Integrating mental health into primary health care settings after an emergency: lessons from Haiti

Following the 2010 Haiti earthquake, there was a need for specialist services for severely mentally ill people who were presenting to the emergencymedical clinics set up for displaced people. That need was unmet. Using guidelines drawn up by the Inter-Agency Standing Committee (IASC), and piloting the Health Information System(HIS) of diagnostic categories in mental health, weekly mental health clinics were begun in eight mobile clinics. A psychiatric liaison service was also started in the main casualty hospital. Haitian general practitioners and psychosocial workers, who received on-the-job training and supervision from the authors, ran these services. This integrated mental health/primary health care model was successful in engaging severely mentally ill patients in treatment; however, the scale of the disaster meant that only a relatively small proportion of the displaced population could access help. This limitation raised a number of questions about the practicality and sustainability of the IASC model in resource poor countries, with poorly developed community services, hit by large scale emergencies, which the authors address.