title: A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake.
abstract: BACKGROUND
  Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti.
  
  
  OBJECTIVE
  The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based psychiatric services in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme ("mhGAP"), a tool developed by the World Health Organization to support mental health care delivery by nonspecialists in LMICs.
  
  
  METHODS
  The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters.
  
  
  RESULTS
  Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress.
  
  
  CONCLUSIONS
  Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings.
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA. Electronic address: dgrelotti@ucsd.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grelotti
authors.affiliation: Palo Alto Medical Foundation, Mountain View, CA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Lee
authors.affiliation: Zanmi Lasante, Haiti; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.
authors.forename: Joseph Reginald
authors.initials: JR
authors.lastname: Fils-Aimé
authors.affiliation: Zanmi Lasante, Haiti.
authors.forename: Jacques Solon
authors.initials: JS
authors.lastname: Jean
authors.affiliation: Zanmi Lasante, Haiti.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Therosmé
authors.affiliation: Zanmi Lasante, Haiti.
authors.forename: Handy
authors.initials: H
authors.lastname: Petit-Homme
authors.affiliation: Partners In Health, Boston, MA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Oswald
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Partners In Health, Boston, MA; Department of Psychiatry, Harvard Medical School and Department of Psychiatry, Boston Children's Hospital, Boston, MA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Raviola
authors.affiliation: Zanmi Lasante, Haiti.
authors.forename: Eddy
authors.initials: E
authors.lastname: Eustache
mesh_terms: D001714:Bipolar Disorder / Q000628:therapy; D003156:Community Mental Health Services / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D003704:Dementia / Q000628:therapy; D003863:Depression / Q000628:therapy; D003906:Developing Countries; D004190:Disasters; D055866:Earthquakes; D006205:Haiti; D006261:Headache / Q000628:therapy; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D009462:Neurology; D010865:Pilot Projects; D011570:Psychiatry; D011618:Psychotic Disorders / Q000628:therapy; D058996:Quality Improvement; D012189:Retrospective Studies; D012424:Rural Population; D012640:Seizures / Q000628:therapy; D013315:Stress, Psychological / Q000628:therapy
keywords: Caribbean region; World Health Organization Mental Health Gap Action Programme (WHO mhGAP); community-based psychiatric and neurologic care delivery; global mental health; implementation