The World Health Organization estimates that untreated mental disorders account for 13 percent of the total global burden of disease, and that by 2030, depression alone will be the leading cause of disability around the world—outpacing heart disease, cancer, and HIV.

Almost half the world’s population lives in countries where, on average, there is one psychiatrist to serve 200,000 or more people. And it’s likely that in these places people are poor and suffer other diseases, which can create and worsen mental health problems. They might also have lived through wars or natural disasters. To make matters worse, stigma against disorders such as schizophrenia, bipolar disorder, depression, and epilepsy often goes unchecked, discouraging people from seeking care and sometimes leading to inhumane treatment.

PIH’s Response

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 training early-career psychiatrists to deliver mental health care in the countries we serve. To complete their one-year clinical rotation, fellows work alongside and mentor PIH colleagues in either Haiti or Rwanda.

We began providing mental health services in 2005 in Haiti, where social workers and a small team of psychologists supported impoverished patients diagnosed with tuberculosis and HIV.

In 2009, PIH started to collaborate with Rwanda’s Ministry of Health to bring mental health care into rural communities. After first improving the quality of care at district hospitals, we then mentored and trained nurses at rural health centers to deliver care in villages and homes. Today we are enhancing supervision, mentorship, and training for community health workers through a new “MESH-Mental Health” program so that they can help people with even the most severe mental disorders.

After the 2010 earthquake and the onset of the cholera epidemic in Haiti, the need for mental health care was clear. At the request of national health authorities, we grew our mental health program across the country to help patients dealing with depression, epilepsy, post-traumatic and acute stress reactions, and other mental disorders. Today we are focusing on reaching people in rural Haiti suffering from severe mental disorders, while guiding the government in developing a national mental health plan. (Hear from one of our patients about the program.)

We are now developing services and government partnerships for mental health care in all 10 of the countries where PIH works. Key to this effort is identifying local experts who can lead the integration of mental health services into existing community and primary health care systems. This work engages beyond formal health systems, forming strong relationships with traditional healers, religious authorities, and schools.

We are serving thousands of people living with mental illness and will continue to work to improve the lives of thousands more, ensuring that illness, stigma, and fear are replaced with health, hope, and opportunity.