Mental health – the silent crisis in Sierra Leone

Bai-Bai Sesay – Freetown

Sierra Leone Telegraph: 9 October 2015

World-Mental-Health-Day-October-10-2012-300x180On October 10th Sierra Leone like all other nations in the world, will be observing World Mental Health Day with the theme – “Dignity in mental health.”

World Mental Health Day was first celebrated in 1992 as an initiative of the World Federation for Mental Health, a global mental health organization with members and networks in more than 150 countries.

People and institutions all over the world observe this annual awareness event, bringing attention to mental and psychological illness and its major effects on people, their families and communities.

Today, thousands of people with mental health conditions around the world are deprived of their basic human rights. They are not only discriminated against, stigmatized and marginalized, but are also subjected to emotional and physical abuse in institutions and in the community.

Poor mental health care, due to a lack of qualified health professionals and dilapidated facilities, promote further violations.

This year, the World Health Organisation is expected to raise awareness of what can be done to ensure that people with mental health conditions continue to live in dignity.

But this has to be underpinned by sound human rights policies and laws, trained health professionals, respect for informed consent to treatment, inclusion in decision-making processes, and public information campaigns.

Mental Health Week - logoIn some countries, World Mental Health Day is observed as part of the wider mental illness awareness week.

The reality is that financial and human resources allocated for tackling mental health issues are inadequate, especially in low resource countries like Sierra Leone. The majority of low and middle-income countries spend less than two percent of their health budget on mental health.

Many countries have less than one mental health specialist for every one million people in the country. And to compound this problem, a considerable proportion of the limited resources are never spent on mental hospitals, but rather on services delivered through community and primary health care.

Countries need to increase their investment on mental health, as well as shift available resources towards more effective and patient-centered services.

Sierra Leone has very few mental health workers, a single psychiatrist, two psychiatric nurses, and a handful of social workers and counsellors. There is therefore a desperate need for more mental health workers in Sierra Leone.

But the situation in Sierra Leone is exacerbated by the fact that it is extremely difficult to recruit students into psychiatry, which is frowned upon and stigmatised in all African countries.

With a decade of one of the most brutal civil wars the world has ever seen and an Ebola outbreak, Sierra Leone is facing an unprecedented mental health crisis, with thousands of trauma cases across the country.

Dr Edward NahimDr. Edward Nahim (Photo) – Sierra Leone’s only psychiatrist, speaking in an exclusive interview, explained that the civil conflict and the Ebola outbreak in Sierra Leone have resulted in serious psychological problems such as post traumatic stress disorder, psychosis and depression.

These conditions he said might also lead to an increase in lawlessness, drug abuse, poverty, discrimination, and further stigmatization.

He noted that mental Health remains a major public health concern in Sierra Leone, and called for appropriate needs and resource assessment to be conducted as a starting point in tackling this crisis.

The consultant psychiatrist said the main goal is to have relevant data in place that will inform future planning and delivery of a comprehensive mental health service.

“Mental health problems fall into two main categories with a certain overlap. The first category includes traditional mental health problems seen in any country, rich or poor and in peace or conflict.

SL rebel war victims2“The second group includes special problems related to conflict, post conflict context with exposure to potentially traumatic events and lack of protective factors to contain these events, due to severe social distress caused by poverty, general hardship, bad nutrition and physical health problems,” he added.

Dr. Nahim says that based on a joint Ministry of Health and Sanitation and WHO survey in Sierra Leone, “more than 700,000 people are with  severe mental health problems needing medical treatment; more than 350,000 psychotic patients induced by drugs and alcohol abuse, as well as by severe infections like cerebral malaria; more than 20,000 with a severe Bipolar manic depressive disorders; more than 175,000 are mentally retarded; and more than 175,000 epileptics and schizophrenics.”

Dr. Nahim mentioned that the present decentralization of the health sector in the country is “one step forward,” explaining that “mental health would be one of the major beneficiaries.”

“The efforts being made by the health ministry, with the country office of the WHO undertaking a completion of the national mental health policy and putting in place a Human Resources Development plan is something to be commended,” the doctor observed.

220px-School_destroyed_by_Sierra_Leone_Civil_War“There are a lot of psychiatric or health issues that need urgent attention, but the existing facilities in the country cannot cope, as up to 80% of the hospitals and health centres were destroyed by the rebels,” Abu Bakarr Sankoh, a former student at the College of Medicine and Allied Health Sciences commented.

“Most people are either direct victims of the war or had witnessed atrocities committed on their loved ones. Also, most of those who are rape victims and limb amputees have been left with psychological trauma which may be with them for the rest of their lives,” the former student said, pointing out that “the bulk of the population have suffered various psychological illnesses such as post-traumatic stress disorder. And the Ebola outbreak in the country is another factor that has caused serious psycho-social problems.

“Can you imagine? There are lots of psychiatric patients roaming the streets, but nobody cares about them because there are insufficient drugs in the hospitals,” a psychiatric nurse at the Kissy mental hospital added.

