Liberia is a country with an approximate area of 111 thousand sq. km. (UNO, 2001). Its population is 3.487 million, and the sex ratio (men per hundred women) is 100 (UNO, 2004). The proportion of population under the age of 15 years is 47% (UNO, 2004), and the proportion of population above the age of 60 years is 4% (WHO, 2004). The literacy rate is 72.3% for men and 39.3% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 4.3%. The per capita total expenditure on health is 127 international $, and the per capita government expenditure on health is 97 international $ (WHO, 2004). The main language(s) used in the country is (are) English. The largest ethnic group(s) is (are) African. The largest religious group(s) is (are) Christian (four-fifths), and the other religious group(s) are (is) Muslim (one-sixth). The life expectancy at birth is 40.1 years for males and 43.7 years for females (WHO, 2004). The healthy life expectancy at birth is 34 years for males and 37 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Liberia in internationally accessible literature. Swiss et al (1998) assessed a random sample of 205 women and girls between the ages of 15 and 70 years (88% participation rate). And found that 49% of them reported experiencing at least 1 act of physical or sexual violence by a soldier or fighter. 15% had been raped, subjected to attempted rape, or sexually coerced. Women who were accused of belonging to a particular ethnic group or fighting faction or who were forced to cook for a soldier or fighter were at increased risk for physical and sexual violence. Young women (those younger than 25 years) were more likely than women 25 years or older to report experiencing attempted rape and sexual coercion.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is absent. From September 2004, an emergency mental health strategy is being developed in collaboration between MOH and WHO.
Substance Abuse Policy A substance abuse policy is absent. An emergency substance abuse strategy has been integrated in an overall emergency mental health strategy being developed in collaboration between the Ministry of Health and WHO.
National Mental Health Programme A national mental health programme is absent.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1970.
Mental Health Legislation The Public Health Act refers to mental health. There is no mental health legislation as such.
The latest legislation was enacted in 1970.
Mental Health Financing There are no budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is out of pocket expenditure by the patient or family.
There are no budget allocations for mental health within MOH. Funds were earlier allocated within the Regional University Hospital (JFK) to a psychiatric hospital, but the hospital was destroyed in 1990. The country does not have disability benefits for persons with mental disorders.
Mental Health Facilities Mental health is not a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Regular training of primary care professionals is not carried out in the field of mental health. There are no community care facilities for patients with mental disorders. A few facilities offer layman counselling and shelter, but these services do not cater to the needs of the severely mentally ill.
Psychiatric Beds and Professionals
psychiatric beds per 10 000 population
beds in mental hospitals per 10 000 population
beds in general hospitals per 10 000 population
beds in other settings per 10 000 population
- Number of
psychiatrists per 100 000 population
- Number of
neurosurgeons per 100 000 population
- Number of psychiatric
nurses per 100 000 population
- Number of
neurologists per 100 000 population
- Number of
psychologists per 100 000 population
- Number of social workers per
100 000 population
There is only one psychiatrist and one psychiatric nurse in the country. No mental health services are currently available in the country as the psychiatric hospital was destroyed during the war. Under the emergency programme, a 25-bedded public hospital is reopening in Monrovia in Fall 2004 along with limited outpatient functions. These will constitute the only clinical mental health services in the country. Mental health is integrated in pre-graduate training of nurses and doctors, but due to the war and the lack of clinical services, the training is sporadic and mainly theoretical. Special training programmes for mental health are not present. The emergency programme plans restarting of in-service training and has restarted training of medical students.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy and prevention. One NGO is involved in reconstruction of emergency mental health services. A few other international NGOs are mainly involved in psychosocial and trauma work. A few local NGOs provide services for substance misuse.
Information Gathering System There is no mental health reporting system in the country. The country has no data collection system or epidemiological study on mental health. There is a strong need, but no current resources, for a national survey on needs and resources in mental health and substance abuse.
Programmes for Special Population There are no services for special population groups.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: phenobarbital, phenytoin sodium, amitriptyline, chlorpromazine, diazepam, haloperidol.
The listed therapeutic drugs are generally not available at the primary health care level. The list and prices are based on pharmacy prices in the capital. Prices vary significantly (minimum and maximum prices from survey 2004 is shown). Benzhexol (5 mg) is used as anti-parkinsonian drugs.
Other Information There is an urgent need for needs assessment as because of the civil war mental health problems have
increased. Technical help is needed. The years of war have had a significant effect on the deterioration of the health system in general with an expected shift also in the population in need of mental health care. Besides patients with classic mental health problems, there are now also serious war/conflict related mental health problems including substance abuse, while resources (funds and professional staff) for assistance are few or non-existent. There are no systematic or recent Needs and Resource Assessment of Mental Health and Substance abuse. In fall 2004, nearly all mental health services were closed due to lack of resources (funds and staff). Traditional and religious healing is common in the communities. The Ministry of Health has appointed a focal point for Mental Health in September 2004. Funding for the Mental Health emergency programme is urgently needed.