PIH Haiti: Zanmi Lasante

Mental Health Program

Pictured Here: Traditional birth attendants at a mental health training

September 19, 2024

Program Overview

Following the devastating 2010 earthquake, the Zanmi Lasante (ZL) mental health team began integrating emergency mental health services into HIV care for a catchment area of 1.5 million people. More than a decade later, the ZL mental health program delivers comprehensive mental health care across all 12 sites in the Central Plateau and Artibonite. This care is delivered through a task-sharing model that includes community health workers (CHWs), psychologists, social workers, nurses, and physicians.

The ZL mental health team integrates mental health and primary care services through training and supervision in continued collaboration with the Ministry of Health (MOH), known as Ministère de la Santé Publique et de la Population (MSPP), and the Pan-American Health Organization (PAHO). Together, the program cares for people living with depression, epilepsy, psychotic disorders, child and adolescent mental health concerns, trauma, and substance use. A key aspect of the program’s success is its collaboration with traditional healers, and traditional birth attendants, to identify and refer people living with mental health conditions to appropriate care. The ZL mental health team has also developed fruitful academic partnerships. The team has hosted many Dr. Mario Pagenel Fellows, a Fellowship in Global Mental Health Delivery organized in partnership with the Harvard Medical School which now exists as a collaboration between PIH and Harvard across all PIH sites to train psychiatrists in global settings.

Despite persisting socioeconomic and political instability, which heightened in July 2021, the ZL team continues to provide dedicated psychological and social support to Haitian communities. The team has adapted to this reality and developed a mitigation plan to better assist communities. The program includes regular phone calls with patients who are unable to reach health facilities and support groups for ZL staff to help overcome fears, acute stress, and anxiety.

Innovation

Mental Health Care Across the Value Chain

The ZL mental health team, in collaboration with Haitian psychologists, medical professionals, traditional healers, community elders, and religious leaders, has developed the Zanmi Lasante Depression Symptom Inventory (ZLDSI), a culturally tailored, 13-item depression screening tool in Haitian Creole. This tool, which incorporates culturally bound idioms, is now used in routine screenings and care across ZL’s network, as well as by other stakeholders in diverse contexts throughout Haiti.

Training and Education

ZL psychologists and community health workers provide Interpersonal Therapy (IPT) for depression. The team has also introduced Cognitive Processing Therapy (CPT) and an adapted trauma curriculum to address trauma in the Haitian context, ensuring culturally relevant care for their patients.

Partnerships

In partnership with the Mennonite Central Committee, ZL implements the "Expanding Community Mental Health Services to Improve Training, Develop Trauma-Focused care, and Enhance Services for Children & Youth.” This initiative strengthens community-based mental health services in Haiti’s Artibonite and Centre regions by enhancing the capacities of community health workers (CHWs) to screen, identify, and refer mental health cases to appropriate health facilities. Traditional birth attendants also received training through this initiative to help prevent and identify symptoms of post-partum depression and psychosis.

Influencing with Evidence

Since its inception in 2010, the program has seen significant growth, particularly in training, monitoring, evaluation, and quality improvement (MEQ). In 2016, ZL transitioned from a paper-based medical records system to an electronic system, enabling the collection of aggregated data across health centers on a monthly basis and improving patient tracking and care delivery.

Impact

Between July 2023 and June 2024, the ZL Mental Health Team:

Conducted 9,056 mental health consultations, 887 home visits, and enrolled 709 new patients into care.
Completed 385 community awareness sessions, 408 educational workshops, and 88 activities with community leaders to promote mental health.
Trained 26 traditional birth attendants in maternal mental health.
Organized 4 mobile mental health clinics to reach patients in remote areas with limited access to health facilities.
Supported the staff wellness team in conducting 20 group therapy sessions, 10 individual therapy sessions, 4 self-care activities, and developing a video on breathing techniques.

Graphics created using programmatic data collected between July 2023 and June 2024

Future Priorities

Strengthen the ability of mental health staff to effectively address priority needs within their communities.
Increase the number of consultation visits by 30% to enhance the quality and reach of mental health care services.
Revise care pathways and update tools and consultation forms to more effectively manage priority mental health conditions.
Facilitate the social reintegration of 20% of patients in the rehabilitation program, ensuring sustained recovery and community re-engagement.
Develop and distribute mental health promotion and awareness tools at ZL sites and in the communities they serve.
Create an e-learning platform to enhance mental health awareness and prevention strategies among ZL staff.

Provider Spotlight:

Read through the story below to learn more about the incredible day-to-day work of Edmé Robes Pierre, a social worker on the ZL Mental Health Team.