Home > Publications > 5 Zanmi Lasante Grelotti et al Mental Health Mobile Clinics

Brief Presenter Biography: Dr. Grelotti completed medical school at The Johns Hopkins University School of Medicine and residency training in adult psychiatry and child and adolescent psychiatry at Harvard Medical School.

TITLE OF PRESENTATION:
The mental health mobile clinic: An innovative approach to improving access to mental health services in rural Haiti

PRESENTERS:
David J. Grelotti, MD; Tatiana Therosme; Reginald Fils-Aime, MD

PRESENTER NAME AND TITLE: David J. Grelotti, MD
Professional Title: Clinical and Research Psychiatrist and Research Fellow
Organization: Partners In Health and Harvard School of Public Health
Complete Mailing Address: Partners In Health, 888 Commonwealth Ave, 3rd Floor, Boston, MA 02215
Email Address: dgrelotti@pih.org
Phone Number: 617-998-8922
Brief Presenter Biography: Dr. Grelotti completed medical school at The Johns Hopkins University School of Medicine and residency training in adult psychiatry and child and adolescent psychiatry at Harvard Medical School. He was the first Pagenel Fellow in Haiti at Partners In Health and Harvard Medical School and provided near full-time support to the Zanmi Lasante mental health team between July 2011 and June 2012 in Haiti’s Central Plateau and Lower Artibonite. Now splitting time between Partners In Health and the Harvard School of Public Health, Dr. Grelotti conducts global mental health research and continues to support mental health capacity building at Zanmi Lasante and Partners In Health Lesotho.

ADDITIONAL PRESENTERS:

2) Tatiana Therosme

Professional Title: Psychologist, Mental Health Team, Zanmi Lasante, Cange/Mirebalais, Haiti; Community Mental Health Worker Educator, Mental Health, Zanmi Lasante

Organization: Zanmi Lasante (Haiti)

Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti

Email Address: thamsingp26@yahoo.fr

Phone Number:

Haiti: +509-48902336

US: 617-835-1892

Brief presenter biography:

Tatiana Therosme serves as a Psychologist at Zanmi Lasante at the L’hôpital Bonne Sauveur in Cange, Plateau Central, Haiti. In addition to this role, Ms. Therosme serves as Mental Health Training Coordinator for community health workers in interpersonal therapy as part of the Zanmi Lasante mental health program in Central Haiti. Prior to her current role, Ms. Therosme served as the head Psychologist at our Zanmi Lasante site in Cange and has been an integral member of the Mental Health and Psychosocial Support team as a clinician and a trainer. Since 2008 she has worked with patients from throughout the country, spearheading ZL’s efforts in providing psychological and psychiatric support for patients with cancer, victims of gender-based violence, and hundreds of patients from Port-au-Prince who survived the earthquake. She has worked to shatter the silence surrounding mental illness through patient care and community outreach. During her time with ZL her work has been recognized globally, and in 2011 she was recognized by Womendeliver.org as one of the top 100 most influential women: http://www.womendeliver.org/knowledge-center/publications/women-deliver-100/women-deliver-100-76-100/

3) Reginald Fils-Aime, MD

Professional Title: Medical Director, Mental Health Clinical Team, Mirebalais Hospital, Mirebalais, Haiti; Dr. Mario Pagenel Fellow in Global Mental Health Delivery, Partners In Health

Organization: Zanmi Lasante (Haiti)                                                                      Complete Mailing Address: Zanmi Lasante, 617 Blvd Jean Jacques Dessalines, Mirebalais, Haiti                                                                                                                 Email Address: rj.filsaime@gmail.com                                                                    Phone Number:                                                                                                         Haiti: +509-37017431                                                                                                               US: 617-835-1892                                                                                                                Brief presenter biography: Dr. Joseph Reginald Fils-Aime graduated from medical school at the Universite d’Etat d’Haiti. He initially worked at Zanmi Lasante since 2009 as a general practitioner, then as the manager of the Multi-drug Resistant Tuberculosis Program at Cange. Currently he is the Medical Director of the mental health program at Zanmi Lasante. 

