Rebecca E. Rollins / Partners In Health
Paul Mainardi, 22, began hallucinating about two years ago. Among other people living with a mental illness, he has received effective treatment and care from a Partners In Health-supported hospital in Lascahobas, Haiti.
"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 [...] 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."
Paul Mainardi, 22, patient of Zanmi Lasante, Haiti
www.pih.org, March 2014

Mental health problems impose a serious and widespread health burden, yet remain a neglected and under-resourced domain of global health. The World Health Organization (WHO) estimates that by 2030, depression alone will be the leading cause of disability around the world—outpacing heart disease, cancer, and HIV. Partners In Health (PIH) is working to train care providers to treat mental disorders with safe, effective, and culturally sound programs that can be adapted for use around the world in order to build capacity and strengthen health systems in resource poor areas.

The bottom line

At Partners In Health and Harvard Medical School (HMS), we believe that there is no health without mental health. We have collectively joined the call for the inclusion of mental health in a comprehensive health agenda for the world’s poorest populations. The pragmatic and moral imperatives are self-evident: without mental health care, there is no justice. The methods are in hand, the advocates have been mobilized, and the message should be unified action.

Lessons learned

  • Effective treatment for mental disorders has a powerful effect on changing attitudes and reducing stigma, especially in communities where formal, comprehensive mental health services may not have previously existed.
  • Integration of community based mental health services into primary care is key in addressing the great global burden of mental illness. In these efforts, community health workers play an integral role in providing mental health services to the most vulnerable and marginalized, and strong linkages between the community, health center, and district hospitals are key in creating community-based models of care.
  • Comprehensive health system strengthening through the inclusion of mental health is essential. Capacity-building must rely on data-driven monitoring and evaluation and quality improvement, sustained training and clinical supervision, and management and leadership development components.

Local barriers to care

Mental illness causes great suffering and death in low-resource settings, including the places where PIH works. In many countries, the very poor are unable to access care for mental and neurological disorders such as schizophrenia, bipolar disorder, depression, and epilepsy. Although effective mental health treatments exist, many low-income countries lack trained mental health care providers integrated into existing health services. The absence of care and lack of education about mental health allows stigma against people living with these conditions to continue unchecked across local communities, and prevents them from seeking support and proper care.

Program successes

Shin Daimyo / Partners In Health
A trained community health worker in Haiti, where PIH provides integrated community-based care programs in mental health at 11 joint Zanmi Lasante/Haitian Ministry of Health hospitals delivering care to 1.2 million people.

Rapid growth of Partners In Health’s mental health implementation platform occurred from 2010 to 2015 as a result of an aggressive post-earthquake response in Haiti. Another success has been the articulation of a community-based model continuum of care within Burera District, Rwanda. The program has also fostered strong collaborations with Harvard Medical School through the HMS Program in Global Mental Health and Social Change and other partners.

Core priorities of the program have included:

  • A community-based approach and integration into primary care systems
  • Team-based collaborative care
  • Adaptation of evidence-based packages of care
  • Local capacity-building through training and career development for in-country implementers
  • Development of research directly aligned with service delivery priorities determined by local leaders

Supported by Grand Challenges Canada, Zanmi Lasante and PIH have created a model system of community-based care in rural Haiti. With additional support from Grand Challenges Canada, Inshuti Mu Buzima (IMB) and PIH will expand a health center training model for mental health services in rural Rwanda within Burera District as a model for potential scale-up. A clear strategic and clinical commitment to mental health service delivery has been made across all eight PIH country sites. This includes new in-country commitments to mental health in Peru and Lesotho in 2015. All work has been in close collaboration with Ministry of Health partners.

Affiliation with NCD Synergies

NCD Synergies is a PIH-affiliated project. Partners In Health’s mental health program works closely with the Harvard Medical School (HMS) Program in Global Mental Health and Social Change, which is also a part of the Global Health Delivery Partnership.

Leadership

Giuseppe Raviola, MD MPH, is director of Mental Health for Partners In Health, as well as an assistant professor of psychiatry and of global health and social medicine at Harvard Medical School, director of the HMS Program in Global Mental Health and Social Change, and director of the Psychiatry Quality Program in the Department of Psychiatry at Children’s Hospital Boston. In his role with PIH, Dr. Raviola works to integrate mental health services into the care provided at PIH sites, supporting local team leaders in Haiti, Mexico, Rwanda and elsewhere on issues related to mental health care delivery. In the Department of Global Health and Social Medicine Dr. Raviola works to advance efforts related to training and education, and research, promoting excellence in global mental health care delivery in the countries with which the program partners and at HMS. Dr. Raviola graduated from Dartmouth College (BA), Harvard Medical School (MD) and Harvard School of Public Health (MPH). He completed training in Psychiatry at Massachusetts General Hospital and McLean Hospital, and Child and Adolescent Psychiatry at Dartmouth-Hitchcock Medical Center.

Shin Daimyo, MPH, is the Clinical Program Officer and Program Manager for Mental Health at Partners In Health. His projects include supporting the integration of data driven and evidence-based mental health services into the primary care in Haiti and creating a community based model of mental health care in Peru. Shin’s past experience includes developing mental health policy recommendations for the WHO, advising NGOs in Pakistan, India, and Liberia on their development of community based mental health programs, implementing health systems strengthening interventions in Lesotho, evaluating trauma-focused mental health programs for victims of torture and natural disaster, developing culturally adapted instruments to aid in the mental health treatment of survivors of the Fukushima Nuclear Disaster and Tohoku Earthquake, and directing health policy initiatives for the Obama Campaign. Shin is a graduate of the Boston University School of Public Health and the University of Southern California, and is a past Humanitarian and Human Rights Policy Fellow of the Sanford School of Public Policy at Duke University.

Zanmi Lasante, Haiti

  • Father Eddy Eustache
  • Dr. Reginald Fils-Aime
  • Tatiana Therosme
  • Dr. Rupi Legha

Inshuti Mu Buzima, Rwanda

  • Dr. Christian Rusungwa
  • Dr. Stephanie Smith