itself as a welcoming committee, and Dr. Brown was quickly sidelined from the proceedings. New possibilities were floated to revitalize mental health and psychiatric care in Liberia, including the creation of a psychiatric hospital within JFK Hospital, the reconstruction of Katherine Mills, and the development of a psychiatric training program at the University of Liberia.
International consultants were hired to produce a formal mental health policy, and in 2009, a national mental health policy was signed into law. The national mental health policy was hailed as a progressive achievement internationally for mainstreaming mental health care into basic health services, expanding psychiatric training to community-based healthcare providers, and committing to providing counseling to the entire population of Liberia. The national mental health policy has also attracted considerable attention from the international media. Its been lauded for its ambitions by global mental health activists and in profiles on NPR (2011) and in The Utne Reader (“Liberia’s Model” 2010), but it has garnered criticism from PBS (2011), The Nation (Ololade 2012), and FrontPage Africa (Maximore 2011) for its insufficient reach.
In 2010, the Carter Center launched a five-year initiative to help develop the mental health sector by supporting the MOHSW implementation of Liberia’s national mental health policy, creating anti-stigma campaigns, and financing and designing psychiatric nursing training for five hundred already licensed Liberian nurses and physician’s assistants employed by the MOHSW. The Carter Center resolved the “indigenization problem” in Liberia’s mental health policy by removing responsibility for mental health and psychiatry from a single Liberian psychiatrist and inserting psychiatric care into primary care. In addition, the Carter Center built alliances with donors and with international NGOs, who worked to revitalize the greater Liberian health sector, ensure bureaucratic efficacy, and sustain supplies of psychiatric medications from the WHO’s list of essential medicines. Cap Anamur left Liberia, and JFK Hospital assumed responsibility for Grant Hospital, which continues to operate as a psychiatric hospital with outpatient care, and has become a central training site for psychiatric residencies in the Carter Center training program. Most of the actors described here have participated in academic and epidemiological research initiatives to advance mental health in Liberia.
Today, Liberia has earned some recognition as an innovator in African mental health services, and all signs seem to point toward an effective “scaling up,” or nationalization, of basic mental health services. With the support of the Carter Center and the Walter P. Annenberg Foundation, monthly coordination meetings are held at the MOHSW, and they include most of the institutions actively involved in providing clinical mental health care. The next step in Liberia’s postconflict recovery involves political and administrative decentralization, and as part of that process, efforts are under way to ensure that inpatient psychiatric care is available through the county medical system. Further localization, to the district level, is on the horizon over the next decade. Thanks to the mainstreaming of mental health services into the general health services basket, the problem of donor whims and dedicated funding lines should be diminished in the short-term foreseeable future, as long as international support continues to finance the remaining 80 percent of the Liberian health sector. In a groundbreaking move, psychiatric medications are now included on the essential medicines list for Liberia, and as the Liberian health system strengthens, each county health office must have a trained mental health specialist to oversee all local mental health activities implemented by subcontracted NGO basic health service providers.
The MOHSW’s new headquarters, constructed as a gift from the Chinese government, now houses a full-time Mental Health Division that works with new health systems experts from USAID, but the afterlife of the early postconflict period remains. CVT departed in 2007, but it left behind several dozen psychosocial workers who insist upon their professional legitimacy as counselors. With the support of their previous employer, CVT, these psychosocial workers have founded a new national organization, the National Association of Psychosocial Workers, that is meant to rival the officially recognized National Association of Social Workers. In 2011, a Washington D.C.-based office of USAID awarded the new organization a US$5 million grant to engage in psychosocial activities without having consulted with the Liberia-based USAID office, which provides financial support to the Carter Center and the MOHSW through the Rebuilding Basic Healthcare Program, and is opposed to recognizing the new organization. At the same time, many former employees of CVT are trying to work within the MOHSW and other government agencies, while seeking donor support for independent counseling and research careers in Liberian mental health.
Occasionally, Dr. Brown appears in the international media as an expert on Liberian mental health, but in national mental health coordination activities, a prominent Ugandan psychiatrist has effectively replaced him. Harvard University, Massachusetts General Hospital, and the University of Liberia are planning to establish a Center of Excellence for Mental Health, but this initiative seems to be connected with Dr. Brown and is evoking longstanding rivalries with the newly strengthened Mother Patern College and Grant Hospital, both of which work closely with the Carter Center.
Конец ознакомительного фрагмента.
Текст предоставлен ООО «ЛитРес».
Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.
Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.
