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Liberia, a country with 3. 5 million population has only one mental specialist, Dr. Benjamin Harris and one psychiatrist hospital, E. S.

Grant Hospital, which is not even a public hospital. It is practically nonexistent because of little or no support: wreck facility, lack of more psychiatrists and outpatient service dysfunctional. This is a gross disproportion to the increasing mental health related illnesses budding in a country where citizens suffered 14 years of civil war with increasing post war traumatic mental health problems.It important to note that Liberia is a country whose citizens experienced 14 years of fratricidal war punctuated by an ad hoc, improper and short term government policy on demobilization and rehabilitation process of over 60 thousands combatants without a defined therapy for victims. With mental health care system practically non-existent and the traditional belief that mental health illness is caused by demonic or supernatural forces, the need for rigorous, efficient and effective mental health policy and program cannot be overemphasized.Status of Liberia’s Mental Health Care The World Health Organization (WHO) defines mental health as a state of well-being in which an individual realizes his or her own abilities, able to cope with the normal stresses of life and can work productively and is able to make a contribution to his or her community. In this positive sense, WHO avers, mental health is the foundation for individual well-being and the effective functioning of a community.Mental health is an essential part of health; and it is an incontestable fact that there is no health without mental health.

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The Liberian Governments yesterday and today cannot pride herself, if there is any glory it is opting to get, on better health care when the troubling concern of no better mental health mechanism and system are actually prevailing.Successive Liberian governments cannot also boast of immeasurable developments if there is anything to boast of, when scores of its citizens are wrestling daily to cope with the unexamined and unhandled stresses, strains and uncouthness and the psychological impact the 14 –year civil war (1989 -2003) continues to perk up in their daily interactions and various communities as result of the deprived effective and efficient mental health care prowling the country.The international community also cannot brag much on this subject because very little was done from them in the mental health care sector probably because of the rush and urgent situation of the country for immediate and temporary solutions like food, medicine and emergency relief during and immediately after the long civil war. Health Policy With Little or no Action Liberia, despite, its 163 years of existence was only able to develop a community-based national mental health policy in the late 2009 for years after the end of the internecine conflict.The Policy highlights the grave problems the country face in mental health care such as the lack of mental health facilities and services, psychiatric drugs, trained manpower, education and training opportunity, monitoring and evaluation, mental health research, forensic services, human rights and epidemiology. In the face of all those problems catalogued in this mental health document, little or nothing concrete has actually been done to significantly improve the mental health care. There are still inadequate mental health drugs for sale and they are vastly costly and often out of stock.

Unqualified mental health workers who shamelessly lack the requisite training, skill, knowledge and ability are the ones who are barefacedly acting as psychiatrists by examining and providing treatments for the mentally ill patients. The A. M. E.

Diglotti Medical College, Liberia’s only public professional medical college up till now does not have “clinical rotation in psychiatry” and instead has “one psychiatrist in the country who intermittently lectures the students… no psychiatric residency program.”(National Health Policy, 2009) Other alternatives are available, but not too viable; for example the Tubman National Institute of Medical Arts (TNIMA) only “focuses on the identification of the referral process for mental health patients, and offers no training or education about vulnerable groups” (National Health Policy, 2009) and Mother Pattern College of Health Sciences and Cuttington University have sparse concentration on mental health areas.It is further heartrending that the Ministry of Health and Social Welfare as indicated in the National Health Policy even up till now stays does not have checking system and mechanism to monitor and “evaluate the process of accreditation of psychiatric education and training programs. There is no standard curriculum or competencies required for practice. There is no system to evaluate teachers or trainers, or guidelines that demand and ensure they have appropriate degrees (from both local and international institutions).”As of the time the problem listed in the Health Policy since 2009, there is still “no certification process for non-physician mental health workers trained by NGOs… no scholarship opportunities in the country to attract students with a natural interest in mental health to the profession… no financial incentives offered for health workers to complete additional training in mental health…no mental health legislation. ”The future of the only available mental health hospital is dangling as the E.S Grant Hospital, a German nonprofit mental health Hospital, is expected to close down and property turned over to its owner after a Memorandum of Understanding (MOU) between the Liberian Government and German-based, Cap Anamur, expires in few years.

