Having experienced more than a decade of civil conflict, which ended in 1993 but then was exacerbated by the Ebola crisis later on, the West African country of Liberia is implementing mental health programs supported by the Atlanta-based Carter Center to restore those who experienced psychological trauma.
In addition to the trauma related to the violence and illness in the past, the center is working in Liberia as it does in the United States to counter the “misconceptions, stigma, and the resulting discrimination surrounding mental illnesses,” according to a recent news release issued by the center.
Former U.S. First Lady Rosalynn Carter hasn’t given up hope for the well-being of Liberians who continue to suffer from the threat of viral outbreaks, famine and potential violence among political factions.
Mrs. Carter, who was a co-founder with her husband of the center in 1982 and has supported mental health programs throughout her public career, says in the release, “Liberia is making a brighter future for all of its citizens by investing in the mental health of adults, children and adolescents.” The project titled “Supporting Psychosocial Health and Resilience in Liberia” is funded by the Japan Social Development Fund, a trust fund administered by the World Bank.
While actively engaged, the Carter Center has no illusions about the enormity of the task it faces as studies show some 45 percent of the population has experienced some form of post traumatic stress from the country’s past history of violence and disease. Also, as one of the poorest countries in the world, many Liberians face day-to-day challenges to survive.
On a positive note, the country is on a course to reach its goal of expanding access to mental health care to 70 percent of the population of 4.6 million Liberians within the next few years. In the meantime, however, Liberia has only three psychiatrists to meet the needs of at least 300,000 Liberians suffering from mental illnesses.
The center announced on March 30 that 19 clinicians specializing in child and adolescent mental health graduated from a program in Monrovia, Liberia’s capital, that the center developed in partnership with the Liberian ministries of health, education and gender, children and social protection.
The graduation of these 19 clinicians brings to a total 249 professionals who have gone through the free, six-month program, which includes nurses and registered midwives. The 19 will join the others, who also had to pass a credentialing exam, in primary care facilities, hospitals, daycare centers and schools throughout the county including some of its remotest areas.
Eighty one of these Carter Center-trained clinicians, their largest concentration, serve a population of more than 1 million residents of Montserrado County, where Monrovia is located.
The program has opened 14 clinical practices in prison systems, treated refugees from the Ivory Coast conflict, supported the nation’s first mental health consumer organizations, worked in Ebola treatment units as well as providing psychosocial support to individuals and families affected by the Ebola virus, according to the release.
Dr. Janice Cooper, a native Liberian, who leads the Carter Center’s mental health initiative in Liberia, indicated in response to questions sent to her by email on behalf of Global Atlanta, that in addition to the general Liberian population, the clinicians themselves on occasion also need psychological support.
“Many health care workers recognized that during the Ebola virus disease, they were often on auto-pilot and did not take time to grieve or address the cumulative stress they experienced,” she replied. “The Carter Center has worked with health care workers and trained mental health care workers on issues related to compassion-fatigue and vicarious trauma and to practice self-care and to manage and relieve stress.”
She added that a session with a health management team conducting psychological First Aid training (an emergency and post-emergency mental health intervention) for a county health management team was “particularly helpful.”
The psychological legacy of the Ebola crisis also has been extensive on the general population, according to Dr. Cooper who said it may exacerbate “unresolved or unaddressed trauma.” “It also leads to anxiety, stress-related disorders, grief, less and trauma as a result of the fear, death and loss of individuals experienced,” she added.
She said that the Carter Center, in conjunction with numerous other health organizations, provided mid-level health care workers with hands-on practices and guidelines for dealing with self-care and stress relief, individual and group therapy, peer support, family support, resilience and anti-stigma intervention.
“We also have worked on a robust referral pathway so individuals and their families can be referred for help quickly,” she added.
And the center has not shied away from dealing with adults who experienced the war as children whether as part of a fighting force or as survivors of war-related violence. “Many adults,” she said, “are living in the society and making contributions to their families or communities. Some have trauma that remains unresolved and rely on substances, particularly drugs or alcohol, to cope.”
The center joined by the World Health Organization and a local nongovernmental organization, the Liberia Association of Psychological Services, are developing recovery groups to help individuals addicted to drugs and alcohol remain sober.
The center’s mental health program in Liberia is supported by contributions from individuals, governments, multilateral organizations, corporations and foundations such as the UBS Optimus Foundation and the John P. Hussmann Foundation. The training is part of a three-year initiative to address the psychological effects of Liberia’s Ebola crisis and to promote psychosocial health in the country.
To learn more about the Carter Center’s activities in Liberia, send an email to Rennie Sloan at rennie.sloan