Assessing Perceptions and Provisions for Mental Health Disorders and the Role of Community-Based Healthcare in Haiti's Central Plateau

Tuesday, July 12, 2011: 1:45 PM

Hunter Keys, BS
School of Nursing, Emory University, Atlanta, GA
Bronwyn Fullard, BA
Department of Anthropology, Emory University, Atlanta, GA
Nayla Khoury, BA
School of Medicine, Emory University, Atlanta, GA
Aimee Brewster, BA
School of Public Health, Emory University, Atlanta, GA

Learning Objective 1: The learner will be able to list three challenges surrounding mental health diagnosis and care in rural Haiti.

Learning Objective 2: The learner will be able to outline the role of community-based health workers in implementing mental health care in resource-poor settings.


Nursing has long recognized the value of understanding explanatory models of illness across cultures to provide quality care. Because mental illness is conceptualized and experienced differently across different cultural contexts, Western approaches and diagnostic tools may not be valid. One of the most understudied areas of need among vulnerable populations is mental health. Although mental health disorders are a leading cause of disability-adjusted life years (DALYs), the mental health burden of rural Haitians is poorly understood. Our project had four objectives:  1) understand perceptions, experiences, and language surrounding mental illness; 2) culturally adapt evidence-based mental health screening tools; 3) identify resources already in place; and 4) provide recommendations to local healthcare providers for referral and care.


We conducted 31 semi-structured interviews with community figures and healthcare personnel, including psychologists, community health workers, priests, and traditional healers. We completed four case studies of persons with mental illness and developed four culturally appropriate mental health screening tools, adapting Beck’s Depression and Anxiety Inventories. To provide the most applicable assessment of mental illness in rural Haiti, we also constructed local scales of distress and functionality.


In rural Haiti, mental illness is not considered a discrete health category, and a unique system of idioms refers to experiences of mental illness. Mental illness is not extensively assessed or treated by healthcare providers or aid organizations. Mental illness is often not a differential diagnosis of healthcare providers, who often do not feel capable of diagnosing or treating mental illness. Traditional healers, churches, and neighbors are primary sources of care for persons with mental illness.


There is great potential to develop a community-based referral and treatment network in Haiti’s Central Plateau. Health worker training may be improved when they learn to identify mental health concerns through an understanding of idioms and applying locally-adapted screening tools.