Recognizing the significant global burden of mental disorders, Partners In Health, with generous support from Grand Challenges Canada, has been working to build a system of mental health care in Haiti that integrates mental health services into the primary health care system. Given the shortage of specialists such as psychologists and psychiatrists, this effort seeks as much as possible to include all health care providers in the delivery of mental health care—a role that is new to the Haitian context but one that has been hugely successful in central Haiti where PIH works.
Ours is a multipronged approach that includes not only the delivery of clinical services, but also the provision of social services to support those made vulnerable by mental illness and stigma. Staffed entirely by Haitians, aside from a visiting psychiatrist—the Dr. Mario Pagenel Fellow in Global Mental Health Delivery from PIH and Harvard Medical School—the program is building the foundation for mental health services to be delivered safely, effectively, and in the community.
One person who has benefited from this work is Paul Mainardi, 22, who began spontaneously hearing voices and hallucinating when he was about 20 years old. He began to believe that demons were persecuting him, and sought help through his church.
Afterward, Mainardi was taken to the PIH-supported hospital in Lascahobas, where he began psychotherapy and received medication for symptoms of psychosis. The following is his story in his words, translated from Haitian Creole.
The first thing I have to say is that I’m a religious person. When I started to feel unwell, I began spending a lot of time fasting in the mountains, praying, spending days without talking to people, without eating, and I reached a point where I was hearing and seeing things. I was feeling more and more that I was being persecuted. I saw people running after me. I told my family that I was persecuted, but my parents said it wasn’t true because I’m a servant of God.
I realized that I don’t have a spiritual problem, I have a mental health problem.
I went to a church, and I spent three days there. I spoke to the pastor, and he said he would perform an exorcism that would either set me free or I would die. Everyone from the congregation who was there made a circle, and they put me in the middle. The pastor restrained me by my neck to rid me of the spirits. I lost consciousness, and when I regained consciousness, I saw everybody crying including the pastor because they thought I died. This is why they brought me to Lascahobas, to the PIH hospital, where I met Emmeline the psychologist.
When I met with her in Lascahobas, I couldn’t see well, and I heard things but my thoughts were somewhere else. My mind was not there. I was thinking of something, I was hearing something, and I was seeing something. Emmeline continued to talk with me. I explained what was wrong. She said that you can survive with a mental illness, that people can support you and how you have to behave with other people.
When I went to Lascahobas, I didn’t feel very well. I didn’t feel well at all. When I was at the hospital, my mind told me I had to just flee. I had a very bad headache. At that time, my family and I thought I had a problem with the demons, and I was afraid someone would do something bad to me. But after I met Emmeline, I realized that I don’t have a spiritual problem, I have a mental health problem.
After I had an explanation of what was happening to me, I started to understand that when I heard a voice, I didn’t have to do what the voice told me. Before, if the voice told me to run away, I would run away, but then I learned that the problem is that I’m hearing this voice. When I see something, when I hear a voice, now I understand that it is not about the devil. I’m not afraid any more. I don’t have to obey them anymore. I sleep well. I can say there have been many changes.
My family has been very supportive. They took me to the hospital and took care of me. In my relationships with other people, in the beginning I was constantly saying nonsense. I met a pastor who could not understand. After I got better the pastor invited me to play drums at his church. He really valued me, and he acknowledged that he had treated me badly. So the relationship got better. I’ve also begun working more and more in radio communication and doing spots for people.
I feel truly good. Because where I came from comparing to today, I can say that the PIH/Zanmi Lasante staff have done a lot for me, and they did great work. I was doing very badly, and Dr. Fils-Aime also did a lot of work with me. So I feel really good. At the end of last year, I organized a big party for my radio show, with colleagues and friends from the show. If my mind wasn’t clear and organized, if I wasn’t feeling well in my mind, I wouldn’t have been able to do it. I feel really good now.
Mainardi was cared for by a collaborative team of providers, including Jospeh Israma, community health worker, Emmeline Affricot, psychologist, and Reginald Fils-Aime, a generalist physician. Mainardi was so moved by his experience that he wanted to share it with others and prevent the harm that can come from not receiving quality care. So he started a radio station in his home. He transmits messages over the airwaves about mental disorders as a treatable condition, and urges people to seek care from the mental health team at Partners In Health.
“In life, anything is possible,” he begins in one radio spot, in which he describes the range of clinical mental health services available in the community—community health workers, nurses, social workers, psychologists, generalist physicians, and, if needed, a psychiatrist.
Paul Mainardi, 22, toasts his recovery with the Partners In Health mental health team in Haiti. Photo: Rebecca E. Rollins/Partners In Health