messages were difficult to translate and hard to heard. Don’t touch. Don’t visit your mother; she is dying. Don’t breath the same air as her. Yes, she is in agony. No, you can’t even say goodbye.
Such levels of repetitive trauma produce mental scars. Yet no one signed up for therapy or joined mental health support groups, and few received prescription drugs to ease the pain.
International Rescue Committee
In December 2014, the International Rescue Committee (IRC) began a program to strengthen the mental health systems and improve quality service delivery first in Montserrado County in communities close to the capital of Monrovia.
In January 2016, the IRC set out for the southeast counties of River Gee and Maryland to implement mental health activities.
Sarah Nalule Lwanga, a Clinical Psychologist who is also the Mental Health and Psychosocial Manager for the IRC, was surprised to discover that there was very minimal mental health care: only four facilities in both Maryland and River Gee Counties, inconsistent supply of psychotropic drugs, no records or system for mental health services. It would be like starting from scratch.
'Although the population has been affected by war and Ebola, there wasn’t much mental health interventions done to address the diverse emotional effects from the two traumatic experiences,' Sarah explains.
'We found it very difficult when we did a county mental health assessment and we knew we had a bigger task ahead of us.
'The biggest issue is that mental health is misunderstood and associated with witchcraft...this age-old practice is still part of Liberia’s DNA, particularly in the rural areas' Sarah Nalule Lwanga
The World Health Organization’s mhGAP aims at scaling up services for mental, neurological and substance use disorders for low and middle-income countries, treating people for depression, schizophrenia and epilepsy, preventing suicide and thus helping people to begin to lead normal lives, even when resources are scarce.
Building a strong mental health care system from almost nothing in Liberia has involved some unique challenges for Sarah and the IRC team.
'The biggest issue is that mental health is misunderstood and associated with witchcraft,' Sarah describes. Witch doctors rule with spells and charms, and this age-old practice is still part of Liberia’s DNA, particularly in the rural areas. Liberians would turn to these familiar, albeit dangerous and complicated sources as a first recourse.
Compounding the problem is unscrupulous, or simply ignorant and untrained pastors, mixing Christianity with traditional African beliefs and using churches as an alternative to physical and mental health services.
'There’s a lot of stigma and discrimination with mental health, and high levels of substance abuse.'
Stigma and syncretism
A common practice among rural churches is ‘Prayer Yards’ – a space outside a church where someone can go for help.
Often for a fee, the person is told what to do and will blindly obey.
'Somebody might lose a loved one, and because they can’t overcome the pain, they go to the prayer yard for comfort.
'There they might be told to fast for 30 days, and before we know it they’re taken to hospital in a critical condition when the problem is just a mental health challenge', Sarah explains.
'There’s also a lot of stigma and discrimination with mental health, and high levels of substance abuse.'
With decades of no proper treatment or counselling for those suffering from mental health issues, many turn to drugs and alcohol which inevitably leads to crime or the breakdown of parent-child relationships. Broken hearts and broken minds.
A new understanding
With such enormous challenges, it’s no small feat that in two and a half years the IRC now has a system in place for all 37 health facilities across Maryland and River Gee Counties that includes setting up a reporting system, offering psychotropic medication to patients, providing group and individual counselling, and support for patients with substance abuse, mental disorders, psychosis, acute stress, depression, grief and bereavement.
In addition to mental health services for patients, the program also expanded to the community, working with prison inmates and correction officers to handle emotional crisis with supportive communication, provide workshops for teachers on technical skills in communicating with children and adolescents, and establishing community mental health support groups.
Sarah couldn’t be happier with the results. 'Now, people seeking mental health services from the health facilities have gone high.'
The only hope is MAF
MAF has supported the IRC by providing the only flights available between the capital of Monrovia and the southeast where they work saving days of time for staff that would otherwise be spent on the rough dirt roads of Liberia.
'We used to drive or take the UNMIL flights, but when they closed off, things changed,' Sarah explains. The UN ended their flights to Maryland County close to the time that MAF began flying in Liberia. The timing was a lifesaver for those working in the southeast – the farthest point on the worst roads.
'People started saying, "the only hope is MAF".' Sarah is grateful she doesn’t have to go by car. 'MAF is my only saviour!' she says. 'If you miss MAF, you take the road.'
Mental health problems can affect anyone, any day of the year, but 10 October, World Mental Health Day is a great day to show your support for better mental health for countries in the developing world, like Liberia, where governments face the greatest challenges with and the least resources.
Our partners working to bring mental health services to the people of Liberia
Greater awareness of depression and anxiety disorders that affect 600 million people around the world but are still largely hidden problems in many countries.
Resources to increase the amount and effectiveness of mental health services for those who need them.