The World Bank and the Liberian government, in partnership with the government of Japan, launched Wednesday a project designed to tackle unaddressed psychological trauma in Liberian communities affected by protracted civil war and a relentless Ebola outbreak.
Developers of the project hope that an increased focus on mental health will help spur economic recovery and growth in the devastated region by helping build social capital and community trust, while fostering positive coping behaviors and helping youth and women in particular manage family upheaval and find their way into the workforce.
“You have to understand the human suffering that’s driving the lack of development and poor social capital, lack of trust in your neighbor, lack of rebuilding,” Dr. Richard Mollica, mental health adviser for the project and director of the Harvard Program in Refugee Trauma, told Devex.
The three-year, $3 million project is funded by the government of Japan through a World Bank-administered trust fund known as the Japanese Social Development Fund. The project will be carried out by the Carter Center, and as World Bank senior health specialist and task team leader Dr. Rianna Mohammed-Roberts told Devex, it will comprise two components to reach approximately 18,000 beneficiaries.
The first component is to address the psychosocial and mental health impact of the Ebola crisis, both at the individual and community levels. Health care workers will receive training in mental and psychosocial treatment in order to treat first responders and members of burial teams, while counseling support groups will be established. Community dialogues will be facilitated and referral systems put in place.
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The second component focuses on longer-term community resilience and psychosocial health with a specific focus on women, victims of gender-based violence and children. A new squad of child mental health clinicians will be deployed to approximately 60 schools, while community-based interventions beyond Ebola-affected communities will be strengthened.
Mohammed-Roberts and her team began planning the project in October. As a country with limited resources, Liberia has historically de-prioritized mental health, which receives only about 1 percent of the national health budget. And while mental health is part of the government’s “essential package of health services” that rolls out in phases, Mohammed-Roberts said the mental health component has yet to be introduced.
But development professionals always need to consider mental health in their work, stressed Mollica, who worked as a consultant in numerous post-conflict countries.
“Whenever there’s a development project, mental health has to be part of it,” he said, adding that it should be integrated into focal areas spanning from primary health care, job training, youth engagement and gender-based violence.
“If you see a development project in a country that’s been through terrible poverty and violence, and there’s no mental health component, something is wrong with that project,” Mollica said. “I would not give that project a high score.”
But can mental health services really spur economic growth?
The international development community is divided on this question, and has been for the past three decades, according to Mollica. Some development professionals, he explained, latched on to what he called the “rubber band phenomena” — the idea that when a country like Liberia endures violence or destruction, it bounces back. But the mental health expert said that this isn’t always true. Mental health and depression are “highly related” to disability, lack of social capital and trust in government, stigma, and poor community relationships.
“We’ve discovered just the last five years or so, that mental health issues related to violence and poverty have enormous impacts on chronic disease,” Mollica said, adding that poor mental health can lead to early death caused by diabetes, heart disease, stroke and other illnesses.
“This mental health issue is not a trivial issue anymore because it leads to tremendous cost in terms of disability, and in terms of early mortality, chronic disease and death,” he said.
Going forward, Mohammed-Roberts hopes that her team’s project will achieve productive results, catching the attention of donors, including physician donors interested in supporting the integration of mental health into global development.
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