Liberia mental health services 'overloaded' after lockdown, MSF says

BARCELONA — As with many other countries, the three-month COVID-19 lockdown in Liberia caused huge disruptions to mental health services while creating an even greater demand for them. Now, Médecins Sans Frontières says a lack of funding and access to medication is overwhelming service providers in a country that has just two psychiatrists, as providers try to ensure that progress around mental health is not lost. Since July, MSF has been working to restabilize mental health patients and accommodate the growing demand for treatment. During the lockdown, the organization’s community engagement activities were put on hold and consultations were done over the phone, since a lack of personal protective equipment meant staff members were unable to see patients in person. Large-scale drug distributions continued outdoors, but with many people leaving Monrovia — the epicenter of the coronavirus in Liberia — or lacking access to a phone, they could no longer receive the medication they needed to cope with a range of mental health issues, said Justine Hallard, mental health project coordinator for MSF in Liberia. “At some point, we lost 30% of our cohort, [and it was] impossible to find people by phone. … They were not coming to the drug distribution because they were not aware where [it was] or what day,” Hallard said. Going without medication for this length of time can destabilize some patients, she noted. “It’s a political decision now to make sure the mental health system is able to take care of people.” --— Justine Hallard, mental health project coordinator, MSF For the most part, MSF’s team was able to track down those patients still in the city, assess their needs, and provide support to them and their families. Some children, however, were found in extremely neglected states or had been abandoned because their families simply could not cope with caring for a child with mental health issues or epilepsy in addition to the lockdown and economic worries, Hallard said. The children were taken to hospital, but it was too late for one boy with epilepsy and he died, Hallard added. The incident reinforces that telemedicine is not enough and that community engagement and seeing patients in person are critical. MSF started its mental health and epilepsy program in Liberia in 2017, having already established a short-term clinic to help Ebola survivors cope with the extreme stigma they were facing following the 2014 outbreak. After carrying out a wider assessment, it became clear the mental health needs were “absolutely huge” in a country that had endured a 14-year civil war and has a high rate of drug use, often leading to psychosis, Hallard said. The organization works on mental health and epilepsy together, since the World Health Organization’s Mental Health Gap Action Programme intervention guidelines focus on scaling up services for mental, neurological, and substance use disorders in places where specialized professionals are lacking. In addition to tackling the stigma around mental health and epilepsy, MSF’s priority has been to help develop the skills of primary health care personnel in dealing with these issues, in line with the WHO mhGAP guidelines. Specialized professionals are still needed, of course, but quality care can also be provided through nurses and physicians, Hallard said. Her biggest worry now, though, is that people cannot access the medication they need because it simply is not getting into the country. This is in part because the Ministry of Health lacks the financial resources to purchase it, but the COVID-19 pandemic has also made it more difficult for partners worldwide to import drugs, especially those that treat mental health issues since they are tightly controlled, Hallard said. Currently, only MSF and a few other NGOs in the country are able to access these medications, but they are also facing supply issues. Meanwhile, the economic worries that the lockdown created for many families have resulted in a greater demand for mental health services. “We’re starting to get completely overloaded,” Hallard said. The organization works with 1,500 patients across five clinics, but a waiting list of about 100 additional patients formed within days of the lockdown lifting. MSF and its partners are ramping up their advocacy efforts for more funding to be assigned for mental health, Hallard said, with only $25,000 dedicated to mental health in the national budget last year, according to MSF. “It’s a political decision now to make sure the mental health system is able to take care of people,” Hallard said. Without that support, it often falls to family members to care for a relative or child with mental health issues or epilepsy, which can take that individual out of the workforce and push them into poverty, she noted. While the Ministry of Health has relevant policies and plans, and a number of partners are coordinating on this work, the “strong foundations” for mental health services in Liberia will completely collapse without enough money and prioritization, putting more lives at risk, Hallard cautioned.