For two weeks Haiti has been at the forefront of our collective consciousness. But looking at long-term rebuilding efforts, aid organizations must recognize a challenge that goes beyond providing basic supplies and rebuilding: helping Haiti’s people to move toward psychological and emotional recovery.
On January 11, 2010, the day before the earthquake struck Port-au-Prince, the gap between Haiti’s need for mental health services and the presence of available care was already enormous. Other than the visionary accomplishments of Partners in Health in the central plateau in Haiti, public sector primary health care did not exist, and similarly, community-based mental health care remained a dream. There were few trained professional personnel and none of the infrastructure necessary to run hospitals and health centers.
Mental disturbance had already emerged as a major public health concern in Haiti, its incidence exceeding that of HIV/AIDS, tuberculosis and malaria combined. The reason for this unfortunate state was the combination of extreme poverty and unremitting despair. The World Bank has ranked Haiti as having the 133rd highest GDP in the world, better off than only several small island nations and a few war-torn African countries. Even the opportunity for people to lift themselves out of poverty by subsistence farming is not an option for struggling Haitians: there are no trees, no top-soil and no arable land. Poverty and minimal hope have devastated the mental well-being of many Haitians, leading to high rates of suicide, gender-based violence (54 percent of women reported sexual assault in one study), child abuse, and alcohol and substance abuse.
We know from experience that a by-product of Haiti’s humanitarian emergency is the psychological toll on the population. Traumatic depression and post-traumatic stress disorder can affect as many as 40 percent to 70 percent of a population. Given Haiti’s already enormous challenges, the numbers will be high. As we have seen in our work in post-conflict countries around the world, mental anguish is one of the single largest barriers to rebuilding and recovery. We’ve also seen that with psychiatric and psychosocial intervention and support, as many as 90 percent of those affected by traumatic depression can be returned to productive lives.
In the immediate aftermath of the earthquake, the aim is to provide psychological first aid, a service which keeps people safe, warm, fed, and informed about their loved ones. Many excellent organizations are on the ground in Haiti doing just that. But following this emergency phase, the real work begins. A national mental health plan must be written for Haiti that is then passed into law and implemented with the goal of scaling-up services to treat and heal what can be incapacitating mental distress. Rebuilding Haiti means returning people to their full mental function as well as providing physical necessities.
At a terrible cost in lives and human suffering, the trajectory of Haiti’s mental health care system has now changed forever. I believe that working in concert with the Haitian government and the Haitian people, to paraphrase former President Clinton: we can build it back better.
*Dr. Stephen J. Alderman is a guest blogger to AmericasQuarterly.org. He is co-founder of the Peter C. Alderman Foundation whose mission is to heal the emotional wounds of victims of terrorism and mass violence by training health care professionals and establishing clinics in post-conflict countries around the globe.