Ganta, Nimba County – In 2014, Liberia was among three West African countries ravaged by the deadly Ebola Virus Disease (EVD). As a result of the EVD scourge on the country, Liberia is now left to fight the new health battle of mental illness.
In rural Liberia, diseases such as depression and schizophrenia are often considered a “curse” and relegated to treatment from spiritual healers, according to a latest report compiled by PBS NewsHour’s special correspondent Molly Knight Raskin, in partnership with the Pulitzer Center.
More than two years since the World Health Organization declared an end to the Ebola virus that killed 11,000 people in Sierra Leone, Guinea, and Liberia, the end of that outbreak left behind a new struggle for survivors: mental illness. And unlike the response to Ebola, this crisis attracts far less attention.
According to Molly, in rural Liberia, mental illnesses are considered a curse. And caring for people who suffer from the most serious of these illnesses, from depression to schizophrenia, is often left to traditional healers, who resort to the only treatments they know.
A local in Ganta, Nimba County, Aaron Debah told Molly a wolden yoke which he referred to as an African handcuff, is used in dealing with mentally ill patients who are so agitated and could harm others, saying, “as you can see, you put your foot here, and he nails it.”
Mental illness is widespread in Liberia, a country deeply traumatized by a long, brutal civil war that ended in 2003. It’s estimated the conflict left more than 40 percent of Liberia’s four million with post-traumatic stress disorder.
Health experts say the 2014 Ebola outbreak compounded such trauma, with Dr. Janice Cooper, a psychologist with the Atlanta-based Carter Center, indicating that “Separation, grief, loss, trauma, you might not see them, but they’re there.”
Dr. Cooper, who led Carter Center’s mental health response to Ebola in Liberia, says Ebola proved the global health community is unprepared to deal with psychiatric emergencies.
“We’d go to meetings and people would acknowledge, yes, psychosocial, that is important. But, mostly, they were thinking about how we could get mattresses and buckets and those kinds of things to people and food, very important, but not about, how do you address the problems of the mind?” Dr. Cooper wonders.
For his part, Dr. Vikram Patel is a professor at Harvard University and an expert on global mental health, “In many parts of the world, mental health problems are already amongst the leading causes, not just of disability and poor quality of life, but actually of death as well.”
But that’s because, until recently, treating mental health conditions in resource-poor countries was considered a luxury, one that required access to medication and mental health professionals.
“There are solutions. But one has to put on a certain set of glasses that allows you to see the world as being far more complex than one has been accustomed to seeing,” Dr. Patel said.
Howbeit, a growing body of research is proving a low-cost, community-based model of mental health care to be remarkably effective.
This model crosses cultures by training local health care workers like nurses to deliver basic mental health services, such as counseling and behavior modification, according to Molly.
In Liberia this kind of program was first launched in 2011 by the Atlanta-based Carter Center. The Carter Center trained 144 mental health clinicians in Liberia, no small feat in a country with almost no access to medicine and just one psychiatrist for a population of four million, Molly report.
An unnamed local interviewed by Molly sai: “At times people, say maybe somebody bewitched another person.”
Molly further reports that clinicians work with traditional healers, churches and hospitals to deliver front-line mental health care that respects the culture in a country where the mentally ill are often outcast and sometimes brutally punished.
The former head of E. S. Grant Mental psychiatric hospital in Monrovia, Psychotherapist Rodney Presley says, “There are people you chained like dogs to a tree because the family just doesn’t know what to do. They don’t know that there is treatment available. They are under the impression that the individual has been witched or is possessed.”
Aaron Debah, a graduate of the Carter Center program who is the only mental health clinician in Nimba County, a rural part of Liberia that’s home to approximately half-a-million people, works with Ebola survivor support groups in Ganta, a city devastated by the virus.
Aaron told Molly that “survivors not only suffer lingering physical ailments, like joint pain and vision problems. They often suffer depression and anxiety.”
The group Aaron works with today is for the continuing needs of people affected by Ebola and also helping to support children or orphans affected by Ebola.
A survivor, Jacqueline Dessi, told Molly: “I got sick. I lost my husband, his mother, his father, and other people I lost every person in my house.”
Two years after Ebola struck, the Government of Liberia (GoL) passed legislation to make mental health a nationwide priority, but the GoL is yet to dedicate the required funding.
The lack of funding raises serious questions about the long-term effectiveness of mental health programs like the Carter Center’s, says director Janice Cooper.
“We’re really hopeful, sanguine about the aftermath of Ebola in terms of having more resources for psychological, psychosocial and mental health services,” she added.
For now, this leaves mental health care in most developing countries to a small, but dedicated number of local health workers, who lack the support and resources needed to do their job.
