Global Mental Health

Promoting Mental Health and Wellbeing

Case Study: Sierra Leone

Dr Ross White

MSc Global Mental Health Coordinator

The recent Mental Health Atlas (WHO, 2011) indicated that globally, spending on mental health is less than two US dollars per person per year. However, in low-income countries this figure falls to less than 25 cents. Despite the high prevalence and burden of mental disorders, 90% of individuals in low and middle-income countries do not receive treatment (Wang et al., 2007). There is an urgent need to address the inequalities and inequities in how mental health difficulties are treated across the globe. The MSc Global Mental Health programme at the University of Glasgow aims to educate students about how to design and deliver services aimed at promoting mental health well-being across the globe. Particular focus is allocated to looking at ways of reducing the treatment gap for mental health problems in low and middle-income countries.

Sierra Leone is a country in west Africa that is classified by the World Bank as a low-income country. Scotland and Sierra Leone have similar sized populations and cover similar geographic areas. However, there are marked differences between the populations in terms of history, ethnicity, race and income. The capital of Sierra Leone, Freetown, was founded in 1792 by abolitionists. The city was specifically created as a land for freed African Americans slaves. The moto of Sierra Leone is ‘Unity, Freedom and Justice’. However, between 1991 and 2002 unity, freedom and justice of the Leonian population was shattered by a brutal civil war. It is estimated that 40-50,000 people were killed and 500,000 civilians fled the country (Dufka, 1999).

In particular, women and children suffered high levels of trauma during the civil war. Approximately 50,000 to 64,000 internally displaced women in Sierra Leone have histories of war-related assault, while 50% of those who came into contact with the Revolutionary United Front reported sexual violence (Physicians for Human Rights, 2002). It is estimated that between 7,000 and 10,000 child soldiers may have been part of the fighting forces in Sierra Leone (Government of Sierra Leone, 2005). Gupta & Zimmer (2008) found High levels of intrusion, arousal and avoidance symptoms in 315 children aged 8-18 in assessments conducted 9–12 months after the war.

Beate Ebert, a Clinical Psychologist working in Germany, became aware of the high levels of trauma experienced by the Leonian population through a family friend. Motivated to do what she could to help support victims of trauma in the country, she and her friends created the commit and act foundation in 2010 to help train psychosocial therapists in Sierra Leone.

In February/March of 2012 in a trip organised by commit and act, I travelled to Sierra Leone with a small group of international psychologists from Germany, Scotland, and the United States. As a group we provided workshops on psychosocial intervention to social workers working with Non-governmental Organizations. The intention was to teach skills and support the creation of a supervision network for therapists in Sierra Leone. Over 90 NGO staff attended the three workshops that we offered. The feedback from attendees was very positive. I was struck by the enthusiasm and interest that the attendees had for the training that we offered. The warm welcome and gratitude that we received was very humbling.

'commit and act' is one of a number of organisations across the world doing mental health related work that is working in partnership with the MSc Global Mental health programme at the University of Glasgow. In 2013 I will be returning to Sierra Leone with Beate and colleagues to conduct further training. I will also be accompanied by an MSc Global Mental Health student who will be conducting research (under the supervision of Prof Andrew Gumley) into people’s experience of the psychosocial training and how this has impacted on the work that they do with their clients. Commenting on the collaboration with the MSc Global Mental Health programme team, Beate Ebert said ‘We are proud that commit and act is one of the partner organizations of this international programme and that health professionals from the programme can support us in the form of an internship. We hope this will give new momentum to our work and open new roads’.

References

Dufka, C. (1999). Getting away with murder, mutilation and rape. New testimony from Sierra Leone. Human Rights Watch; 11: 3.

Government of Sierra Leone (2005). Poverty Reduction Strategy Paper.

Gupta, L. and C. Zimmer (2008). Psychosocial intervention of war-affected children in Sierra Leone. British Journal of Psychiatry 192, 212-216.

Physicians for Human Rights (2002). War-Related Sexual Violence in Sierra Leone: A Population-based Assessment.

United Nations Population Fund (2005). Gender-based violence in Sierra Leone: a case study.

UN Committee on the Convention on the Elimination of all forms of Discrimination Against Women: Combined initial, second, third, forth and fifth periodic reports of State Parties, Sierra Leone (2007).

Wang, P.S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M.C., Borges, G., Bromet, E.J., et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007;370: 841—50.

World Health Organization (2011). The Mental Health Atlas. Geneva, WHO.