Examining mental health in Haiti
The numbers associated with the Haiti earthquake in January 2010 are still hard to comprehend: more than two-million affected; 222,750 killed; 80,000 bodies missing; 188,383 houses destroyed or damaged; 1.5 million displaced.
In the aftermath of that devastating event, the International Organisation for Migration (IOM) recognised the enormous emotional and psychological damage inflicted on millions of Haitians, and carried out an assessment of psychosocial needs. The staff interviewed 950 families in displacement camps over a four month period, from May to August of 2010.
Before the earthquake, there was no mental health system in the country. There was a great deal of social stigma surrounding mental health. "Psychologist" was a dirty word.
Alwrich Pierre Louis from IOM explains: "When we discuss mental health with them, the person says, 'No, I don't have any kind of problem, maybe it's another thing. You think that I'm crazy but you're wrong."
In the days and weeks and months after the earthquake, millions of Haitians were confronted with death, trauma, loss, grief, survivor guilt and fear. And for many, those still haven't gone away.
Hundreds of thousands of people are still living in tent cities, four years after the quake. The IOM study revealed anxiety and depression are compounded by concerns about overcrowding, lack of clean water and facilities, fear of sexual assault, gangs and a lack of police.
IOM found thirty-two percent of those surveyed said they had experienced at least one of the three major distress indicators: panic attacks, serious withdrawal or suicide attempts.
On a scale of 1 to 5, with 5 being the maximum, 60 percent of those interviewed said their pain level was 5.
When participants were asked to list their three main needs, more than 70 percent said housing, health was second, followed by work and security.
So where can Haitians go for help? What mental health services are available? The short answer is, not many.
IOM told Al Jazeera that mental health has never been a priority for the Haitian government and it still isn't. 15 percent of its budget is allocated to health; less than 5 percent of that is spent on mental health.
This was painfully obvious when our crew visited a state-run mental health hospital in Port-au-Prince. According to Dr Louis Marc Jeanny Girard, the facility can only take in 112 patients, and more Haitian psychiatrists are needed across the board.
He says the most common conditions associated with the earthquake are agitation, delusional and bipolar disorders, epilepsy, schizophrenia and drug-related mental disorders.
One of the most persistent obstacles to better mental health services is deeply entrenched in Haitian culture: religion.
Alwrich from IOM explains "Maybe they don't have the capacity or inclination to go see a psychologist. So instead, they go to see a person of voodoo."
But mental health professionals say they're committed to working with religious people because they have such large connections and influence in their communities. They are making inroads.
IOM staff say it took a devastating earthquake to push mental health out into the open and now there's less stigma and more mental health support.
But hundreds of thousands of people still aren't getting the help they need. There are growing pleas to the Haitian government to increase its investment in the mental health system and make it a priority. But no-one is sure if anyone is listening.
Follow Cath Turner on Twitter: @ajecathturner