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Taking steps to transform Sierra Leone’s Mental Health services

Mental Health Coalition, Sierra Leone
The Mental Health Coalition, Sierra Leone

Dr Carmen Valle is a CBM Co-worker, who works as project coordinator and mental health specialist with the ‘Enabling Access to Mental Health Programme’. In this article, she discusses the progress made in Sierra Leone for people with psychosocial disabilities and also the current threat the Ebola virus is bringing to this progress.

First impressions

This image shows Dr. Carmen Valle ©Laurence West
Dr. Carmen Valle
When I first travelled to Sierra Leone, long before working there for CBM, I got to visit the few mental health services in the country. The conditions that I saw, the situation of so many human beings in a country recovering from a cruel civil war, with no specialists but one retired psychiatrist for the whole country, no medication available, and the shadow of stigma reinforcing the chains of the patients, broke my heart.

That was some years ago, and for the past four, Enabling Access to Mental Health, a programme funded by the EU that CBM is implementing in collaboration with GIP, has been working with enthusiasm in transforming this reality and moving towards greater inclusion, and a comprehensive system for the care of persons with psychosocial disabilities in Sierra Leone.

Making progress with the Enabling Access to Mental Health programme

This image shows a mental health expert interviewing a young girl ©Tamsin Evans, Enabling Access to Mental Health
Mental Health professionals in Sierra Leone, supported by EAMH, offer counselling and psychosocial support to victims, relatives and health professionals.
The programme has established a strong, committed Mental Health Coalition that brings together stakeholders, including professionals and persons with psychosocial disabilities in the country, to advocate for the inclusion of mental health in the government’s agenda, for the transformation of society and for the recognition and respect of the human rights of those with psychosocial disabilities. They have made notable progress in raising the profile of mental health in the country, promoting the passage of a progressive mental health policy, and integrating mental health into other key policy and rights documents.

In the area of service development, a national Steering Committee for Mental Health is now in place, 21 psychiatric nurses have been trained to deliver services in district hospitals and 130 PHU (Peripheral Health Units) staff have been trained in basic mental health. Together, they constitute the beginning of the first nationwide network of mental health services.

With professionals on the ground and a governmental commitment to develop mental health structures, the other most important achievement is to reach each member of the community to raise awareness about the real nature on mental illness, to break down stigma, reduce prejudice and discrimination and bring the whole community together in shared responsibility to include those with psychosocial disabilities in community life.

Enabling Access to Mental Health is addressing key areas for promoting recovery and it is doing so in accordance with the principles of best practice in Global Mental Health:
-    Universal values (e.g., promoting access to care and a life with dignity)
-    Contextual adaptation with a locally established agenda and a multi-stakeholder involvement.
-    Emphasis on feasibility, acceptability, effectiveness and scalability.
-    Sharing knowledge

A recent WHO report about the social determinants of mental health  established that mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live. There is no wonder then, that in a country like Sierra Leone, with a recent brutal war, and ongoing social inequalities, there are high rates of many common mental disorders. The challenge has just been increased with the emergence of the Ebola Virus in Sierra Leone.

The Ebola epidemic and mental health

this image shows a man in Sierra Leone sitting in an eye clinic in front of an eye checking instrument ©CBM
Our work in countries affected by Ebola have been temporarily scaled down.
The recent terrible Ebola virus disease outbreak affecting West Africa is challenging what has been accomplished in these years. At present, the country is in a state of crisis, with free movement curtailed, schools, hospitals and businesses closed, and many people affected by the death of loved ones. In this difficult environment, our team is demonstrating the commitment and strength that these wonderful professionals have. The Mental Health Nurses posted to districts are supporting the whole community that is suffering the distress and trauma that this outbreak is bringing with it. The Mental Health Coalition is assuring that mental health is not forgotten and is pushing for the inclusion of mental health in every aspect of the Ebola response. Our partners are raising awareness about the importance of mental health in this situation and are fighting to address the distress that humanitarian crises always bring.

Sierra Leone is fortunate to have the network of nurses in place, which have become the backbone of mental health services, supporting many other organisations who provide first-line counselling. They are giving extraordinary support in an extraordinary difficult time, and CBM is committed to standing by them as the emergency passes, and we start to rebuild services and the work of promoting inclusion again.

Read more

Interview with Dr. Carmen Valle about Ebola Crisis

We spoke to Dr. Carmen Valle, a Mental Health Specialist based in Sierra Leone, about the Ebola Crisis in West Africa.



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