Global Mental Health Systems in Post-conflict Countries
One billion people, a sixth of the world’s population, have directly experienced torture, terrorism or mass violence through civil war, ethnic cleansing or genocide. Many of these victims are left with incapacitating traumatic depression or PTSD—unable to work, care for themselves or their children. In the developing world, and particularly in post-conflict countries, there is an extreme scarcity of mental health services relative to the need. We want to see a world in which all people, particularly those suffering from PTSD and traumatic depression, have access to free, culturally appropriate mental health care.
About You
About You
First Name
Steve and Liz
Last Name
Alderman
About Your Organization
Organization Name
Peter C. Alderman Foundation
Organization Website
Organization Phone
888.764.1804
Organization Address
P.O. Box 278, Bedford, NY 10506
Organization Country
United States, NY, Westchester County
Country where this project is creating social impact
Uganda, XX
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
Innovation
Entry Form title
Global Mental Health Systems in Post-conflict Countries
What change do you want to bring to the world?
One billion people, a sixth of the world’s population, have directly experienced torture, terrorism or mass violence through civil war, ethnic cleansing or genocide. Many of these victims are left with incapacitating traumatic depression or PTSD—unable to work, care for themselves or their children. In the developing world, and particularly in post-conflict countries, there is an extreme scarcity of mental health services relative to the need. We want to see a world in which all people, particularly those suffering from PTSD and traumatic depression, have access to free, culturally appropriate mental health care.
What are the primary activities of your project?
PCAF (1) trains indigenous health workers and (2) establishes international trauma treatment clinics in post-conflict countries, with over 100,000 victims of terrorism and mass violence treated to date.
TRAININGS: Since its inception in 2003, through annual training seminars in partnership with the Harvard Program in Refugee Trauma, Partners in Health and the African Regional Trauma Training Workshop (see below), PCAF has trained or conducted workshops for over 1,000 doctors and mental health workers from 22 countries on four continents. Each of these healers has gone on to train a countless number of healthcare personnel in his or her own country. Training programs include basic training in the HPRT 11-Point Toolkit in Healing Mass Violence, continuing education and caregiver support. Several PCAF trainees have risen to the highest level of their nation’s healthcare system.
In July 2011, in Nairobi, Kenya, PCAF convened the Fourth Peter C. Alderman Regional Conference on Psychotrauma, the region’s only multi-disciplinary conference on psychological trauma in war-affected societies. The conference features plenary sessions, workshops and trainings by some of the world’s foremost experts in global mental health. Organized with the African Mental Health Foundation, nearly 600 mental health professionals from Uganda, Kenya, South Africa, Tanzania, Sudan, Rwanda, Burundi, Somalia, Ethiopia, DRC, Zimbabwe and Liberia attended the five-day conference.
The proceedings of the conference are published in The African Journal of Traumatic Stress (ISSN-2218-4937), the first peer review journal of its kind, which is underwritten by PCAF and is edited by an accomplished team of psychiatric professionals.
CLINICS: PCAF established its first mental health clinic in Cambodia in 2005 and now operates seven clinics: in Cambodia, Uganda and Liberia; and works with Partners in Health in Rwanda and Haiti. PCAF’s clinics treat patients with culturally appropriate therapy, partnering with governments, medical schools and religious institutions and works exclusively with local, indigenous caregivers. In 2010, PCAF Clinics treated over 7,000 patients.
What is innovative about your initiative? How is it a new contribution to the field?
In post-conflict countries, there is an extreme scarcity of mental health services relative to need. PCAF works to fill this gap by establishing innovative indigenous mental healthcare clinics dedicated to returning victims of trauma to productive lives. Designed for high impact in regions that have the greatest need and the highest likelihood of success, they serve as a model for global replication.
PCAF's unique clinical model treats patients with culturally appropriate, evidence-based therapy through partnerships with government, medical schools and religious institutions deeply embedded in the country served. Government provides clinic space, inpatient beds and medications. PCAF provides salaries and trains primary healthcare workers to serve as mental health workers specializing in trauma treatment delivery.
Clinics are staffed by a multidisciplinary team, including a psychiatric clinical officer, a psychiatric nurse, a counselor and a social worker, with overall supervision conducted by a psychiatrist. PCAF’s therapy model uses structured diagnosis and treatment based on a patient's trauma narrative, incorporating individual and group therapy, integrated spiritual treatment and community re-integration.
After 10 years, PCAF turns over its clinics to local government partners to integrate into the national healthcare system. Afterwards, PCAF will provide ongoing quality assurance and trainings, and disseminate scientific studies on the impact of mental health services in post-conflict reconstruction around the world.
What stage is your project in?
