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Taskshifting: translating theory into practice to build a community based mental health care system in rural Haiti
Rupinder Legha1, Eddy Eustache2, Tatiana Therosme3, Kate Boyd4, Fils-Aime Reginald5, Gertruna Hilaire6, Shin Daimyo7, Gregory Jerome8, Helen Verdeli9, Giuseppe Raviola10
1 Pagenel Fellowin Global Mental Health Delivery, which is sponsored by Partners in Health and Harvard Medical School’s Program in Global Mental Health and Social Change, USA., USA
2 Director of Mental Health and Psychosocial Support Services at Zanmi Lasante, Haiti., Haiti
3 Mental Health and Psychosocial Support Team’s Mental Health Supervisor for Community Health Workers at Zanmi Lasante, Haiti., Haiti
4 Doctorate in Public Health candidate at the Colorado School of Public Health, USA. She was previously the Mental Health and Psychosocial Support Coordinator at Partners in Health, Haiti., Haiti
5 currentlya student in the Masters in Medical Science in Global Health Delivery at Harvard Medical School, USA. He was previously the Mental Health and Psychosocial Support Services’ Mental Health Supervisor for Physicians at Zanmi Lasante, Haiti., Haiti
6 Coordinator for Monitoring and Evaluation at Zanmi Lasante, Haiti., Haiti
7 currently Senior Advisor for Mental Health at Partners in Health, a Master of Science in Nursing candidate at the Yale School of Nursing, and a Paul and Daisy Soros Fellow. He was previously the Clinical Programs Officer and Program Manager for Mental Health at Partners in Health, USA
8 Director of Monitoring and Evaluation and Quality Improvement at Zanmi Lasante, Haiti., Haiti
9 Associate Professor of Psychology and Education and Director of the Global Mental Health Lab at Teacher’s College, Columbia University, USA., USA
10 Director of Mental Health at Partners in Health, Boston; and the Directorof the Program in Global Mental Health and Social Change, which is based at Harvard Medical School’s Department of Global Health and Social Medicine, USA., USA
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
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In 2012, Zanmi Lasante, a Haitian nonprofit organisation, along with its sister organisation, Partners in Health, developed a mental health plan intended to go beyond the immediate post earthquake context by building capacity for mental health and psychosocial services within primary care services at 11 Zanmi Lasante sites throughout Haiti’s Central Plateau and Artibonite regions. This paper describes laying the foundation for a community based, mental health care system through the articulation of a ‘depression care pathway’, in which patients are identified and treated within the community, but referred to clinics and more specialised care when required. We emphasise taskshifting clinical, service delivery, systems building, and quality improvement responsibilities to psychologists, the central players in the Zanmi Lasante mental health model. By describing challenges and providing practical, implementable solutions, we highlight how this fundamental theory in global mental health translates into daily practice in a health care setting with limited biomedical services, clinical training and human resources. We also provide recommendations for optimising taskshifting when initiating community based mental health services in similar resource limited settings.
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