Sometimes thought to be an affliction of wealthy countries, mental illness in fact causes great suffering and death in low-resource settings, including the places where PIH works. The World Health Organization estimates that by 2030, depression alone will be the leading cause of disability around the world—outpacing heart disease, cancer, and HIV.

In many poor places, the absence of care for mental and neurological disorders such as schizophrenia, bipolar disorder, major depression, and epilepsy has allowed stigma against people with these conditions to continue unchecked, discouraging people from seeking care and sometimes leading to inhumane treatment. Although effective mental health treatments exist, much of the world lacks trained mental health care providers and comprehensive health care services that address mental health conditions in conjunction with other diseases.

In partnership with the Program in Global Mental Health and Social Change and the Dr. Mario Pagenel Fellowship in Global Mental Health Delivery at Harvard Medical School, PIH is working to train care providers to treat mental disorders with safe, effective, and culturally sound programs that can be adapted for use around the world. 

Delivering care and changing perceptions

Treatment, including sound medical evaluations, social assistance, psychological support, and, in some instances, medication, can help people with mental illness make dignified recoveries that transform attitudes and fear. At a growing number of sites, PIH works to deliver high-quality mental health care to people suffering from mental disorders.

In Rwanda, PIH is collaborating with the Rwandan Ministry of Health to move mental health care away from locked inpatient facilities and into the rural communities where people live. PIH/Inshuti Mu Buzima provides clinical mentoring and technical support on training, quality improvement, and technologies to improve care, all with the goal of enabling local clinicians and non-specialists to deliver high-quality mental health care.

In Haiti, after the 2010 earthquake exacerbated the existing need for formal mental health care, PIH worked to implement a community-based model of mental health care. PIH and our sister organization, Zanmi Lasante (PIH/ZL), are now expanding services across the Central Plateau and lower Artibonite region through the support of Grand Challenges Canada and the Integrated Innovations in Global Mental Health program. Informed by the understanding that there is no health without mental health, the project in Haiti aims to create a model for community-based care that integrates seamlessly with PIH/ZL’s existing health care system.

PIH projects in Lesotho and Mexico are also in the process of developing their nascent mental health programs.

Mental health in an epidemic

When an epidemic of cholera broke out in Haiti in 2010, PIH launched a comprehensive response—prevention, education, treatment, and psychosocial support for more than 4,000 families affected by cholera. Because cholera was unfamiliar to Haitians and acted quickly, killing within 24 hours in some cases, the outbreak caused stigma against people who fell sick with it. People feared that caring for a sick family member would cause them to die as well. And some cholera victims felt ashamed to tell their families that they were sick because they thought they would lose standing in the community.

Father Eddy Eustache, director of ZL’s psychosocial and mental health program in Haiti, led the creation of a four-session curriculum to aid psychologists working with cholera survivors. The program built on an existing group therapy format developed by PIH/ZL social workers and psychologists in 2008 to support families and young people affected by HIV and TB. The work helped to limit stigma around cholera and encourage people to seek treatment.

“Support groups enable cholera survivors to find a network of people with similar experiences who have lived through the devastating physical and emotional stress that cholera has created. It is amazing to see the change in people’s perceptions of their self-worth from the first session to the fourth,” said Elysee Noesil, a PIH/ZL psychologist working in central Haiti.