Barriers to Mental Health in Liberia

The effects that wars and conflict leave on a population are much greater than one might imagine. Economically, structurally, physically and mentally, a war leaves deep scars and lasting hardships on all parties involved.  Witnessing war crimes, having your loved ones killed and raped, and being tortured leaves persistent and distressing effects on a person’s mental health. Unfortunately, a person’s mental health is closely linked to his or her physical health as well. Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD), both very conflict in post-conflict societies, can disrupt a person’s daily life enough to miss many days at work and remove themselves from the community. Mental illnesses can dampen personal, community and national level economic improvements, which after conflict are fragile, to begin with.

In post-conflict societies, the rates of mental illnesses are staggeringly higher than in developed countries. The average rates of MDD and PTSD are 7 percent and 13 percent, respectively. In Liberia, the west-African country that is still recovering from 14 years of civil war that ended in 2003, the rates are 40 percent and 43 percent for MDD and PTSD, respectively.  The staggering difference is partly due to the effects of the conflict, but the lack of mental health services available to the population in Liberia is exceptionally depleted and centralized that treatment is, more often than not, not received.  The consequences of untreated mental illnesses cause more and more difficulties in a post-conflict society. Without treatment, individuals suffering from mental disorders are unable to control their symptoms and the effects can lead to devastating outcomes. Rates of homelessness, violent outburst, suicide and incarnation all increase when mentally ill persons are untreated.

The mental health services available in post-conflict societies are often insufficient for the needs of the population. In Liberia, 1.6 million (46 percent) people suffer from mental illnesses; there is one psychiatrist in the country.  There are no outpatient or inpatient services available at health clinics around the country, and no psychiatric wards at country hospitals. There is one mental hospital, the Grant Memorial Mental Hospital, located in the capital, Monrovia, which can accommodate for only 50 inpatients. At the hospital, there are no doctors and no psychiatrists. There is an extreme dearth of trained manpower in Liberia to effectively identify and treat the 1.6 million persons needing care.

Gaining access to treatment is difficult in the rural areas of Liberia. It is imperative that mental health services are decentralized throughout the country. Much of the violence and atrocities that occurred during the war, until the final days in 2003, occurred in the rural areas of the country. Those that could, moved from the rural areas and into Monrovia during the war to escape the violence and hardships. Those that remained experienced some of the greatest atrocities, and now suffering greatly from the mental devastation the violence left.  Due to there being no mental health treatment or care available outside of Monrovia, many of persons suffering from dire mental illnesses are not able to receive care.

The Ministry of Health and Social Welfare put out a mental health policy in 2009 that aims to improve the capacity of mental health services for the nation. It looks at decentralization, training mental health professionals, and civic education to increase awareness and decrease stigmas associated with mental illnesses.  The training of professionals is a process that will take about 5 years to complete, meaning implementing the other aspects of the policy will not come for a few more years when the country has enough manpower to carry out the services. The mental health policy is a start to solving the issue of treatment services available to Liberians, but, like in many developing countries, implementation is a bigger battle.

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