MODE OF PRESENTATION

Panel Presentation:  Friday June 07, 2013 (45- to 50-minute long)

DESCRIPTION OF SESSIONS AND LEARNING OBJECTIVES

ABSTRACT:

Background: The mental health team at Zanmi Lasante (ZL) provides care to persons suffering from mental and neurological disorders in many of the most rural, remote, and impoverished areas of Haiti. ZL’s free, clinic-based mental health services helped many, but there appeared to be a considerable mental health treatment gap in areas far away from the ZL clinics but within the ZL catchment area. For some patients, the time and expense related to transportation to and from clinic hindered adherence to treatment and follow-up. In conversations with individuals in rural and remote communities, ZL also learned that many people with mental or neurological disorders never sought treatment. Thus, sustainable and cost-effective models to provide safe and effective care to individuals from remote areas were needed. To address this issue, ZL piloted a mental health mobile clinic in a rural community of Haiti’s Central Plateau.

Methods: Beginning in January 2012, a group of ZL mental health clinicians traveled monthly to a rural Haitian community located between Cange and the border of the Dominican Republic to conduct a mental health clinic. Before starting the clinic, the team partnered with local ZL community health workers (CHWs) who received a brief training on mental disorders and subsequently recruited patients to the clinic believed to be in need of mental health services. The community also was engaged, converting a local church into the temporary clinic and helping shuttle patients back and forth from home. Initially, an American psychiatrist and ZL psychologists staffed clinics, but ZL generalist physicians subsequently joined psychologists and the American psychiatrist in patient care in February 2012 and then replaced the American psychiatrist in June 2012. Characteristics of clinics conducted from January 2012 to January 2013 were reviewed and are presented here.

Results: The number of patients seen at the mobile clinic increased over time, and the majority of patients returned for follow-up at least twice. Clinicians generally noted patients as improving, as did CHWs. Clinicians evaluated patients with a wide range of psychiatric and neurological conditions over a wide range of ages, many of whom were never previously treated. The clinic also received a number of people with general medical complaints in addition to people in need of emergency services. At first, patients were referred by CHWs, but later family members and other members of the community who learned of and/or experienced our services were important sources of referral. A variety of services were provided, including medication consultation, psychoeducation, and therapy. Because this mobile clinic was tied into existing community-based mental health services at ZL, additional cost was minimal and limited to transportation and food for staff.

Conclusions: Providing free access to safe, effective, context-sensitive community-based mental health services seemed to dismantle many of the presumed barriers to mental health care including stigma, medical literacy, distance, and the cost of obtaining care and medication. Close collaboration with CHWs seemed to have the unexpected benefit of improving adherence to follow-up, providing active case finding, and treatment continuity between appointments. This mobile clinic was also an opportunity to educate clinicians, CHWs, patients, and members of the community of the importance of mental health care. Because much of Haiti is rural and many rural Haitians are going without mental health care, mental health mobile clinics may be a useful model for mental health care delivery in communities where currently no services exist.

Brief description of session:

To address the large mental health treatment gap in rural Haiti, the Zanmi Lasante mental health team has partnered with community health workers to develop a mental health mobile clinic in one rural Haitian community. The monthly clinics served a wide range of patients with mental and neurologic disorders, were cost-effective, and were associated with good outcomes. The mobile clinics reduced many barriers to care and are a useful model of care delivery in rural Haiti.

Learning objectives for panel presentations:

  1. The audience will be able to describe the challenges and importance of delivering mental health care in rural, remote, and resource-constrained areas of Haiti.
  2. The audience will be able to describe treatments that can be adapted to a mental health mobile clinic as well as how characteristics of the mental and neurological disorders commonly seen in rural settings informed those treatments.
  3. The audience will learn about a collaborative, sustainable, and mobile model of health care delivery joining clinicians at health centers and individuals in rural communities to improve mental health care in rural and remote areas of Haiti.

 

TARGET AUDIENCE (Mark all that apply.)

Mental Health Providers
Medical Providers
Educators/School Administrators
Paraprofessionals
Policymakers/Legislators

Legal/Juvenile Justice Personnel
Administrators
Students
Faith-Based Organizations
Community Leaders
General Public

Other

KNOWLEDGE LEVEL: Introductory (useful for professionals/students new to this field, or non-mental health professionals)

AUDIO VISUAL EQUIPMENT: LCD Projector/Computer

ACCOMMODATION REQUEST: None