Liberia faces a complex and considerable burden of mental, neurological, and substance abuse (MNS) disorders, stemming from the layered effects of widespread poverty and social vulnerability, pandemic health crises (Ebola and COVID in succession), and devastating civil war. In response, the Government of Liberia has instituted a series of policy actions to promote the delivery of mental health and psychosocial support services (MHPSS) at all levels of the health system. But extending the national MHPSS response to the community level has been a persistent challenge.
Following the Ebola epidemic (2014-16), the Government of Liberia, together with partners, rapidly established and scaled up a national community health system to support a cadre of Community Health Assistants (CHAs) in remote locations to provide a series of basic health services. The first iteration of the national policy on community health over 2016-2021 provided for limited package of mental health services. However, the resources for and implementation of community-level mental health services in practice was scant and largely neglected, with key coordination and capacity gaps undermining the ability of the national community and mental health systems to collaborate and implement effectively.
The Health Systems Strengthening Accelerator supported the Government of Liberia (GOL) in expanding the provision of high-quality mental health and psychosocial support (MHPSS) services. One of the core components of the Accelerator’s scope of work in Liberia was to support the Ministry of Health’s Mental Health Unit in strengthening community-level mental health programming. In order to better understand the challenges and best practices observed in previous and ongoing local initiatives, the Accelerator conducted a rapid desk review of salient community-level mental health interventions in Liberia. The Accelerator’s assessment revealed that:
- The roles and responsibilities of community health workers in MHPSS were limited,
- Training of community health workers was severely lacking,
- CHAs did not coordinate with or receive supportive supervision from trained PHC workers or secondary-level clinicians on mental health, and
- Coordination, monitoring, and oversight of community-level mental health services was weak overall.
This brief summarizes the results of the desk review, and puts forward recommendations the following for a) revising the package and training module for MHPSS delivery at the community level, and b) sustainably improving how community mental health is implemented and coordinated by integrating certain strategic and promising approaches observed in the Liberian initiatives under review.