Operating for more than 5 years
Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
PCAF operates clinics in Cambodia, Uganda and Liberia, and with Partners in Health, in Rwanda and Haiti. Patients include former child soldiers, IDPs, refugees and survivors of civil war and unrest.
PCAF’s longest-standing and largest mental health clinics are in Cambodia. Cambodia remains a country in transition as it moves into the future still burdened by the legacy of its bloody past. The reign of terror and genocide perpetrated by Pol Pot and the Khmer Rouge killed 21 percent of the country’s population (1.7 million people) and continues to maim today through landmines and traumatic depression. Cambodia’s conflict has left much of the population internally displaced, widowed, orphaned and disabled.
The single largest public health problem in Uganda is debilitating traumatic depression, with 70% of its 31 million people suffering from war-induced psychological trauma. In Northern Uganda, the Lord’s Resistance Army terrorized the Acholi population for over 20 years, exposing the region to unrelenting violence; population displacement; collapse of economic and social structures; and the breakdown of the healthcare delivery system. In partnership with the Ugandan Ministry of Health, PCAF operates four clinics in Uganda.
In 2010, 80% of Ugandans visiting a PCAF clinic were women and children. For children, the average age was 11.66 years; 46% lived in IDP camps; 23% were orphans; 25% had a family history of trauma; 20% had suffered trauma; and 16% had lost a family member to violence. Of these children, 45% were girls. Among women, 41% had a family history of trauma; 31% had suffered trauma; 28.81% were victims of domestic violence; and 27.96% had lost a family member to violence. Fifteen-percent of women were former child soldiers and 13% were HIV positive.
Fourteen years of civil conflict in Liberia has left this war-torn society of 3.5 million with 250,000 dead, 500,000 internally displaced persons and 800,000 refugees. A recent study by Johnson and colleagues (2008) reported that as many as 40% of Liberians suffer from major depressive disorder, and 44% suffer from PTSD.
The Ministry of Health and Social Welfare of Liberia (the MoHSW) has included mental health as one of the components of the Liberian Basic Package of Health Service. Yet there is only one psychiatrist for the entire country. PCAF is partnering with the MoHSW to bring in a Ugandan psychiatrist, and will open a training clinic to train Liberian mental health professionals in late 2011.
Share the story of the founder and what inspired the founder to start this project
Ten years ago, in the aftermath of losing their 25-year-old son to the terror attacks of 9/11, Elizabeth and Dr. Stephen Alderman made a decision to fight terrorism head on by helping people in post-conflict countries suffering from the emotional wounds of mass violence.
They had no prior experience in the parts of the world they were about to embrace. But after months of grieving, as the Aldermans watched a news program on the devastating emotional wounds caused by conflicts in Afghanistan, Cambodia, Rwanda and other war-torn countries, they set out to leave an indelible mark on the world in honor of their murdered son, Peter.
In 2003, the Aldermans used the money they received from the 9/11 Victims Compensation Fund to establish the Peter C. Alderman Foundation (PCAF), an operating foundation, to provide mental healthcare to people in post-conflict countries whose psyches are scarred by violence and trauma due to civil war, ethnic cleansing or genocide—estimated at a sixth of the world’s population, or one billion people.
To support Liz and Steve’s dream of a world in which all people have access to free, culturally appropriate mental healthcare, PCAF will continue to serve as a catalyst for putting mental healthcare on the agenda for post-conflict recovery around the world. Through their tireless efforts to achieve this vision, the Aldermans have transformed the devastation and hopelessness they experienced after the loss of their son into promise and hope for thousands of people.
Social Impact
This Entry is about (Issues)
Please describe how your project has been successful and how that success is measured
PCAF’s clinics use a Quarterly Reporting Form to measure progress. Clinics stratify the total number of cases by diagnosis, age, gender, location; and treatment and study outcomes by test-retest methods. PCAF’s Director of Research, Dr. Ethel Nakimuli-Mpungu, a psychiatric epidemiologist completing her PhD at the Bloomberg School of Public Health at Johns Hopkins, analyzes and compiles this data for senior staff.
Based on this information, PCAF knows who is coming to the clinics, the frequency of their visits, and the treatments provided (kind of counseling, drugs prescribed, etc.). The data is used to inform decision-making and adjustments to clinic management. For example, when a high number of patients with HIV were identified, PCAF was able to respond by training staff in how to counsel HIV-positive patients, as well as work to institute HIV screening at all clinics. Similarly, when it was reported that too few patients were being referred for spiritual healing, PCAF conducted a training workshop for senior clinic staff to teach the importance and effectiveness of spiritual healing.
