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Addressing the impact of war, widespread poverty, limited access to mental health care, and the stigma surrounding mental illness through specialized care, rehabilitation, and social reintegration for vulnerable women

Liberia, a country scarred by decades of civil war, economic hardship, and a fragile healthcare system, faces a significant mental health crisis. The country has endured unimaginable trauma, from the devastating Liberian civil wars (1989–1997, 1999–2003) that caused mass displacement, extreme violence, and loss of life, to the Ebola outbreak of 2014–2016. These events have left millions of Liberians struggling with mental health challenges, yet access to adequate mental health services remains critically limited.

In a context of overwhelming poverty, stigmatization of mental illness, and a lack of trained professionals, many Liberians are left without the proper care and support needed for recovery. Initiatives like We Are Like You, launched by Sisters Hospitallers, are crucial in providing specialized care to those most in need. This project, focused on women, is dedicated to tackling both the immediate mental health needs and the long-term social reintegration of people living with mental illness.

 

The mental health crisis in Liberia

1. A nation scarred by war and trauma

The Liberian civil wars left over 250,000 dead and displaced 1.3 million people—nearly half of the country’s population at the time. Thousands of children were recruited as soldiers and forced to commit atrocities, while many women suffered sexual violence. According to studies by the World Health Organization (WHO), around 40% of Liberians today suffer from post-traumatic stress disorder (PTSD), depression, or other anxiety disorders, yet the majority remain untreated.

A 2011 study by the Harvard Humanitarian Initiative found that 44% of former child soldiers in Liberia displayed symptoms of PTSD, while 65% had depression. Many of these individuals remain marginalised and struggle to reintegrate into society.

2. Critical shortage of mental health services

Liberia’s healthcare system is severely underdeveloped, with less than 200 doctors serving a population of over 5.4 million. Mental health care is even more neglected:

  • Liberia has fewer than five psychiatrists for a population of over 5.4 million people.
  • There is only one psychiatric hospital, located in the capital, Monrovia—E.S. Grant Mental Health Hospital—with limited resources and a very low number of trained staff.
  • Despite the mental health challenges, only 2% of the national health budget is allocated to mental health services.

This dire shortage means that mental health services are highly inaccessible, especially in rural areas. Many individuals with mental health issues face barriers to receiving care or must resort to harmful practices, such as being chained to trees or locked in their homes by family members due to fear or a lack of knowledge.

3. Poverty and economic barriers to care

Liberia is one of the poorest countries in the world, with 64% of the population living below the poverty line (less than £1.70 per day). Economic hardship contributes to stress, anxiety, and depression, and prevents many from seeking care. Even when mental health services are available, treatment costs are often prohibitive, leaving the most vulnerable without help.

4. Stigma and social exclusion

Mental illness in Liberia is highly stigmatised, often associated with witchcraft, curses, or spiritual possession. As a result:

  • Many individuals with mental health conditions are shunned by their families and communities.
  • Women, in particular, face double discrimination—both for their mental illness and their gender.
  • Some families resort to chaining individuals to trees or beds due to lack of knowledge or fear.

5. Psychological impact of the Ebola Crisis

The 2014–2016 Ebola outbreak, which killed over 4,800 Liberians, further intensified the country’s mental health crisis. Many survivors suffer from survivor’s guilt, depression, and anxiety. A 2018 study found that 48% of Ebola survivors in Liberia exhibited symptoms of PTSD, and many healthcare workers experienced burnout and trauma due to the overwhelming loss of life.

The Role of “We Are Like You” in addressing mental health needs

To address these overwhelming challenges, Sisters Hospitallers launched the We Are Like You project at the San Benito Menni Catholic Hospital in Monrovia. This initiative focuses on providing specialised mental health care, rehabilitation, and social reintegration, particularly for women facing mental illness.

Key Contributions of the Project

1. Providing Access to Specialised Mental Health Care

  • The programme offers free or affordable psychiatric treatment to women with mental illness, filling a crucial gap in Liberia’s healthcare system.
  • Patients receive medical evaluations, therapy, and medication to help them stabilise and recover.

2. Training Healthcare Professionals

  • We Are Like You provides mental health training to doctors, nurses, and caregivers, helping to strengthen Liberia’s fragile healthcare infrastructure.
  • More than 250 healthcare workers have received specialised training, improving mental health services beyond the hospital setting.

3. Combating Stigma and Raising Awareness

  • The programme conducts public education campaigns to challenge myths about mental illness and reduce social discrimination.
  • Community outreach efforts have helped change attitudes towards mental health, encouraging more families to seek professional care.

4. Rehabilitation and Social Reintegration

  • Beyond medical treatment, We Are Like You provides vocational training, life skills workshops, and psychosocial support to help women regain independence.
  • Former patients receive support in finding jobs or returning to their communities, reducing the risk of homelessness and neglect.

5. Promoting Collaboration for Long-Term Impact

  • The project works with local and international partners, including the Liberian Ministry of Health, to advocate for policy changes and increased investment in mental health.
  • Through collaboration, We Are Like You contributes to sustainable improvements in Liberia’s mental health care system.

The Road Ahead: Challenges and Future Needs

Despite the significant progress made by We Are Like You, many challenges remain:

  1. Scaling up services is essential: The project must expand to reach rural areas, where mental health care is almost non-existent.
  2. Financial support is crucial: More funds are required to train additional professionals, improve treatment facilities, and provide ongoing care for patients.
  3. Stronger government commitment to mental health policies is needed, along with better integration of mental health into national healthcare frameworks.

Liberia’s mental health crisis is one of the most pressing yet underfunded public health issues. The scars of war, poverty, and disease continue to affect millions, yet mental health remains a low priority in national policy. In this challenging landscape, We Are Like You is a lifeline for many women, providing essential care, combating stigma, and advocating for systemic change.

However, more international support is needed to ensure Liberia’s most vulnerable populations receive the mental health care they deserve. With continued investment, collaboration, and awareness, initiatives like We Are Like You can help build a future where mental illness is no longer a sentence of isolation, but a treatable condition with hope for recovery.

 

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