The World Health Organization—prior to the arrival of COVID-19—has estimated that untreated mental disorders account for 13 percent of the 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. Additionally, stigma against mental disorders such as depression, schizophrenia, bipolar, and epilepsy often goes unchecked, discouraging people from seeking care and sometimes leading to inhumane treatment.
With COVID-19, we can expect that the toll of mental health problems will multiply, for individuals and communities. These problems develop at the intersection of inequalities within and across societies, particularly in times of crisis or pandemics, and are compounded by a global lack of trained providers. Innovative and brave solutions are needed to meet the growing burden and complex array of new problems that health care staff and systems must collectively address, across high-, middle-, and low-income countries.
In Liberia, 30% increase in patients enrolled in mental health care.
102 facilities providing mental health care in 10 countries.
More than 9,500 people receiving mental health care, with more than 55,000 visits each year.
From 2010 to 2020, our mental health programs grew significantly to deliver care everywhere that PIH works. Given common co-morbidities between mental health and other areas—HIV, tuberculosis, non-communicable diseases such as cancer, substance abuse, domestic violence, and poverty—our priority has been to make mental health care a central part of primary care, across PIH-supported health systems.
We have emphasized comprehensive care for both common and severe mental health problems based on a service-planning model that has successfully guided expansion and improvement of quality care for hundreds of thousands of people. Our cross-site learning collaborative has built capacity for mental health care delivery and service implementation across 10 PIH-supported countries.
PIH’s mental health programs focus on four pillars:
- Sustained clinical supervision and mentorship to local providers
- Implementation support and guidance to local managers
- Nimble use of quality improvement methods, data collection systems, and technology integrated within local systems
- Targeted research support to answer critical questions in local health care contexts
Here are just a few examples of how teams in PIH-supported countries are bringing mental health care, awareness, and education to vulnerable communities.
Starting in 2009 in post-genocide Rwanda, we built a program that supports affordable, community-based mental health care in the public primary care system, and increases the use of effective treatment by non-specialists, through the training of government-employed health center nurses. Read about how Sifa Dorcas played a vital role in helping a young man receive treatment for schizophrenia.
In the country’s northern Burera District, mental health care and education also are a focus of community groups who meet regularly to talk about health issues, financial challenges, and plans for local economic growth. Bringing people together to share common struggles is eroding stigma and building awareness of mental health illnesses and successful treatment.
Following Haiti’s devastating earthquake in 2010, PIH began building a system for mental health care to serve an area of 1.5 million people. We created a community-based model integrated into our primary care system in rural Haiti, across 11 hospital sites in the country’s Central Plateau and Artibonite departments. Read how one man's life was changed, and hear his doctor's perspective on the importance of mental health care.
In the urban district of Carabayllo in Lima, Peru, PIH has been a global leader in modeling community-based approaches to successful treatment of multidrug-resistant tuberculosis. Our mental health program uses similar approaches to integrate innovative psychological treatments for depression across clinical programs, while developing a national model for safe houses for people living with psychotic illness. Our program also has embedded new technologies to help particularly vulnerable groups access support during the COVID-19 response.
In rural Chiapas, Mexico, we serve 10 clinics staffed by first-year physicians known as pasantes and community health workers known as acompañantes. Pasantes receive ongoing monthly trainings on best clinical practices, mental health diagnosis, and treatment, while acompañantes provide basic psychoeducation, monitor treatment adherence, and refer patients to care. Eudeli Velasquez is one such acompañante—read how she helped one man rejoin his family and community after being treated for schizophrenia.
At the national psychiatric teaching hospital in Freetown, Sierra Leone, we have supported the rehabilitation of the oldest mental health asylum in sub-Saharan Africa. Read about how PIH's partnership with the government of Sierra Leone is embodied in the effort to strengthen the country’s mental health system, both in the capital and in rural Kono District.
Additionally, PIH is developing mental health programs in Kazakhstan, Lesotho, Liberia, Malawi, Navajo Nation, and the U.S. state of Massachusetts. 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 building platforms for the delivery of safe, effective, evidence-based, and culturally sound mental health services everywhere it works. PIH also has expanded its response to meet the challenges of COVID-19, for both patients and our dedicated, courageous health care providers.
Mental Health Programs
We are helping thousands of patients around the world through innovative programs — proving that high-quality mental health care can and should be available to all people, no matter where they live.