Thursday, June 6, 2013

Mental Health in Liberia - Maithri Ameresekere -The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital

With the support and mentorship of Dr. Benjamin Harris of A.M.
 Dogliotti Medical College at the University of Liberia, Dr. David Henderson and Dr. Christina Borba of the Chester M. Pierce M.D. Division of Global Psychiatry at Massachusetts General Hospital, and the MGH/Mclean Adult Psychiatry Residency program I have had the opportunity to come to Monrovia, Liberia as a rising PGY3. The focus of my trip is manifold and includes understanding psychiatric practice in post-conflict Liberia, teaching medical students and mental health clinicians about psychiatric diagnosis and management, providing consultation for patients at Grant Mental Health Hospital and hopefully encouraging some students to go into the fascinating and underserved field of psychiatry. I have returned to Monrovia nearly twenty years after my first visit as a child when my mother was stationed in Monrovia working for UNICEF. Returning now many years later, the country seems both familiar and unfamiliar. Now I look at the city of Monrovia with a new set of skills as a psychiatric resident. My hope is to develop a more nuanced understanding of the challenges faced by both clinicians and psychiatric patients here in Liberia. The experiences I have had so far have provided immeasurable insight into the local Liberian context and will lay the ground-work for any future research endeavors regarding mental health service provision for this population.

Liberia has suffered from violent civil conflict from 1989 to 2003 with over 250,000 people killed in two Liberian civil wars and more than one-third of the nation’s inhabitants forced to flee their homes as refugees and internally displaced persons. Although there is limited data regarding prevalence of psychiatric illness in Liberia there appears to be high rates of mental illness including depression, post-traumatic stress disorder and substance abuse. Despite the high prevalence of psychiatric illness, individuals often face multiple barriers to accessing appropriate psychiatric care including lack of human resources, minimal access to psychotropic medications, and lack of culturally appropriate interventions or treatment settings. In fact, there is only one psychiatrist to serve a population of approximately 3.5 million! Additionally, lack of perceived need for treatment, the view that mental illness is a result of personal weakness, and stigma are also significant barriers to detection and treatment of mental illness.

I have spent the majority of my time thus far at Grant Mental Health Hospital, the sole psychiatric hospital in Liberia. It has a variable census ranging from 40-70 patients and is run by psychiatric nurse specialists and mental health workers. Patients are typically brought by the police, family or community members for concerning behavior, and often after many years of wandering the streets and/or visiting traditional healers for herbal treatments. In addition to patient consultations, I am working with the medical students to provide case-based teaching and lectures on the fundamentals of psychiatric diagnosis and treatment. I have also had the good fortune to work with Dr. Benjamin Harris, the only psychiatrist in Liberia, who, in addition to the students, nurses and patients have provided an invaluable educational experience for me regarding the practice of psychiatry in Liberia. 

Dr. Harris and myself listening to case presentations 
Grant Mental Health Hospital
5th year students on their Psychiatry Rotation


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