Abdul Nahim Koroma – community Psychiatric nurse, confirmed that drug abuse is now on an increase among the youths, adding that “drug abuse has serious repercussions on mental health in the country.

“The most commonly abused drugs in our country are Marijuana (Diamba), cocaine and ‘Brown Brown’ (heroin).  As a result of the abuse of these drugs, psychiatrists are now in high demand,” said Koroma.

He attributed the rebel war and the Ebola outbreak as contributory factors to the mental health crisis in the country. Many residents were victims, perpetrators and, or witnesses of the brutal and gruesome events of the war.

It is undeniable that some people may now be using illicit drugs to drown their sorrows, but adding that psychoactive drugs will only worsen rather than reduce the trauma or guilt.

marijuana2Cannabis, the popular name given to the leaves, resin and flowers of the cannabis sativa plant has psychoactive chemicals. There are different preparations of the plant resulting to various names, such as Marijuana (leaves); hashish (resin); sensemilla (female flowers) and cannabis oil (alcoholic extraction of the resin).

The plant has 60 cannabinoids (chemicals) of varying proportions, depending on the differing preparations. But the most potent is the THC (tetrahydrocannabinol). The new hybrids of cannabis such as skunk, big bang, white widow, etc, have high levels of THC.

Sierra Leone with an estimated population of more than six million or more has people with psychosis (2%); depression (4%); substance misuse disorder (4%); learning disabilities (1%) and epilepsy (1%).

In a brief chat, a mental health patient, who prefers anonymity, said this about some of the social problems in post war Sierra Leone and that of the Ebola outbreak: “The dignity of many people with mental health conditions is not respected. People with mental health conditions in Sierra Leone and the world in particular experience stigma, discrimination and wide-ranging violations which strips them of their dignity.”

This mental health patient, who has recovered from the illness, further said that many people suffering from mental illness are subjected to physical, sexual and emotional abuse, and neglect in hospitals and prisons, but also in the communities.

“This is a serious problem, because they need the support of psychiatrists to help combat some of the social problems which emanated from trauma of war and the Ebola outbreak in the country”, he concluded.

A father, whose son is suffering from a mental health condition, says that any person with mental health problem in Sierra Leone faces high level of stigma and discrimination.

“They are tagged as having mental health problem; they experience social deprivation; losing their jobs; losing social prestige and becoming isolated from their families and society,” he said.

But how can the authorities solve this problem of stigmatization and discrimination in order to promote the rights and dignity of people with mental health conditions in the country?

mentally ill treated by traditional herbalistsDr. Nahim says that in the health-care system, the health ministry needs to provide better support and care for people with mental health conditions, by providing community based services, respecting people’s autonomy, including their right to make their own decisions about their treatment and care, and ensuring access to good quality care which promotes their human rights.

When asked what is the World Health Organisation doing to promote dignity for people with mental health conditions globally, Dr. Nahim says that WHO is committed to ensuring that the dignity of people with mental health conditions is respected all around the world.

But a retired civil servant – Abu Kamara is of the opinion that the dignity of many people with mental health conditions is not respected.

He said people with mental health conditions around the world experience stigma, discrimination and wide-ranging violations, which strip them of their dignity.

Mental health begins with meArticle 1 of the Universal Declaration of Human Rights affirms that: “All human beings are born equal in dignity and in rights.”

The Preamble of the UN Convention on the Rights of Persons with Disabilities states that: “…discrimination against any person on the basis of disability is a violation of the inherent dignity and worth of the human person.”

Abu Kamara pointed out that this UN Declaration is just paper work, and not applicable in Africa, especially in Sierra Leone.

“If you have got mental problems, you are labeled at home, and you are labeled by the system. So there is not a great deal of dignity afforded to you,” he pointed out.


  1. The Problem with mental health in Sierra Leone is that most people have one way of thinking about the illness. Most people think that anybody with mental illness is devilish or has abused drugs.

    There are lots of factors that have increased the level of mental illness in Sierra Leone, as the writer points out, such as social problems, the rebel war, and economic hardship. Some people are not too strong enough to resist difficulties. This creates stress that will result in chronic depression. The person then loses the ability to control his or her behaviour.

    The Ebola is another cause of mental illness for some people, because of the psychological trauma it has created in their lives. The Ministry of Health and Sanitation in collaboration with the Ministry of Social Welfare should organise a team of psycho-social clinicians to provide therapy for the people who have been infected and those who have lost their families, friends and loved ones.

  2. I wonder what Dr Nahim feels whenever he is described as the only mental health doctor in Sierra Leone. It is no secret that people with mental problems are known to have no place in the Sierra Leone social structure.

    However, Dr Nahim who knows much more than most Sierra Leoneans, should have utilised his expertise and international influence to recruit an adequate number of staff to better the situation. He should know that a government that does not care for the mentally normal people, will never care for those who are not.

    I have to say that this is not only peculiar to the Current administration, but runs through all post-independent governments that have “ruled” this socially unlucky COUNTRY.

    This will change in the very near future, through a NEWS ALLIANCE FOR DEVELOPMENT political initiative.

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