PCAF also learned from the data that patient attrition had to be addressed: many patients did not return for treatment after more than one or two visits. A three-phase qualitative evaluation of this problem included surveying clinic staff, returning patients and non-returning patients for reasons for attrition. Barriers to return included: travel distance to the clinic and lack of transportation; lack of financial support; and family resistance. Based on this data, PCAF allocated additional funds for social-worker outreach and patient follow-up, and hope to be in a position to increase this program in 2012.
Outcomes Study: A one-year study on outcomes for 113 patients at the PCAF’s Gulu, Uganda clinic used psychiatric assessment tools at baseline, 3 months, 6 months, 9 months and 1 year to measure depression and anxiety symptom load, as well as social functioning and physical functioning scales. Mean total scores were compared over time, and analyzed for subgroups based on demographics, trauma history, and visit frequency.
Data demonstrated that all patients who received psychotropic drugs and psychotherapy had an excellent sustained decline in depression and PTSD symptom load and sustained an increase in social functioning (such as being able to perform work and home activities, maintain sound finances and socialize with family and friends). These findings were despite differences in demographic characteristics, trauma history and diagnosis.
Independent University Studies: PCAF has begun to work with two prominent academic research institutions, Johns Hopkins University and University of Brighton, to begin rigorous independent studies of patient outcomes at its Cambodia and Uganda clinics.
How many people have been impacted by your project?
More than 10,000
How many people could be impacted by your project in the next three years?
More than 10,000
Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact
To standardize procedures across the Ugandan clinics, PCAF will create and disseminate a training and operations manual and begin to adapt it for other countries.
Task 1
Create the manual, including protocols for patient management (i.e., the psychological consequences of war trauma and torture) and clinic operations (i.e., data collection, evaluation).
Task 2
Introduce the manual at a series of workshops at the four PCAF Ugandan clinics.
Task 3
Based on evaluations and observations of the workshops, revise the manual for use in other countries, including seeking the guidance of in-country mental health experts.
Identify your 12-month impact milestone
Enhance capacity for community outreach by reaching more patients in their homes for follow-up treatment and support, as a routine feature of our program.
Task 1
Distribute funds to Soroti, Kitgum and Arua clinics for petrol and carfare to allow social workers and counselors to make regular home visits.
Task 2
Once a month, a social worker and a psychiatrist will conduct home visits to deliver psychosocial support, resulting in fewer patients lost to follow-up.
Task 3
Report on the results of these visits, which will be collected with new data tracking in our quarterly reporting framework.
How will your project evolve over the next three years?
In addition to opening the Liberia training clinic, PCAF will begin working in Kenya to enhance delivery of mental health services in Kibera, Africa’s second largest slum. It will refine and enhance its service delivery systems, and adapt its manual for use in each country in which it operates. It will continue to train and support indigenous doctors and mental health workers, working with post-conflict governments requesting its assistance in establishing trauma treatment systems.
Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?
One of the challenges reported at the Ugandan clinics is getting patients to adhere to treatment schedules. Based on internal qualitative surveys of clinic staff and of 60 ongoing clinic patients, the main reason for lack of adherence is the long distance patients need to travel to reach the clinics. This, combined with the stigma of mental illness, competing priorities and lack of social/family support for treatment, makes return visits too challenging to attempt.
PCAF plans to devote more resources to patient outreach for follow-up treatment and support. In 2011, PCAF began to provide the means for the clinics’ social workers to go into the community to make follow-up visits. The success of this effort has led to the strategic conclusion by senior staff that the program must be expanded and improved and integrated into the services at all PCAF clinics, with: (1) regularly scheduled weekly visits to homes and into the community within a 15km radius; (2) funds for both fuel and carfare; (3) mobile telephones and airtime for patient scheduling and follow-up; and (4) dedicated reporting tools for social workers. PCAF is pursuing continuation of funding for this project.
Tell us about your partnerships
PCAF partners with the Harvard Program in Refugee Trauma, Partners in Health and the Africa Mental Health Foundation for its training seminars. PCAF has trained over 1,000 doctors and mental health workers from around the world.
The African Journal of Traumatic Stress is published twice yearly in partnership with Makerere University College of Health Sciences. The Journal supports the development of a pan-African network of mental health professionals, and is advancing the knowledge base of traumatic depression and PTSD.
The Governments of Cambodia, Uganda and Liberia provide the clinic space, drugs and raise awareness about PCAF clinics in the community. PCAF works closely with Makerere University and Butabika National Psychiatric Referral Hospital in Uganda. In Rwanda and Haiti, PCAF partners with Partners in Health to enhance their mental health capacity at their hospital-based program. PCAF will partner with the Carter Center in Liberia to provide clinical training to its psychiatric nurses once the training clinic opens later this year.
