Liberia Marks Milestone In Mental Illness Fight

In this African country, locals are still trying to heal from years of civil war, while the only psychiatric hospital has 36 beds and one practicing doctor. And yet, Liberia's first ever class of mental health clinicians graduated last week with help from the U.S.-based Carter Center. A Liberia mental health expert speaks with guest host Tony Cox.

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TONY COX, host: Imagine an entire nation whose people have endured more than a decade of brutal civil war, but a nation where there is just one practicing psychiatrist charged with helping victims deal with that post-war trauma. That has been the case for the west African country of Liberia until now.

To help address the shortage of mental health professionals, the first class of 21 mental health clinicians has just graduated from a special training program in Liberia. That program was created with the assistance of the US-based Carter Center, a nonprofit organization founded by former US President Jimmy Carter and his wife Rosalynn.

Joining us to talk about this is Dr. Janice Cooper. She is the country representative for the Carter Center Mental Health Program in Liberia. She's on the phone from Liberia's capitol, Monrovia.

Welcome to the program.

JANICE COOPER: Thank you, Tony. It's a pleasure to be with you.

COX: On the Carter blog, you wrote this: Near the night spots on Carey Street, daylight reveals young men languishing, many lacking jobs and nearly all having some residue of trauma resulting from the civil war. It is a trauma that lingers close to the surface and is sparked by the smallest of disagreements.

My question is what's the nature of the trauma many Liberians suffered because of the war and what kind of illnesses have resulted from it?

COOPER: The Liberian population endured over 15 years of civil conflict and it was a conflict that came about in many stages, so sometimes, people had recurring episodes of real traumatic experiences. There is no one in this country that has not been touched by trauma; however, most studies suggest over 40 percent of the population has post-traumatic stress disorder and, as a result, experience significant anxiety and trauma related to that.

COX: One of the issues I'd like you to address is, not only do you have to deal with the existence of these mental disorders, there is also a stigma associated with getting treatment for it, isn't there?

COOPER: Absolutely. The stigma is both related to the fact that people really believe that mental health clinicians, the people that we are training, are not necessarily the best to deal with mental health conditions, that these can be dealt with by the medicine man, the mole' man, the spiritualist.

So having them understand that the mental health clinicians that we have trained have both the skills and the medicine to be able to address mental health conditions is extremely important.

COX: What can you tell us about the association between mental illness and witchcraft?

COOPER: We're a developing nation, and this is clearly true of Western nations that are more developed, as well. During their history, there was a belief that people that had mental health disorders were somehow special in some cases, somehow bewitched in other cases - many myths related to the causes of mental illness.

And that pertains today here in Liberia, that many people feel as if you have a mental health condition, it must be because you're either bewitched or because you perpetrated significant things during the war. So these are - it's like chickens coming home to roost, or justice.

And so our job is to help to debunk these myths and demystify mental illness. Only when we start to do that will we be able to address the significant stigma in the society.

COX: If you're just joining us, this is TELL ME MORE, from NPR News.

We're talking about efforts to improve mental health in Liberia. Our guest is Dr. Janice Cooper. She's the country representative for the Carter Center Mental Health Program in Liberia.

Can you tell us what graduates of that program are likely to face when they get into the field to do the work that they have been trained for?

COOPER: In many communities, there's not the belief that the health center is the place to take someone that is psychotic, for example. There is a belief that those people can be treated by the traditional healer. So one thing they face is just the belief about whether the health center can really treat them.

The other thing they face is the lack of resources, especially medications in this country, to treat mental illness. However, there is a lot of hope.

They've also been trained to work with family members, so family members are less likely to shun their loved ones if they have a psychotic episode or if they're depressed, for example.

COX: I want to ask you about that, because I believe people would normally assume - rightfully or wrongfully - that post-traumatic stress would affect those who were fighting in the war more than others. But is that the case?

COOPER: Well, actually, no. First of all, there are people to whom terror was perpetrated upon, and whether that was rape as a weapon of war, whether that was seeing your loved one killed in front of you or tortured in front of you, or whether that you yourself were tortured, all of those will contribute to post-traumatic stress disorder.

In addition, there are people with mental health illnesses and mental health conditions, irrespective of the trauma, so people with depression, people with schizophrenia. And in this country, there's a high prevalence of epilepsy and neurobiological disorder, and often lack of resources to treat people with seizures. And they are often lumped in with people with mental illnesses.

COX: Is there enough medication to handle the problem? Do you have enough medication to do the job?

COOPER: We do not have enough medications. The Carter Center is working with the government on policy to support good practice. And as we speak, our current essential medical list - which is the list from which the government derives medications for the government hospitals - does not include any psychotropic medication. So we're working with them to make sure that there is the availability of psychotropic drugs.

Currently, non-governmental organizations help the government to bring in psychotropic drugs into the country, but they're not enough.

COX: My final question is this: This is the first 21 graduates of the program. Congratulations on that, number one.

Number two, what's next? Is there another class that is beginning?

COOPER: Tony, we're really proud of the first 21 because they're clearly pioneers, but the Carter Center is committed with the government to train 150. So we have two cohorts a year, and we'll alternate the site between Monrovia, which is the capitol, and Bonga, which is a city in the center of Liberia.

COX: Dr. Janice Cooper is country representative for the Carter Center Mental Health Program in Liberia. She joined us by phone from Liberia's capitol, Monrovia.

Thank you very much for being with us.

COOPER: It's a pleasure. Thank you, Tony.

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