Building Sustainable Mental Health In Haiti Post the Earthquake:
A Look at Rebati Sante Mentale
While a number of individuals have been involved in variety of projects over many decades, the 2010 earthquake reinforced the need to have a more collective, unified approached to our individual work. Rebati Sante Mentale (RSM) is the logical result of the Haitian Mental Health Summit that was convened at the University of Miami on June 26, 27, 2010. That Summit itself resulted from the impetus and urgent necessity for an organized coalition of international mental health professionals to: a) assess the preexisting and post disaster mental health situations of the population in Haiti and in the Haitian Diaspora; b) develop specific strategic goals and action plans for working collectively in addressing mental health needs of Haitians; and c) create a network of mental health professionals and stakeholders aimed at addressing behavioral health needs of Haitians.
The Summit was attended by representatives from the Haitian American Psychiatric Association (HAPA), the American Psychiatric Association (APA), the National Institutes of Mental Health (NIMH), New York University (NYU), the State University of New York (SUNY) Downstate Medical Center, the World Psychiatric Congress (WPC), the University of Miami Miller School of Medicine, the University of Miami School of Education, Department of Educational and Psychological Studies, the Haitian Ministry of Health, Partners in Health, the Black Psychiatrists of America (BPA), the American Association of Black Psychologists, and several Haitian mental health professionals (psychiatrists, psychologists, social workers) practicing in New York, Boston, Miami, Chicago, Canada, and Haiti.
Prior to Rebati Sante Mentale, charges of carrying out the recommendations of the Summit were delegated initially to a Task Force of 25 members. Two face to face meetings (October 2010 and February 2011), again at the University of Miami, in addition to several teleconference calls, allowed the Task Force to discuss and begin implementation of the Summit recommendations. “Rebati Sante Mentale” was conceived as one professional and legal way to proceed with the tasks at hand. Rebati Sante Mantal Haiti is a non-profit organization dedicated to the overall goal of establishing an effective mental health capacity in Haiti, that is an integral part of Haiti health services, policy, and funding, and that provides evidence-based systems, delivery, and treatment strategies.
Mission and Objectives of Rebati
Rebati Sante Mantal Haiti is dedicated to the overall goal of establishing an effective mental health capacity in Haiti, that is an integral part of Haiti health services, policy, and funding, and that provides evidence-based systems, delivery, and treatment strategies. We support that goal through a focus on:
ü Coordination of efforts towards these goals through a role of monitoring, capturing, sharing, mapping, and giving visibility to the range of often fragmented efforts in different regions in Haiti
ü Highlighting and supporting efforts to bring financial, planning and faculty/mentoring/trainer support for the re-establishment and sustained excellence of psychiatric clinics and hospitals, and for the realization of integrated community primary care health model as part of overall health systems strengthening in Haiti
ü Supporting and encouraging efforts that build the capacity of Haitians to sustainably provide these services.
ü The mobilization and recruitment for direct support and assistance to achieve these goals from Haitian and Creole speaking mental health specialists in Haiti and outside of Haiti
ü The mobilization of networks of support from funders, decision makers, governmental and non-governmental health providers
With such a focus, RSM uses the PEP (project, events, and partnership) model to guide the many activities of the organization.
RSM operates on the premise that collaboration is key to building a sustainable program in Haiti. As such the projects being implemented are in partnership with several organizations internationally as well as in Haiti.
1) Teachers Mental Health Training Program
Overview of the project: The specific aims of the mental health training program are to:
a) train and provide ongoing support for health care providers, teachers, and community health workers in Haiti to identify, screen for, and offer support for mental health needs of individuals;
b) prepare a selected group of trainees to become trainers in identifying, screening for, and offering mental health support; and
c) pre- pare selected trainers to raise awareness about mental illness and importance of mental health in Haiti.
Since 2013, a total of 550 teachers and school directors have participated in the program. But with the walkathon and additional workshops, we estimated that a total of 1,057 individuals have been directly impacted by the program in the region.
