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Addressing the Mental Health Crisis in Sierra Leone

Sierra Leone is a small country in West Africa which is home to approximately 8 million people. The country is populated by various ethnic groups and is divided in 4 geographical areas with 12 districts. The country is rich in natural resources but is also considered to be one of the lowest- income countries in the world. The majority of the people in the nation still rely on traditional ways of living, earning income through farming and small-scale trading, with an average annual income of $800 US.

Writing about the current mental health crisis in Sierra Leone, Dr. Rebecca Esliker, president of the Amen Foundation, and Senior Lecturer and Head of department, Clinical Psychology, University of Makeni states the following in her published paper (“Mental Health in Sierra Leone: Beliefs, Myths and Truth”):

Dr. Rebecca Esliker

First: Mental health illness has taken a toll on the lives of the people of Sierra Leone.

Findings from studies suggest that the 10-year civil war and the Ebola outbreak in Sierra Leone presented major contributions to the increase in mental health cases in the country. The sufferings of the people and their horrifying experiences paved way to them acquiring mental health problems and disorders such as depression, drug-abuse, psychosis, epilepsy, post-traumatic stress disorder and schizophrenia among others. Due to the lack of mental health services and professionals, the people of Sierra Leone had to resort to seeking the help of traditional healers in order to address their mental health issues. In most cases, the people first go to traditional healers before seeking help from professional health care providers. As a result, the issue of mental health in Sierra Leone has become a priority area due to the decline in mental health in the country, contributing to high mortality rate and slow economic recovery and development. Therefore, improved mental health policies must be embedded in Sierra Leone’s national strategy in an aim to promote accessible professional mental health treatment and services to the public.

Second: The 10-year civil war and the Ebola outbreak had contributed to the increase in the number of people affected by mental illness. As of August 2015, the number of people affected with Ebola in Sierra Leone had reached approximately 13,000 with more than 3,000 included in the death toll.

Third: According to an interview with Dr. Edward Nahim, a psychiatrist and head of Sierra Leone’s Psychiatric Hospital in Freetown, there were already about 400,000 patients recorded to be suffering from mental illness but due to lack of time and resource scarcity, only 10 per cent of the patients were provided with appropriate mental health care while 90 per cent had resorted to seeking healthcare from traditional healers. In addition, the entire country severely lacks mental health services with only one psychiatric hospital, one psychiatrist, and two trained psychiatric nurses.

Fourth: A national mental health survey conducted by the World Health Organization revealed prevalence rates of ~2% (50,000) for psychosis; ~4% (100,000) for severe depression; ~4% (100,000) for severe substance abuse; <1% (25,000) for mentally retarded and <1% (25,000) for epilepsy. There is no community mental health care, and only one institution (Sierra Leone Mental Health Hospital) which is 183 years old. The hospital has one consultant who is retired, one medical officer and two qualified psychiatric nurses. The hospital can only accommodate some 400 patients on average.

Fifth: The Ministry of Health and Sanitation of Sierra Leone has made it a commitment to: "set clear directions for the development of mental health services and the promotion of mental health in the country" and "integrate mental health services into the public health agenda and encourage an inter-sectoral approach to mental health, as well as reduce the burden of mental disorders in the population."

Following a successful fact-finding and health mission project organized by Action Africa and Amen Foundation, Dr. Esliker and the Department of Clinical Psychology at the University of Makeni have positioned themselves to collaborate in training and commissioning mental health workers for the country. Seminars, workshops, weekend trainings, summer programs, and inter- departmental courses and certificate program offerings will be used to facilitate this process. These efforts are expected to work hand in hand with the Ministry of Health in Sierra Leone, and the participating mental health experts from Johns Hopkins Healthcare System in the USA. Other sponsors and collaborators will be needed to maximize the results of this initiative to help the people of Sierra Leone.


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