"Listening to lived experience: authentic voices for real change," is the theme chosen this year by the World Health Organization (WHO). While this call aims to emphasize the necessity for mental health policies to be rooted in reality, putting at the heart of public health initiatives those who are most affected, it remains that its translation in Haiti may face specific challenges. In Haiti, the stigmatization of mental disorders is compounded by representations that complicate recognition and care. When these disorders are attributed to supernatural causes or reduced, in the collective imagination, to the sole manifestations of "madness," agitation, or violence, sufferings such as depression and anxiety disorders are likely to go unrecognized as health issues requiring care. These perceptions can thus delay, or even prevent, access to appropriate care, while reinforcing the silence of those affected, who are often reluctant to expose their suffering for fear of being stigmatized. This WHO call urges them to speak out, but society creates and maintains the conditions that condemn them to silence.
One must therefore applaud the courage of those who dare share their experiences in this relatively hostile Haitian context. Their testimonies help raise awareness among the population, combat prejudices, and shed light on a reality that is too often obscured. However, if those who recount their lived experiences have no means to influence public health decisions, then this participation would, despite the organizers, merely resemble a clever communication campaign.
Indeed, initiatives led by the Ministry of Public Health and their local or international partners exist and must be recognized. Nevertheless, the situation is alarming: the two largest hospital centers (Mars and Kleine Hospital; Beudet Hospital) treating patients with mental disorders have been dysfunctional for several years; few public structures offer services for those with mental disorders; a limited number of psychologists and psychiatrists for the entire population; and sporadic projects funded for short periods that are unable to ensure continuity and permanence of care across the territory for the population.
The problem is therefore not only that those affected struggle to make their voices heard. It is also that the institutions that should listen to them, protect them, and guarantee them care are insufficiently equipped to meet their needs. This situation directly engages the responsibility of the Haitian state whose interventions, despite their importance, have not always succeeded in building sustainable capacities.
Furthermore, the socio-economic context in which a large part of the Haitian population operates, marked by persistent insecurity, extreme violence, economic precariousness, forced displacements, and uncertainty about the future, fosters the emergence, worsening, and persistence of mental disorders. How can one hope for a sustainable improvement in mental health when families live daily in fear, children grow up in an environment of violence, and millions of people are deprived of their social anchors and means of livelihood?
Under these conditions, a genuine mental health policy cannot be limited to clinical management, awareness-raising, or the multiplication of sporadic psychosocial interventions. It must also address the social and structural determinants of mental health, including insecurity, poverty, inequalities, social exclusion, and the weakening of public institutions. One cannot claim to sustainably treat the psychological consequences of a crisis while allowing the conditions that fuel them to persist. It then becomes hardly acceptable to continually ask a population faced with violence, fear, and precariousness to learn to manage its emotions, preserve its mental health, or become more resilient without acting on the conditions that feed its distress. Such an injunction risks trivializing the intolerable and shifting to citizens a responsibility that primarily belongs to the state: to guarantee their safety and the necessary conditions for a dignified life. Resilience should not become an obligation to indefinitely endure insecurity, precariousness, and institutional failures, nor should it obscure citizens' right to peacefully mobilize, defend their rights, and hold institutions accountable.
To these difficulties is added another weakness, less visible but equally concerning: the inadequacy of evaluation mechanisms for interventions. In a system where the continuity of care remains fragile, where medical records are not always systematically created, preserved, or accessible, and where research evaluating the outcomes of mental health interventions remains limited, a fundamental question arises: how can we know if the therapeutic and psychosocial approaches implemented are truly producing the desired effects? The risk is to multiply interventions without being able to determine which ones work, for whom, under what conditions, and with what lasting results. It is, however, against the yardstick of these results that a mental health policy should be judged, and not by the number of conferences organized, the volume of announced funding, or the quantity of people sensitized.
We must pay tribute to the dedication, courage, and tenacity of these men and women, psychologists, psychiatrists, and other mental health professionals who, despite insecurity, the precariousness of their working conditions, and the chronic insufficiency of available resources, continue, day after day, to welcome, treat, and support those in psychological distress. Their commitment extends beyond patients: it also reaches their relatives, to whom they provide listening, advice, and comfort, helping them better understand the illness and cope with the challenges it imposes on the entire family. This dedication, often discreet and insufficiently recognized, represents a precious source of support and hope. However, it cannot indefinitely compensate for the failings of a system that should provide them with the means to fulfill their mission with dignity.
The WHO theme is undoubtedly universal in its ambition, but it risks becoming a paradoxical injunction in the Haitian context. Those affected are asked to break their silence, while society stigmatizes them, the state struggles to guarantee them care, and the interventions of numerous partners remain dependent on temporary funding. Before demanding authentic voices, there must first be responsible institutions, functional services, and a political will capable of transforming these testimonies into decisions and concrete actions. This situation raises a double question: what trust can citizens still place in continually renewed commitments that are insufficiently upheld? And what means can they legitimately consider to assert their rights in the face of the state's persistent failings? Without concrete responses to these questions, this World Mental Health Day risks becoming an annual celebration of speech without real change for those who need it most.