Liberia’s Government only public Hospital, Catherine Mills Rehabilitation Center, was destroyed during the civil war.Mental health care, in effect is practically non-existent in the country. There are no outpatient or inpatient treatment options available at health clinics or health centers, and no psychiatric wards at county hospitals.In addition, there are no specialized services for the developmental and mental health needs of children and adolescents, and no services for other vulnerable groups, such as geriatric patients. There are also no rehabilitation services for alcohol and other substance use disorders or for individuals with deficits and handicaps that result from their mental illness (National Health Policy, Republic of Liberia, 2009). Psychological Impact of the Liberian Civil WarThere is no doubt the Liberian civil war has had a grave impact on the psychological wellbeing of both combatants and non-combatants as well. The scare of the war continues to resonate in the minds and hearts of direct and indirect victims since little or nothing sustainable has been done to provide relief and treatment as result of the dysfunctional mental health system in Liberia.

As one writer puts it, there are many “walkingtalkers” persons in Liberia, referring to people who absentmindedly soliloquize while walking in the streets.This goes on even in offices, homes, schools, churches and mosques. “I heard many voices in my head everyday and I just cannot understand,” a professor at a Liberian University lectured on post war trauma suggesting to his class that there are many abnormal people, including him in Liberia who appear normal by physical look but abnormal mentally. Those are clear indicators of the alive-abnormal lives of former combatants and non-combatants experienced the protracted Liberian Civil war. Swiss, S.et al (2008) survey showed Liberian women during the war experienced violence, including sexual coercion from 1989 through 1994. Liberian women were raped and some killed in the glare of their children, parents, and/or relatives.

And so the victims, children, parent and relatives are still living with the scare of trauma in the course of poor mental health care.Another survey conducted by Kirsten Johnson, M. D. , M.

P. H. , of the Harvard Humanitarian Initiative, Harvard University, Cambridge, Mass.

, and colleagues conducted in May 2008 showed “ both female and male former combatants who experienced sexual violence had worse mental health outcomes than non-combatants and other former combatants who did not experience exposure to sexual violence… and that rehabilitation programs that do not address this specific population risk failing a critically vulnerable group. ”Liberia’s only psychologist Benjamin Harris commented on the insufficiency of the Disarmament, Demobilization, Rehabilitation and Reintegration (DDRR) program of the Liberian Government .He told IRIN news in 2008 that the DDRR program left out the psychological needs of the ex-combatants and merely focused on hasty demobilization. “The focus of the [DDRR] program was to get the arms away from the ex-combatants and now we are beginning to experience the repercussions of a failed demobilization program relating to the psychosocial needs and mental well-being of the ex-combatants,” he told IRIN news.The repercussion is glaring in the street of Monrovia, the capital city of Liberia and the rest of the 15 political sub-divisions. Young girls and boys, women and men roam and ramble crazy in the streets while ghettos continue to be crammed by the day with hopeless wild youths who, strangely enough, regard marijuana, cocaine and other illegal drugs and harmful substances as form of appeasement for mental torment.Public officials, including some ministers and deputy ministers, directors, legislators, aspirants and the like in the current Government of Liberia and preceding the first post war interim governments, the Charles Taylor administration are alive-abnormal “walking talkers” and “hearing many things in their heads” because they were combatants who still suffer from the hasty DDRR process and lack helpful psychotherapy and yet they are occupying strategic public offices. They wallow in slow insanity and pretend they are sane.

One wonders how high the level of poor productivity and inefficiency in those offices they work. One wonders what added value they bring on the table of effectiveness and output when they are living abnormal lives. This is a gross disincentive to taxpayers’ monies and the overall growth and development of post war Liberia. It is not only combatants but direct and indirect victims of the Liberian civil war who also suffer mental distress that warrant psychotherapy solution.Their properties were destroyed; relatives were killed in their presence, some were internally and externally displaced and some were amputated or wounded and carried the scares with them alone without even a help from national psychiatric therapy initiative of government since there was no proper one in place to do so. They are painfully and helplessly living with the trauma.

Barley few months ago, the former Justice Minister in the 80s, Jenkins K. B.Scoot was seen eating on the garbage with torn out clothes, deep sores on body parts, huge unshaved moustache and beard and was in tatters and called “crazy man” by passers-by. It was reported that he virtually lost everything he had during the war: family, properties, self-esteem, status and money.

He was reportedly seen on the street of Monrovia begging from streets to streets, dry and pale as a bone and then he eventually died. Another person commonly known as “Forum” also died few months back. He had been on the streets of Monrovia several years with colossal moustache and long beard and sores on legs.He ate on garbage at times and was shouted at as “crazy forum.

