Five years af­ter a mas­sive earth­quake rocked Haiti, killing more than 200,000 peo­ple and re­duc­ing homes to rub­ble, few sur­vivors would say they were trau­ma­tised or suf­fer­ing de­pres­sion as a re­sult of the dis­as­ter.

Haitians do not tend to use the word "de­pres­sion" to de­scribe symp­toms of men­tal ill­ness. In­stead they may com­plain of a lack of en­er­gy or ap­petite, in­som­nia, night­mares, a con­strict­ed heart or think­ing too much, health work­ers say.

Men­tal ill­ness is still a taboo in the Caribbean na­tion, which had no func­tion­ing men­tal health sys­tem in place be­fore the earth­quake. In Haiti, it is com­mon for peo­ple with men­tal ill­ness­es to be locked up in hos­pi­tal psy­chi­atric wards or, be­liev­ing they are pos­sessed, to seek help from voodoo priests. Yet plagued by guilt, fear, trau­ma and grief, men­tal ill­ness re­mains a re­al­i­ty for many Haitians still strug­gling to cope with the loss of their rel­a­tives, homes and even, limbs, in the af­ter­math of the Jan­u­ary 12, 2010 quake.

"The im­pact of the earth­quake on men­tal health was huge and unimag­in­ably deep in peo­ple's lives. Some lost all bench­marks and ref­er­ences be­cause of their great loss," said Regi­nald Fils-Aime, a doc­tor with Zan­mi Las­ante, a Hait­ian med­ical NGO and sis­ter or­gan­i­sa­tion of Boston-based Part­ners in Health.

"We still have peo­ple com­ing to clin­ics with men­tal health prob­lems re­lat­ed to the earth­quake. They talk about the earth­quake, about be­ing un­der the rub­ble," Fils-Aime told the Thom­son Reuters Foun­da­tion in a tele­phone in­ter­view from Boston.

Symp­toms of men­tal ill­ness have been built in­to a screen­ing tool used by Zan­mi Las­ante to train health work­ers, in­clud­ing nurs­es, doc­tors, so­cial work­ers and psy­chol­o­gists, to iden­ti­fy de­pres­sion among rur­al com­mu­ni­ties in cen­tral Haiti.

Ten psy­chi­a­trists for

ten mil­lion peo­ple

The earth­quake high­light­ed the ur­gent need to ad­dress men­tal health but this has been a de­mand­ing task in a coun­try with on­ly around ten psy­chi­a­trists for a pop­u­la­tion of ten mil­lion.

"It was on­ly af­ter the earth­quake that the health min­is­ter said men­tal health should be a pri­or­i­ty and that the is­sue was talked about," said Fils-Aime.

In Haiti, a key way to im­prove men­tal health­care is to work with re­li­gious lead­ers from Catholic, Protes­tant and voodoo faiths, says the Cen­tre for Ad­dic­tion and Men­tal Health (CAMH) in Toron­to.

Haiti's voodoo re­li­gion heav­i­ly in­flu­ences how men­tal ill­ness is per­ceived and treat­ed. For cen­turies Haitians have turned to voodoo priests for help.

Both male "houn­gan" priests and fe­male "man­bo" priest­esses per­form cer­e­monies and sac­ri­fi­cial rit­u­als to treat peo­ple.

"Voodoo heals the mind, soul and body. The soul is what we are, which con­trols every­thing, all our ac­tions and mind," Max Beau­voir, the "Ati" or supreme leader of Hait­ian voodoo, told the Thom­son Reuters Foun­da­tion.

Around 70 per cent of Haitians are be­lieved to prac­tise voodoo, a re­li­gion with roots in Africa. There are more than 60,000 voodoo priests across Haiti, of­ten liv­ing in rur­al com­mu­ni­ties, Beau­voir said.

At his voodoo tem­ple in­side his coral stone-walled home, a 40-minute dri­ve from the cap­i­tal Port-au-Prince, Beau­voir has treat­ed peo­ple with men­tal health dis­or­ders, as well as can­cer and oth­er phys­i­cal ill­ness­es for the past four decades.

In­side the small tem­ple–sur­round­ed by lush bam­boo and palm tree court­yards–is an al­tar with the benev­o­lent spir­its' favourite drinks in bot­tles and where cows, goats and chick­ens are sac­ri­ficed to God and the dif­fer­ent spir­its.

"Voodoo is the soul of the Hait­ian peo­ple and noth­ing can be done with­out that cul­tur­al ba­sis. It is a way of life. Voodoo has al­ways been on the front­line. It can pro­vide treat­ment to peo­ple who are both phys­i­cal­ly and men­tal­ly ill," Beau­voir said.

In­creas­ing bur­den

Many Haitians at­tribute men­tal ill­ness to su­per­nat­ur­al forces such as curs­es or pos­ses­sion by spir­its from a past life, and some be­lieve men­tal dis­or­ders can be trans­mit­ted to oth­er peo­ple.

"Our aim is to have a col­lab­o­ra­tion, share ex­pe­ri­ences and see how do you as­sess, in­cor­po­rate and im­prove the chances of peo­ple with men­tal ill­ness like de­pres­sion and psy­chosis, get­ting bet­ter, by work­ing with spir­i­tu­al lead­ers," said Ak­watu Khen­ti, head of CAMH's Of­fice of Trans­for­ma­tive Glob­al Health.

The or­gan­i­sa­tion is work­ing with 40 re­li­gious lead­ers in Haiti to de­liv­er cog­ni­tive be­hav­iour­al ther­a­py, a type of psy­chother­a­py to treat men­tal ill­ness.

Yet hun­dreds of thou­sands of Haitians are still get­ting no treat­ment for men­tal ill­ness­es rang­ing from de­pres­sion and bipo­lar dis­or­der to schiz­o­phre­nia.

The World Health Or­ga­ni­za­tion says that treat­ing men­tal ill­ness is cru­cial, both in Haiti and world­wide.

It pre­dicts that by 2030, de­pres­sion will be­come the num­ber one cause of dis­abil­i­ty, and that the bur­den will be great­est in poor coun­tries where at least 75 per cent of peo­ple with men­tal dis­or­ders re­ceive no treat­ment.

While peo­ple with men­tal health prob­lems still face so­cial stig­ma in Haiti, there are ten­ta­tive signs of progress.

(Reuters)