In November 2011, PCAF, in partnership with the NYU/Bellevue Program for Survivors of Torture will convene the one-day conference Surviving Trauma: Lessons from Ground Zero and Beyond.
Current annual budget of project, in US dollars
$500,001‐1 million
Explain your selections
On September 11, 2001, Peter C. Alderman was murdered at the World Trade Center. He was 25 years old. To honor his memory, in 2003 his family established the Peter C. Alderman Foundation (PCAF), a 501(c)(3) non-profit organization dedicated to returning survivors of torture, terrorism and mass violence to productive lives. The Alderman family established the foundation with the 9/11 recovery funds, supplemented by generous individual donations and government partnerships. The Foundation has two annual fundraising events: The Friends of Peter Alderman Walk and an annual Benefit Dinner. We continue to have strong support from individual donors, and currently have support from a small number of foundations. In 2012, the Foundation hopes to grow foundation support and has added additional staff to support this goal.
How do you plan to strengthen your project in the next three years?
PCAF, at the request of the Government of Kenya, will begin working in Kenya to enhance delivery of mental health services in Kibera, Africa’s second largest slum. It will refine and enhance its service delivery systems, and adapt its manual for use in each country in which it operates. It will continue to train and support indigenous doctors and mental health workers and work with post-conflict governments requesting its assistance in establishing trauma treatment systems. All services are free for patients.
PCAF will continue to grow its base of individual contributions, energetically pursue further foundation support and set the groundwork for establishing an endowment. The organization has added new staff to reach this goal. Additionally, PCAF will continue to advocate for global mental health by raising awareness through continued media coverage.
Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.
PRIMARY
Limited human capital (trained physicians, nurses, etc.)
SECONDARY
Restrictive cultural norms
TERTIARY
Lack of physical access to care/lack of facilities
Please describe how your innovation specifically tackles the barriers listed above.
PCAF works with governments in post-conflict countries to get political and logistical support for establishing treatment clinics through private-public partnerships. Government provides outpatient facilities, inpatient beds and medications. PCAF provides salaries to clinic staff. Most importantly, PCAF trains primary healthcare workers to also serve as mental health workers specializing in trauma treatment delivery.
By working exclusively with indigenous health care workers and with government, universities and religious institutions, PCAF provides culturally appropriate mental health care and helps to reduce the stigma attached to mental illness.
How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Grown geographic reach: Global
SECONDARY
Influenced other organizations and institutions through the spread of best practices
TERTIARY
Repurposed your model for other sectors/development needs
Please describe which of your growth activities are current or planned for the immediate future.
PCAF is in the process of opening a training clinic for Liberian psychiatric nurses at Phebe Hospital in Bong County in September 2011. The new staff will begin their training with a six-week course in Uganda, led by Dr. Eugene Kinyanda and clinical staff from Makerere University and Butabika Hospital.
On November 12, 2011, PCAF will convene a one-day conference in New York City in partnership with the NYU/Bellevue Program for Survivors of Torture, entitled: Surviving Trauma: Lessons from Ground Zero and Beyond.
Do you collaborate with any of the following: (Check all that apply)
NGOs/Nonprofits, Academia/universities.
If yes, how have these collaborations helped your innovation to succeed?
PCAF wants to see a world in which all people, particularly those suffering from traumatic depression, have access to free, culturally appropriate mental health care. Through private-public partnerships, PCAF trains indigenous health workers and establishes trauma treatment systems in post-conflict countries around the globe.
Government and academic institutions help us succeed by providing outpatient facilities, inpatient beds, administrative support, refresher training, spiritual healing and community outreach, including patient recruitment and referral.
The PCAF Psychotrauma Conference is funded and organized by PCAF with the Africa Mental Health Foundation and is the region’s only multi-disciplinary conference on psychological trauma in war-affected societies.
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 | 35 weeks agoSteve and Liz Alderman updated this Competition Entry. |
| 36 weeks agoSteve and Liz Alderman updated this Competition Entry. |
| 37 weeks agoSteve and Liz Alderman updated this Competition Entry. |
| 37 weeks agoSteve and Liz Alderman said: Thank you for your kind words and encouragement. Best wishes, The Peter C. Alderman Foundation about this Competition Entry. - read more > |
| 38 weeks agoTosin Ogunsola said: I just want to commend you on turning your loss into helping others. Really great work. I hope you get the resources to increase your ... about this Competition Entry. - read more > |
| 40 weeks agoSteve and Liz Alderman updated this Competition Entry. |
| 40 weeks agoSteve and Liz Alderman updated this Competition Entry. |
| 40 weeks agoSteve and Liz Alderman submitted this idea. |
