Building a sustainable, community-based model of depression care into a government-run health care system: A case study of 11 major health care facilities in rural Haiti

Over the past 25 years—and particularly since the 2010 earthquake—Zanmi Lasante/Partners In Health has found a high prevalence and incidence of depression in its patients. However, given the high stigma surrounding depression in local communities, lack of a skilled mental health care workforce to address this need, a formalized structure, system, and locally defined science to find, assess, refer, and treat mental health issues, and a lack of financial resources to support such initiatives, these needs were unable to be effectively addressed by the existing health care system. However, long term strategic investments into mental health care from various avenues provided the resources to build the local Haitian capacity to address mental health issues that is based on a community based model of care. This presentation will focus on the first year of this three year initiative, which focuses on building the service delivery, clinical supervision, management, monitoring and evaluation, and capacity building of local community health workers, psychologists, social workers, nurses, and physicians to address the burden of depression in ZL/PIH's catchment area of 1.2 million people. The findings will provide a step by step road map on how to build mental health services into a government run health care system. Additionally, I will demonstrate not only that the most effective means to address mental health illness burden in low resource settings requires a community based approach whose core lies in partnership with and investment in local partners to ensure long term sustainability, but that this can be successful.