Abstract
Sierra Leone is a West African country with a population of just over 7 million. Many Sierra Leoneans lived through the psychologically distressing events of the civil war (1991-2002), the 2014 Ebola outbreak and frequent floods. Traditionally, mental health services have been delivered at the oldest mental health hospital in sub-Saharan Africa, with no services available anywhere else in the country. Mental illness remains highly stigmatised. Recent advances include revision of the Mental Health Policy and Strategic Plan and the strengthening of mental health governance and district services. Many challenges lie ahead, with the crucial next steps including securing a national budget line for mental health, reviewing mental health legislation, systematising training of mental health specialists and prioritising the procurement of psychotropic medications. National and international commitment must be made to reduce the treatment gap and provide quality care for people with mental illness in Sierra Leone.
Highlights
More than half (52.9%) of Sierra Leoneans live below the poverty line (UNFPA, 2018)
Two Sierra Leonean psychiatrists returned to the country following completion of specialist training in 2016: one is the medical director at Sierra Leone Psychiatric Hospital (SLPH) and the other is the commanding officer of military medical services
Mental health is included in the Minimum Package of Essential Health Services and the Health Policy and Strategic Plan, this has not translated into adequate investment towards the strengthening of the mental health system
Summary
Sierra Leone is a West African country with a population of just over 7 million. Many Sierra Leoneans lived through the psychologically distressing events of the civil war (1991–2002), the 2014 Ebola outbreak and frequent floods. Many Sierra Leoneans have experienced traumatic events that are associated with negative mental health outcomes (Betancourt et al, 2015). These include a decade-long civil war which ended in 2002, the 2014 Ebola outbreak (Jalloh et al, 2018), and recurrent floods which in August 2017 caused a deadly mudslide that left an estimated 1141 dead or missing (The World Bank, 2017). Alcohol use is significantly higher than the regional average (WHO, 2014) and substance misuse, especially of marijuana and tramadol, are of increasing concern (Shackman & Price, 2013)
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