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Rebuilding Hope after War: Mental Health and Community Recovery

In May 2008, Tiyatien Health worked in collaboration with partners, including the International Medical Corps and the Center for Disaster and Humanitarian Assistance Medicine, to conduct the first national population-based study to assess the prevalence and impact of psychological and social trauma in post-war Liberia. The study, which was recently published in the Journal of the American Medical Association (full citation below), found that over 40% of the adult Liberian population suffers from depression and posttraumatic stress disorder (PTSD). Furthermore, it found that Liberians who experienced sexual violence had worse mental health outcomes than noncombatants and other former combatants who did not experience exposure to sexual violence.  Based on this work, Tiyatien Health was invited to join National Mental Health Policy Committee, and is working with other stakeholders to draft Liberia’s first national policy and plan on mental health.  Our study has since been cited by the Government of Liberia's National Mental Health Policy, which TH staff were involved in drafting.

TH's national work in mental health builds on over three years of local efforts to provide comprehensive healthcare, including to those with mental health disorders, with the Ministry of Health at Tubman Hospital in Zwedru.  In 2006, TH leadership also previously advocated with senior MoH officials for the creation of a national mental health policy while serving as national policy advisers during the National Health Policy Reform process.

Program Objective:

To develop an equitable model for delivery of mental healthcare and psychosocial services in rural Liberia within the public sector. Results of this program, will be used through Tiyatien Health’s representation on the National Mental Health Policy Committee to inform expansion of the Liberia’s mental healthcare services.

Program Description:

This program applies the innovative interventions used in Tiyatien Health’s HIV Equity Initiative to the prevention and treatment of mental illness while providing much needed psychosocial support to improve the quality of life of individuals and their families residing in southeastern Liberia. The pilot project will provide comprehensive social and psychological care for at-risk rural communities, including special populations such as victims of sexual violence, former child soldiers and people living with HIV.

The goal is to support these individuals and families so that they are able to manage their illness, fully integrate into their community, and experience a sense of agency and well-being. Core components of the program include clinical care, prevention and outreach to rural and vulnerable communities, trainings for community Health Workers and other MoH staff in case management, and reconciliation and socioeconomic support through interventions such as group counseling, food packages, transportation stipends, vocational assistance.

Representative Publications:

• Johnson K.., Asher J., Rosborough S., Raja A., Panjabi R., Beadling C., Lawry L. (2008). Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. Journal of the American Medical Association, 300(6), 676-690.

Project Contacts:

• Amisha Raja, Psy.D. // Director of Mental Health // araja@tiyatienhealth.org
• Valentine Sawyer, MD // Liberia Medical Director // vsawyerr@tiyatienhealth.org

Key Outputs:

• Improved quality of life for patients and families dealing with mental health difficulties
• Improved health and social outcomes for vulnerable populations, including former child soldiers, victims of sexual violence and those living with HIV/AIDS
• Trained community health workers
• Trained staff in mental health at Liberia's public health facilites
• Improved public health infrastructure in southeastern Liberia
• Improved socioeconomic status
• Reduced stigma associated with mental illness
• Patients with mental illness given appropriate treatment and intervention
• Reduced safety risk to individuals and communities
• Advocacy for the need for care of mental illnesses
• Documentation of program successes and challenges