A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake
Background: Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health an...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2016-03-01
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| Series: | Annals of Global Health |
| Subjects: | |
| Online Access: | https://annalsofglobalhealth.org/articles/1476 |
| _version_ | 1818571609144819712 |
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| author | David J. Grelotti Amy C. Lee Joseph Reginald Fils-Aimé Jacques Solon Jean Tatiana Therosmé Handy Petit-Homme Catherine M. Oswald Giuseppe Raviola Eddy Eustache |
| author_facet | David J. Grelotti Amy C. Lee Joseph Reginald Fils-Aimé Jacques Solon Jean Tatiana Therosmé Handy Petit-Homme Catherine M. Oswald Giuseppe Raviola Eddy Eustache |
| author_sort | David J. Grelotti |
| collection | DOAJ |
| description | Background: Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti. Objective: The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based <a title="Learn more about Psychiatric Service" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/psychiatric-service">psychiatric services</a> in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme (“mhGAP”), a tool developed by the World Health Organization to support mental <a title="Learn more about Delivery of Health Care" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/delivery-of-health-care">health care delivery</a> by nonspecialists in LMICs. Methods: The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters. Findings: Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress. Conclusions: Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings. |
| first_indexed | 2024-12-14T13:58:18Z |
| format | Article |
| id | doaj.art-340fa6339aa843eca533d2682e3b4ecf |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-12-14T13:58:18Z |
| publishDate | 2016-03-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-340fa6339aa843eca533d2682e3b4ecf2022-12-21T22:58:47ZengUbiquity PressAnnals of Global Health2214-99962016-03-0181571872410.1016/j.aogh.2015.08.0281381A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 EarthquakeDavid J. Grelotti0Amy C. Lee1Joseph Reginald Fils-Aimé2Jacques Solon Jean3Tatiana Therosmé4Handy Petit-Homme5Catherine M. Oswald6Giuseppe Raviola7Eddy Eustache8Department of Psychiatry, University of California San Diego, La Jolla, CA; Department of Psychiatry, Massachusetts General Hospital, Boston, MAPalo Alto Medical Foundation, Mountain View, CAZanmi Lasante, Haiti; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MAZanmi Lasante, HaitiZanmi Lasante, HaitiZanmi Lasante, HaitiPartners In Health, Boston, MADepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Partners In Health, Boston, MA; Department of Psychiatry, Harvard Medical School and Department of Psychiatry, Boston Children's Hospital, Boston, MAZanmi Lasante, HaitiBackground: Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti. Objective: The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based <a title="Learn more about Psychiatric Service" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/psychiatric-service">psychiatric services</a> in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme (“mhGAP”), a tool developed by the World Health Organization to support mental <a title="Learn more about Delivery of Health Care" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/delivery-of-health-care">health care delivery</a> by nonspecialists in LMICs. Methods: The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters. Findings: Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress. Conclusions: Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings.https://annalsofglobalhealth.org/articles/1476Caribbean regioncommunity-based psychiatric and neurologic care deliveryglobal mental healthimplementationWorld Health Organization Mental Health Gap Action Programme (WHO mhGAP) |
| spellingShingle | David J. Grelotti Amy C. Lee Joseph Reginald Fils-Aimé Jacques Solon Jean Tatiana Therosmé Handy Petit-Homme Catherine M. Oswald Giuseppe Raviola Eddy Eustache A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake Annals of Global Health Caribbean region community-based psychiatric and neurologic care delivery global mental health implementation World Health Organization Mental Health Gap Action Programme (WHO mhGAP) |
| title | A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake |
| title_full | A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake |
| title_fullStr | A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake |
| title_full_unstemmed | A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake |
| title_short | A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake |
| title_sort | pilot initiative to deliver community based psychiatric services in rural haiti after the 2010 earthquake |
| topic | Caribbean region community-based psychiatric and neurologic care delivery global mental health implementation World Health Organization Mental Health Gap Action Programme (WHO mhGAP) |
| url | https://annalsofglobalhealth.org/articles/1476 |
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