” Stories are told that he suffered mental problem as a result of frustration he endured as a result of his wife being unfaithful to him.The cases of both Scott and Forum, it was only lately when they edged on the Great Beyond that good Samaritans sprang up. What a society we have. What is also important to note about the two scenarios is that had there been a well established mental health care center with the requisite trained manpower and drugs and care, those people Prev Page and many others would probably have been living because such institutions would have been the one to take such people from the streets and take them for rehabilitation.Besides the psychological impact of the 14 years senseless war, studies proved about 10% of the world populations suffer mild mental disorder whereas about 3% suffer from serious mental illness.

Mathematically computing this, Liberia with the population of approximately 3. 5 million, is thus projected that 350,000 individuals in Liberia suffer from a mild mental illness and 105,000 suffer from a severe mental disorder.This is grave and requires concrete and practical action not empty paper-policy and empty talks and rhetoric. Faulty Perception of Mental Health Illness Another area of concern is the issues of myth and perception regarding mental illness. Some Liberians hold the perception that once a person has mental illness it is either because of the victims own evil deeds, getting the backlash for magical charm as result of the breaking the laws of talisman. Such unscientific belief often leads families to neglect and discrimination against and stigmatizes those who suffer from mental illness.Conclusion Liberia should take heed and make improvement in its mental health services; otherwise this will continue to greatly affect the social-economic growth and development of Liberia. As indicated in Poverty Reduction Strategy (PRS) of Liberia, mental health poses serious socio-economic problem issue and directly linked to the incidence of poverty.

Liberia does not have a place in its national budget for mental health and this is a sad story for a country sunk in 14 years war.There should be budgetary allotment for mental health under the Liberia’s national Heath budget; scholarships opportunities should be provided for medical students as long term plan to go abroad for mental health studies so that Liberia will be able to have more psychiatrists and professional mental health workers at the various major public hospitals like the John F. Kennedy and the Chinese built hospital in Ganta, Nimba and backed by viable decentralization plan and action. Government has to be able to also put in a short term program that will encourage and attract Liberians in the Diaspora wit Prev Page specialties in mental health care to come home and contribute.Following the destruction of the Catherine Mills Rehabilitation Center, Government should not see this as an end of rebuilding its own mental health center.

This is over 14 years since Catherine Mill was destroyed. Dependency on foreigner donors for Liberia’s health sector as attested 80% of Liberia’s health expenditure in 2007 and 2008 was funded by foreign donors, is a non-viable and non- sustainable approach when donors’ fatigue arises.Also donors have their own demands, priorities, reportorial benchmarks, etc that may crash and clash with government and health authorities priorities.

Such competing interests can contribute to dawdling progress or no progress at all. The Government of Liberia should not limit the carving, evaluation and implementation of health policy only to the Ministry of Health and Social Welfare but should get overall involvement of major Liberian stakeholders, like the Ministries of Planning, Finance, Justice, major hospitals, civil society organizations, NGOs, media institutions, religious sectors, police and family institutions.The Liberian government mental health policy should go beyond broad and excess ambitious descriptions rather should proffer comprehensible and clear information as to how the policy will be accomplished with timeline. Government must therefore prioritize the improvement of effective, efficient, viable and sustainable mental health services. This is a wakeup call for the government of Liberia. As former United Nations Secretary General Kofi Annan told world leaders, “It is time for governments to make mental health a priority and to allocate the resources, develop the policies and implement the reforms needed to address this urgent problem.One in four people will suffer from mental illness at some time in life.

” Gro Harlem Brundland, M. D. , Director General of the World Health Organization (WHO), realizing the lackadaisical interest showed by half of the countries in the world, admonished world leaders that mental health is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light. The government of Liberia should take cue and make serious improvement in the mental health care system instead of the usual empty paper and empty speech-makings.

____________________________________________________________ _____ Prev Page About the Author Ernest S. Maximore is a Liberian journalist, a poet, a lawyer, a statesman. He earned B. A. Mass communication and Bachelors of Law (L.

L. B) from the University of Liberia. Currently he is on study leave in the US pursuing MBA with concentration in Public Administration. At present, he serves as Director of Communications of Liberia’s General Auditing Commission (GAC). He can be reached at [email protected]

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