Abstract
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.
Highlights
Around the world, lower- and middle-income countries are disproportionately affected by natural and manmade disasters [1, 2], 1 creating increased mental health needs in countries that often already have under-resourced mental health systems
In an evaluation of the Ebola virus disease (EVD) outbreak mental health and psychosocial support (MHPSS) response in 2015, a significant critique still concerned the dominance of international organizations in mental health intervention decision making, leading to culturally insensitive work and a disenfranchisement of national actors [4]
The article was reviewed by two Sierra Leonean mental health experts, including a physician trained in child and adolescent mental health (CAMH)
Summary
Lower- and middle-income countries are disproportionately affected by natural and manmade disasters [1, 2], 1 creating increased mental health needs in countries that often already have under-resourced mental health systems. Systemic improvements in the implementation of evidence-based mental health care for children and adolescents appear to be lacking. In an evaluation of the EVD outbreak MHPSS response in 2015, a significant critique still concerned the dominance of international organizations in mental health intervention decision making, leading to culturally insensitive work and a disenfranchisement of national actors [4]. Colleagues observe, many postemergency MHPSS interventions “remain relatively top–down and external They focus on a very specific population and are often not well integrated into the health system at national, district and primary levels. In the context of this paper, I will not attempt to give a comprehensive overview of the cultural values, practices, and beliefs that affect CAMH care development in Sierra Leone, especially when considering the diversity of cultures within the country. While some progress has been made towards these goals, in many areas the implementation is found deficient and hindered by a lack of referral systems [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
