LiCORMH

Improving mental health

outcomes through research

S. Benedict Dossen, BSW

Lead, LiCORMH

Outline

Overview of Liberia

Perception of Mental Health Illness

LiCORMH as a strategy (Outcomes)

Liberia at a glance

Geographical size: 111,369 km2

Independence: 1847

Population: 3.7

Per capita gross domestic product: 247USD (2010)

Poverty status: 76.2% living on less than 1USD/day

Life expectancy: 59 years (2010 UNDP)

Liberia at a glanceMajor Depression: 40%

PTSD: 44%

Exposure to sexual violence: 42-73%

Substance Abuse among ex-combatants: 12% - 44%

Sexual violence of ex-combatants: 42%, female; 32%, male

Suicide: 11% contemplation; 6% unsuccessful

Epilepsy: 45% of all outpatient MH cases

Proximity to health facility: 41% located more than one hour away from nearest health facility

Idioms and Causes of Mental Illness

0

5

10

15

20

25

Health Worker

Pharmacy Religious Leader

Police Community

Soci

al D

ista

nce

(M

ean

, 95

% C

I)

Social Distance from Persons with Mental Illness (e.g. willing to work with, live nearby, be friends with, or marry a person with mental illness)

More

Distance

Less

Distance

Health workers, n=45; Pharmacy workers, n=45; Religious leaders, n=38; Police, n=45;

Other community members, n=179; Total=352

ANOVA, F=4.70, p=.001

*

* Religious leaders differ from police and community.

No association between correct identification and perceived functioning.

Creation of LiCORMH

LiCORMH’s Purpose and mandates

Promote evidence-based practice

Improve mental health governance

Improve mental health data/information

Increase mental health researchers

Foster culture of ethical research

Measure access and quality

Develop standards and guidelines

Why outcomes strategy?

Ensure development and application of outcomes measures that assess

mental health policies

services

practice

research

Strengthen the health care delivery system

Programmatic framework

Policy

Research

Practice

Services

Major Cores for Improving Outcomes

Policy Core

Centralized repository for information, data, and research policy analysis

Translate interventions into locally supported and sustainable mental health programs

Develop strategic plans

Scientific Core

Establish a Review Board

Increase quality of mental health research

Increase quantity of relevant ethical mental health studies

Develop impact monitoring system

Develop scholarly activities

Training & Development Core

Build local mental health research capacity

Explore local and international training opportunities for mental health workers and researchers

Fund Development/ Public Relations

Engage in fund raising and development

Promote publicity

Maintain a virtual host

Research collaboration

Ongoing strategies to improve outcomes

Expected Outcomes

Short term (0 - 5 years) Increase evidence-based practice

Expand local MH research

Establish MH-IRB

Establish Virtual MH library

Increase interests in MH

Identify training opportunities for MH workers and researchers

Support MH indicators/target development

Increase awareness of MH research

Long term (5 – 10 years)

Increase access and availability of MH information and services

Enhance adherence to ethical standards and guidelines

Establish outcomes-based monitoring systems for MH

Establish MH repository

Improve quality of MH services

Challenges

Governance Limited funding

Poor regulations (i.e. services, ethics, practice etc.)

Poor integration in PHC

Inability to adequately measure access and quality

Social Stigma and

discrimination

Diminished interest in the profession

Lack of confidence in outcomes based strategies for LMICs

Limited professionals

Challenges

Treatment

Lack of psychotropic medications

Reduced confidence in psychotherapy

Education & Information

Lack of accurate information

Limited data/information

Concurrent researchMental Health Beyond

Facilities (GCC): To develop and evaluate a Comprehensive Community Based Mental Health Services package for persons with severe mental disorders and epilepsy

Adolescent girls psychosocial development (ReBuild): To determine the extent to which MH services are informed by context, gender and social-cultural norms?

Future research

National prevalence of mental health and substance use disorders

Community based mental health care

User advocacy and information dissemination programs (radio)

Psychotropic drugs effect determination

National prevalence of open mole (cultural bound syndrome)

Enhancing referral among traditional healers and religious leaders

Efficacy of Crisis Intervention Teams in reducing stigma and discrimination and improving care

Maternal depression and improved child outcomes

Suicide in youth

Peer support models in Liberia

Acknowledgements:

Janice L. Cooper, PhDRodney D. Presley, MSW

Research Committee of the Technical Committee for Mental Health, MOHSW

LiCORMH Governance Board

Thank You!!

Sources

Brandon Kohrt & TCC MHP-L Program, 2012

National Mental Health Policy, 2009

Essential Package of Health Services, 2012

Essential Package of Social Services, 2012

Country Situational Analysis (GOL), 2011

Health Seeking Behavior Survey (GOL), 2008

Johnson, K. et al., 2008

Lee et al., 2011

BPHS Accreditation Final Results Report., 2011