Liberia’s Ministry of Health and Social Welfare (MOHSW) is using an open source platform, mHero, to tackle mental health issues that have arisen in the aftermath of the Ebola epidemic.

Before the Ebola crisis, which was responsible for more than 11,300 fatalities two years ago, common mental health disorders in Liberia included depression, anxiety, psychosis and posttraumatic stress disorder— much of the latter a result of a 14 year long civil war that killed over a 250,000 million people.

Using the app that helped the country deal with Ebola, Mental health workers, Angie Nyakoon and Amanda Gbarmo Ndorbor, are using the mHero platform to collect and analyse data on the prevalence of mental health issues since the Ebola outbreak.

“We were happy to learn about mHero and develop use cases to find out more information from mental health clinicians in Liberia,” said Ndorbor.

Despite the growing need for mental health data to be routinely captured in the national system, IntraHealth says identifying mental health service delivery indicators, collecting and updating data and ensuring they flow to the right team at the ministry are not easy processes.

In order to bridge the information gap, Nyakoon and Ndorbor are using SMS and interactive voice response for sending and receiving critical information to and from frontline health workers, in real-time.

The mHero app combines health worker records in the national iHRIS—the IntraHealth-developed human resources information system—with RapidPro, an SMS tool that facilitates two-way text messaging, to send targeted SMS to health workers on their mobile phones.

They developed a workflow of 14 questions about the prevalence of depression and other mental health disorders, diagnoses encountered, the age of the diagnosed and the kinds of treatments provided. Using the mHero app, they sent the workflow to 39 mental health clinicians across the country.

The results revealed that depression was the most common mental illness plaguing citizens—three times as many clinicians reported diagnosing the illness than those who did not. The responses also showed that depression, along with anxiety, posttraumatic stress disorder and suicidal ideation were all seen more in individuals under the age of 18 than in any other age group.

After receiving these SMS responses, Nyakoon and Ndorbor shared their data with a group of mental health clinicians, physician assistants and nurses from nine of Liberia’s 12 counties.

Some of the functional modifications they identified were simple, such as requesting yes/no answers to questions or slightly adapting the context of the questions.

Since then, Nyakoon and Ndorbor have sent out monthly workflows to collect routine information on mental health services.

One of their key strategies is to regularly share information about mental health services with the National Health Sector Coordination Committee, so that crucial resources can be mobilised to better support mental health services in the country.

“Ebola has affected this country a whole a lot in terms of mental health, not to mention the civil war. We know there is a serious impact and we need to have more psychosocial and mental health interventions where people will be talked to and be able to pass back into the community,” concluded Nyakoon.

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