Liberia’s Model for Better Mental Health

From 1989 to 2003, a brutal civil war took place in Liberia. The country’s 3.5 million people endured 14 years of intense violence, “above and beyond that of your average war,” Myles Estey writes in Maisonneuve (Winter 2009). “The memories are as bizarre as they are horrific: child soldiers dwarfed by the AK-47s they cradle; the Butt Naked Brigade storming into battle, doped-up, wearing nothing but boots; . . . checkpoints marked with human heads and intestines strung across the road.”

The lasting effect of extreme violence on the psyche of a population remains “largely uncharted territory,” according to Estey, who works in Liberia as a media trainer. And in the aftermath of war, mental health is rarely a priority: “When you’re left with a country missing basic political, social, and economic systems, it makes sense that reconstruction groups (and their donors) would prefer waste-no-time goals that can be quickly met and easily measured,” Estey writes. At the time he was writing, Liberia had a single psychiatric facility, run by a German nonprofit. There was one psychiatrist.

Then, in late 2009, Liberia developed a comprehensive, community-based national mental health policy–the first of its kind in a post-conflict country. It’s an ambitious approach designed to address a substantial need: A recent survey of 1,600 households indicates that 44 percent of Liberians meet diagnostic criteria for posttraumatic stress disorder; up to 40 percent meet the criteria for major depressive illnesses. Under the new policy, medical workers will be trained to deliver mental health care at local clinics (outpatient services) and county hospitals (at inpatient “wellness units”). Increasing the number of mental health professionals in the country is also a priority, as are services for children, including mental health education.

The decentralized approach reflects the government’s acknowledgment, in the policy’s introduction, that mental health is “not only for the chronically mentally ill . . . but for the many people who suffer from common mental diseases.” In a country where mental illness has long been stigmatized, the policy is nothing short of a sea change–and has potential to prove the importance of including mental health in postwar recovery plans.

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