Building mental health capacity in Haiti: The Teachers Mental Health Training Program
By Gemima St. Louis, PhD
Haitian psychologists in the diaspora began responding to the call for more sustainable partnerships by collaborating with Haiti-based organizations to help build mental health capacity throughout the country and provide training to a cadre of key stakeholders (e.g., teachers, physicians, nurses and spiritual and community leaders) that could better respond to the growing mental health needs of the population. This is how I became involved with the Teachers Mental Health Training (TMHT) program in Arcahaie, Haiti.
The TMHT program was spearheaded by a Haitian colleague, Guerda Nicolas, the chair of the Department of Educational and Psychological Studies at the University of Miami, who had been engaged in similar capacity-building efforts in other parts of Haiti for more than a decade. Initially, we were invited by community leaders in Arcahaie, a city located approximately two hours from Port-au-Prince, to provide training to teachers who resided throughout the region. Arcahaie is well known for its historical role in the Haitian revolution, and for being the birthplace of the Haitian flag. As such, it provided an ideal backdrop for launching one of the most comprehensive mental health capacity building initiatives in the area. At the time, community leaders were seeking a best-practice (i.e., culturally appropriate) training model that could be implemented in schools to address the unmet mental health needs of Haitian children and adolescents. Prior to initiating the training program, however, we took several preliminary but important measures.
First, we held planning meetings with the mayor, school administrators, teachers and other stakeholders to assess the needs, values and priorities of the community with the ultimate goal of designing a training program that would be culturally sensitive and tailored to the community’s needs. Second, we formed partnerships with local organizations, in particular the Musée Ogier-Fombrun. The museum, which was built on the ruins of an authentic sugar cane plantation, became the main training site for the program. In the spirit of building capacity, we took steps to ensure that the teachers would maintain an ongoing relationship with the museum staff and that, following their training, they would bring students to the museum (for most this would be their very first visit) to learn about the rich history of the region as well as Arcahaie’s key role in the Haitian people’s fight for independence. Lastly, we worked collaboratively with the community partners to identify a wide range of schools and program participants that were representative of the local community.
The TMHT program took place over the course of six months. Its primary goals were to (1) provide intensive psycho-educational training to teachers on the signs, risk factors and symptoms associated with various mental illnesses among children and adolescents; (2) enhance teachers’ understanding of the impact of mental illness on children’s academic, social and emotional development; and (3) equip teachers with the knowledge that would enable them to better support students in the classroom environment. The program was grounded in a community empowerment and sustainability framework, and included a “train-the-trainer” model whose aim was to provide more intensive training to a core group of teachers who would, in turn, conduct mental health training sessions with other groups in their respective communities.
During the course of the program, we conducted week-long training sessions for more than 70 teachers, representing different rural and urban areas as well as public and private schools. The curriculum, which was made available in Haitian Creole and French, served as the primary training tool. It included topics on the cultural meaning of mental health and mental illness in Haitian society; differences between symptoms, syndromes and disorders; causes and manifestations of mental illnesses among children and adolescents; frequently occurring childhood disorders, including depression, anxiety, trauma and grief; strategies for assessing signs and symptoms of mental illnesses among children and adolescents; and culturally bound syndromes. In addition to the mental health curriculum, all program participants received a guided tour of the Musée Ogier-Fombrun along with an overview of the history of Haiti from pre-colonization to independence. Prior to and following each tour, group discussions were held to address the impact of slavery and the history of colonization on the identity and mental health of Haitians.
At the conclusion of the program, all participants completed a post-evaluation tool that assessed their knowledge of the materials covered during the training. Given that the primary focus of the program was on capacity building, at the end of each training session, a core group of teachers was selected to receive additional training that would further prepare them as trainers. To ensure that the selected group of trainers would continue to engage in meaningful collaborations, a peer group system was developed to provide additional support as teachers continued to conduct mental health training sessions for other educators and providers in their communities. Furthermore, the trainers received ongoing consultation and “booster” training sessions from the senior staff.
The Teachers Mental Health Training program included some key components that we believe contributed to its successful implementation in the Arcahaie region of Haiti. These included (1) the participatory, community empowerment approach, which was used throughout the training program to increase awareness and knowledge among educators; (2) the inclusion of the community’s perspectives on cultural belief systems, values, traditions and practices that were germane to understanding how mental illness was perceived in the community; (3) the recruitment of a diverse group of teachers from a variety of backgrounds and regions; (4) the integration of the historical curriculum into the TMHT program; and (5) the selection of a subgroup of trainers who could build local capacity by training others in their respective communities. As the need for culturally sensitive mental health services continue to rise in low-resource countries such as Haiti, psychologists can play an important role in addressing these growing needs by working collaboratively with local communities and implementing capacity-building initiatives that are inclusive of the values, cultural beliefs and practices of the communities that they intend to serve.
Guerda Nicolas (front row, first from left) and Gemima St. Louis (front row, fifth from left) with the Director of the Musée Ogier-Fombrun, Mireille Fombrun Mallebranche (front row, first from right), and teachers who completed the training program in February 2013.
About the Author
Gemima St. Louis is a clinical psychologist and professor at the Massachusetts School of Professional Psychology (MSPP). She is the president of the Boston-based Haitian Mental Health Network. For more information, please contact St. Louis by email.
Nicolas, G., Jean-Jacques, R., & Wheatley, A. (2012). Mental health counseling in Haiti: Historical overview, current status, and plans for the future. Journal of Black Psychology, 38(4), 509-519.
World Health Organization. (2010). Culture and mental health in Haiti: A literature review. Retrieved from http://www.who.int/mental_health/emergencies/culture_mental_health_haiti_eng.pdf.