"Relief for the Spirit" in Post-Earthquake Haiti: The Development, Implementation, and Evaluation of a Lay Mental Health Worker Project.

Abstract

In light of the frequency and impact of natural and social disasters, the development of empirically-informed and culturally-appropriate approaches to post-disaster mental healthcare is a priority. However, it is also a topic of spirited controversy – particularly regarding the potential dangers of importing a psychological model based in dominant Western culture to other cultural contexts. In three manuscripts and a fourth chapter documenting ongoing research, this dissertation contributes to this debate through an account of the development, implementation and preliminary evaluation of an intervention designed to balance indigenous and psychological perspectives in addressing disaster-related distress. This grass-roots lay mental health worker project, called Soulaje Lespri Moun (SLM; “Relief for the Spirit” in Haitian Creole) is designed to aid displaced survivors of the 2010 earthquake in Port-au-Prince, Haiti. It entails a theory-based merging of mental health and psychosocial expertise contributed by US and Haitian mental health professionals, with the cultural and situational expertise of local lay earthquake survivors, to create a cost-efficient, culturally-adapted model suited to a post-disaster context. A series of multi-methodological studies support the effectiveness of SLM in decreasing distress and increasing use of coping strategies among participants (Chapters III, V). The feasibility of the model is further supported by evidence that the lay earthquake survivors implementing it experienced limited compassion fatigue, and rather, elements of posttraumatic growth (Chapter IV). Further, using a tailored outcome measure created for this purpose, an evaluation trial in Chapter V provides preliminary evidence that SLM can increase participants’ psychosocial coping skills (themselves associated with decreased distress) without disrupting use of pre-existing cultural and religious coping strategies. Thus, results provide initial support for SLM’s proposal that, if using a strategic and culturally-appropriate approach, participants can benefit from both psychologically-informed and indigenous belief systems simultaneously.