Intern Blog: Confronting Mental Health Stigma – From the US to Haiti

This is the first in a series of blog posts written by Hope for Haiti intern Maya Hardimon about her experiences with the organization.

When I came on board as a Public Health Communications Intern at Hope for Haiti this summer, I knew one of my top priorities would be working to mitigate the mental health challenges posed by the COVID-19 pandemic. Depression and anxiety have risen considerably in China, the US, and other countries hard-hit by the pandemic so far, and many people with underlying mental health conditions have seen their symptoms worsen. 

Mental health struggles in the US have been growing more common since COVID-19 began to spike in late March and early April — since COVID-19 numbers in Haiti have just begun to rise considerably, it’s probable that mental health challenges will soon begin to rise as well. 

Earlier this year, I began serving as the Health and Wellness Chair for the student government of Princeton’s School of Public & International Affairs. When Princeton switched to remote learning in mid-March, my plans for holding in-person meditation groups and first aid training sessions were put on hold, and I began focusing on ensuring that students had access to online mental health services and had tools to practice self care during this challenging time.

I knew that the messages I had been sending graduate students in the US wouldn’t all be relevant for a general audience in Haiti and that certain details would need to be adapted accordingly. However, until beginning my internship I didn’t realize how challenging mental health communications in the Haitian context would be. 

Working Around Stigma

Although mental health challenges are still stigmatized in the US, we have seen an increasing openness about mental health in recent years, and I’m optimistic that one positive side effect of the current pandemic-related uptick in depression and anxiety will be a further reduction in stigma. However, so far there has been no corresponding reduction in mental health stigma in Haiti, meaning Haitians will be struggling with their mental health in similar ways to Americans during the pandemic but without as many options to talk about it. 

So far, I’ve been working with Hope for Haiti’s Director of Employee Experience and a fellow intern based in Haiti on mental health and wellness communications for our staff. Because of enduring stigma, there are few resources created by Haitians for Haitians about managing mental health challenges during the pandemic. Because of this, we have been brainstorming ways to use American-made guides and graphics about mental health and tweak them to fit a Haitian context. 

Some changes have been straightforward, like taking out the recommendation of “play with a dog” (since dogs aren’t seen as pets in Haiti). Others have been more challenging; we recently struggled with how to use a list of “tips for self-care during quarantine” when “self-care” has no corresponding phrase in Haitian Creole. We managed to get past this hurdle by reframing the list as “ways to take care of yourself during quarantine,” which fixes the basic translation problem but also avoids the stigma that a “self-care” list would bring up due to that concept’s association with mental health. 

Because of my past mental health work in the US, where mental health is still stigmatized despite recent progress, I’m fairly confident that I’ll be able to continue helping the Hope for Haiti team come up with mental health interventions that avoid activating stigma by framing our messaging about health in general and not mental health specifically. However, I’m less sure about how to design interventions that directly target stigma, which would allow more Haitians struggling with mental health challenges to get the care and support they need. Part of this challenge comes from being a foreigner, particularly one who’s never lived in Haiti; however, the team I’ve been working with includes Haitian colleagues who fully understand the country’s context, and we’re still struggling to come up with ideas to reduce mental health stigma in Haiti rather than just work around it. 

Stigma Reduction

Reducing health-related stigma is particularly important in Haiti today because of the current stigma associated with COVID-19. Survivors of the disease fear violence by frightened neighbors, and healthcare clinics have been burned because of a distrust in government and fear of COVID-19. The stigma and fear surrounding an official COVID-19 diagnosis has led many Haitians with symptoms to avoid getting tested or treated, which has led to underreported case numbers and avoidable deaths.

When I first began my internship at Hope for Haiti, one of my first assignments was performing background research on what had been done to combat disease-related stigma in previous pandemics. I looked into the cases of AIDS and Ebola-related stigma and found many articles and studies describing the prevalence of stigma associated with these diseases. However, I found surprisingly few mentions of interventions designed to reduce this stigma (and any mentions of successful interventions provided only vague details about how those interventions were actually pulled off). 

Any change in societal perceptions, including issues of stigma, is usually achieved over a long period of time. In the middle of this pandemic, we’re trying to alter two major types of stigma — around mental health and around COVID-19 — in a shortened period of time. Throughout this summer, I’m looking forward to working with Hope for Haiti to think of creative ways to deal with this daunting challenge. 

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