2) Gerald Rigaud Fund Psychopharmocology Program in Haiti
Overview of the Project: A key objective in strengthening capacity and access to psychotropic medications in Haiti was securing a donor-partnership with a reliable supplier. In early February of 2015, the Haitian American Nursing Association answered the call of a key supplier and created the opportunity for Rebati Sante Mentale to implement the Gerald Rigaud Fund (GRF) Medication Project: ensuring the sustainable inventory and provision of psychotropic meds to poor patients diagnosed with mental disorders. Summaries of Activities: 2015: RSM in partner- ship with the Haitian American Nursing Association, the Center for Haitian Studies in Miami, FedEx, Haitian American Psychiatric Association, and the Center Specializing For The Rehabilitation of People with Amputations all play a part of the supply chain management system that is now successfully processing shipments of medications to the following destinations: L’Hopital Justinien in Cap Haitian, Mars & Klein in Port-au- Prince, and L,Hopital Beudet in Croix Des Bouquets.
The first shipment delivered to Dr. Girard of Mars & Klein included more than 200 assorted named meds. The second and most recent third shipment delivered to Drs. Malary, Girard, and Vulcain included more than 100 assorted named meds. These three separate shipments this year totaling more than 50,000 units of delivered psychotropic and non psycho- tropic meds can only be described as an act of total generosity and the successful execution of the GRF Psychopharmacology Project named after Dr. Gerald Rigaud who dedicated his life to improving the mental health and overall wellness of his homeland. Testimonials from the recipient doctors have characterized the program as life-saving and critical to the psychiatric treatment of the mentally ill.
3) Psychiatric Training Program
Overview of the Project: Within its primary objective of assisting in improving and rebuilding the mental system in Haiti by increasing its capacity, Rebati Sante Mentale (RSM), in collaborative partnership with the Haitian American Psychiatric Association (HAPA), the Department of Psychiatry of the University of Montreal and Haiti’s Health Department (MSPP) has completed Phase ONE of a psychiatric training curriculum module for medical students, residents at the Universite d’Etat d”Haiti (UEH) and Primary Care professionals. As designed, the curriculum module includes an academic component which primary focus on medical students and a clinical component directed primarily at residents and primary care. A successful program of psychiatric education will guarantee a growing interest in the field and encourage more graduates to pursue a residency training in the field. The medical student module will include core basic and fundamental issues that form the foundation of Psychiatry, such as the understanding, recognition, etiology and pathophysiology and recognition of major psychiatric problems. Those who choose other specialists will still have a basic know- ledge, which will enhance their skills in managing mental aspects in their practice.
Summaries of Activities 2015: The training curriculum for the residents is aimed at providing future Haitian Psychiatrists with sound clinical skills, judgment and knowledge about diagnosis, treatment and prevention of all psychiatric disorders together with other common medical and neurological disorders that re- late to the practice of psychiatry. Clinical exercises and experiences will provide clinical expertise in evaluating the entire range of psychiatric disorders and competence in their treatment and utilization of currently available fundamental modalities of therapy.
4) CENTER FOR HAITIAN STUDIES, HEALTH & HUMAN SERVICES (CHS)
Psychiatry Services Clinic
This rotation provides residents with exposure to cross cultural psychiatry among a largely underserved Haitian patient population. Services focus on evaluation of psychiatric ailments that include Mood Disorders (depression/bipolar disorder), Psychosis, Anxiety and PTSD, as well as appropriate psychopharmacologic treatments. To ensure continuum of care, primary care providers at the CHS identify patients with symptoms of psychiatric illness and refer them to psychiatric services for evaluation and treatment. Patients who are found to be candidates for psychotherapy are referred to the CHS psychologists. Services are provided on the 3rd Saturday a month at the clinic.
Personnel: Dr. Douyon (direct supervision attending), Psychologists, Translators. Staff is available to assist with scheduling and contacting patients. Psychiatric services are part of comprehensive Primary Care Health services provided at the site.
Summary and Conclusions:
When RSM started eight years ago, there were many organizations implementing mental health projects in Haiti, leading us to believe that one of the key roles that we could play is that of a convener of many of these organizations to reduce the level of duplication and increase the efficiency of the work in the county. At our recent summit in 2017, we learned that RSM is one of the few organizations still in existing and continual the work that it started post the earthquake. While sustaining our work has been most challenges, we are committed to ensuring the well-being of Haitians in Haiti and abroad. While many organizations are focusing on building the much-needed infrastructures in the country, it is imperative that we address the mental well-being of the people, the next generations depend on it!
More information about RSM
Rebâti Santé Mentale, Inc.
Richard Douyon,MD, FAPA
Marie-Claude Rigaud, MD, MPH