Mental health in Sierra Leone

Harris, Dawn; Endale, Tarik; Lind, Unn Hege; Sevalie, Stephen; Bah, Abdulai Jawo; Jalloh, Abdul; Baingana, Florence

doi:10.1192/bji.2019.17

Cited by 22 publications

(21 citation statements)

References 6 publications

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“…The small number of individuals reported with MHD is of concern, especially given the high prevalence of anxiety, depression and post-traumatic stress disorder following the Ebola outbreak 8 . This finding may reflect underreporting and a persisting treatment gap for MHD 9, 10 .…”

Section: Discussionmentioning

confidence: 96%

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

et al. 2019

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Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June–December 2015) comparing findings with the pre-Ebola (June–December 2013) and Ebola outbreak (June–December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.

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Section: Discussionmentioning

confidence: 96%

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

et al. 2019

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“…Over 100 Community Health Officers have been trained in mhGAP, a package developed by the WHO to scale up prevention and management services for mental, neurological and substance use disorders in countries with low- and lower-middle incomes (WHO, 2016), but most are yet to receive any supervision or refresher training (Harris et al ., 2020). A roll-out of Psychological First Aid training for primary healthcare workers (Sijbrandij et al ., 2020) has lacked the follow-up that research has indicated is required to sustain a major uplift in capacity in this setting (Horn et al ., 2019).…”

Section: Understanding Mental Health In Sierra Leonementioning

confidence: 99%

“…However, authors do refer anecdotally to common terms for distress and mental illness in Sierra Leone, particularly crase and poil heart (e.g. Jones, 2008; Harris, 2007; Harris et al ., 2020). Crase is a Krio term indicating that someone is ‘crazy’, with poil heart (or pwɛl at ) indicating ‘heavy heartedness’ (Cavallera et al ., 2019: 121).…”

Section: Understanding Mental Health In Sierra Leonementioning

confidence: 99%

“…On the basis of population projections of need and mapping of current provision the mental health ‘treatment gap’ in Sierra Leone has been estimated to be 98% (Alemu et al ., 2012). Formal mental health service provision is limited to one psychiatric hospital which receives referrals from provincial and district hospitals, NGO services and recent attempts to strengthen capacity at the primary care level through the training of mental health nurses (Harris et al ., 2020). There is anecdotal evidence of widespread use of traditional healers and herbalists (Alemu et al ., 2012), supported by a small number of studies (Jones et al ., 2009), and a memorandum of understanding has been established between the Ministry of Health and Sanitation and the traditional healers' union in an attempt to coordinate care.…”

Section: Understanding Mental Health In Sierra Leonementioning

confidence: 99%

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Expressions of psychological distress in Sierra Leone: implications for community-based prevention and response

et al. 2020

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Background Over recent decades there has been considerable mental health research in Sierra Leone but little on local conceptualisations of mental health conditions. Understanding these is crucial both for identifying the experienced needs of the population and utilising relevant community-based resources to address them. This study took a grounded approach to identify the ways in which adults in Sierra Leone express psychological distress. Methods Rapid ethnographic methods deployed included 75 case study interviews with community members, 12 key informant (KI) pile sorts and 55 KI interviews. Thematic analysis of data was supported by frequency analysis and multi-dimensional scaling. Results Thirty signs of distress were identified. The only consistent ‘syndrome’ identified with respect to these was a general concept of crase, which referred to psychosis-related presentation but also a wide range of other signs of distress. We did not find consensus on locally defined concepts for mild-moderate forms of mental disorder: people use multiple overlapping signs and terms indicating psychological distress. Conclusions Analysis supports calls to view mental health problems as a ‘continuum of distress’ rather than as discrete categories. This framing is coherent with opportunities for prevention and response in Sierra Leone which do not focus primarily on formal healthcare service providers but rather involve a range of community-based actors. It also enables attention to be paid to the identification of milder signs of distress with a view to early response and prevention of more severe mental health problems.

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“…However, using prevalence rates from similar contexts, the treatment gap for this population is estimated to be 99.8–99.9% (6). Current specialized mental health services for children and adolescents are limited to one outpatient clinic at the Ola During Children’s Hospital in the capital Freetown, where services are provided by a mental health nurse who was trained in CAMH in Nigeria (7, 8). Three other nurses and four medical doctors were trained through the same program but are yet to be deployed in this capacity by the Government of Sierra Leone (S.K.…”

Section: Introductionmentioning

confidence: 99%

Reflections on “Building Back Better” Child and Adolescent Mental Health Care in a Low-Resource Postemergency Setting: The Case of Sierra Leone

Brink

2019

Front. Psychiatry

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Over the past three decades, Sierra Leone has experienced two major humanitarian crises: an armed conflict (1991–2002) and an Ebola virus disease outbreak (2014–2015). In addition to these country-wide crises, the capital Freetown experienced a mudslide affecting thousands of people in 2017. In response to these emergencies, donors and aid organizations showed an increased interest in supporting and implementing mental health and psychosocial support interventions. Despite these efforts, the mental health infrastructure of the country remains frail. Specifically, systemic improvements in the implementation of evidence-based mental health care for children and adolescents appear to be lacking. In this article, the Interactive Systems Framework for Dissemination and Implementation is used as a tool to analyze issues related to the development of a sustainable, contextually relevant child and adolescent mental health-care delivery system. The author draws on her long-term experience as a child mental health specialist in Sierra Leone. Observations and hypotheses are tested and supplemented by formal and informal reports and national and international literature. The three systems described by the Interactive Systems Framework are explored in the context of Sierra Leone: (1) Synthesis and Translation, (2) Support, and (3) Delivery. Interaction between the three Systems is discussed as critical to the successful dissemination and implementation of interventions. Ample attention is given to contextual factors that are believed to be paramount to the development of child and adolescent mental health care in Sierra Leone. The article concludes with a reflection on the usefulness of the Interactive Systems Framework in the dissemination and implementation of child and adolescent mental health-care interventions in low-resource, postemergency settings. It is suggested that, in addition to funding and policies, the child and adolescent mental health system in Sierra Leone could benefit from the development of contextually relevant interventions, improvement of capacity-building efforts, and acknowledgment of the role of community-based practitioners in the delivery of services. Local mental health experts, especially those trained in child and adolescent mental health, should be empowered to work together with culturally competent expatriate professionals to improve child and adolescent mental health care in Sierra Leone.

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Mental health in Sierra Leone

Cited by 22 publications

References 6 publications

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

Expressions of psychological distress in Sierra Leone: implications for community-based prevention and response

Reflections on “Building Back Better” Child and Adolescent Mental Health Care in a Low-Resource Postemergency Setting: The Case of Sierra Leone

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