New Humanitatian: ‘Providing mental healthcare in Sierra Leone is a challenge, due to the beliefs of people.’

23 November, 2019

Extracts below and a comment from me. Read online:


The World Health Organisation estimates that 10 percent of the seven million Sierra Leoneans have mental health problems...

For decades, there was only one psychiatrist practising in the country (now there are two) and treatment in the only psychiatric hospital until recently involved restraining patients using chains due to the unavailability of psychotropic drugs.

As a consequence, almost 99 percent of those affected go untreated. Instead, spiritual beliefs drive those in need into the shrines of the country’s 45,000 traditional healers.

In Sierra Leone, mental health problems are widely believed to be caused by witchcraft or demons...

“Providing mental healthcare in this country is a challenge, due to the beliefs of people,” explains Rebecca Esliker, director and only employee at the institute for psychology at the University of Makeni (UniMak) in central Sierra Leone...

The psychologist has a long list of accusations against the healers: financial exploitation of families hoping for a cure for relatives; irresponsible use of psychotropic medication mixed with herbs without knowing anything about side-effects; and, finally, violence.

“When you take someone to the traditional healer, especially severe psychotic cases, they beat them mercilessly because they say that’s the way to get rid of the devil,” says Esliker, recalling the experiences of her patients...

She is part of the local Mental Health Coalition, which is pushing for the country’s 1902 mental health law – tellingly called the “Lunacy Act” – to be rewritten.

The MHC has already had some success, with the establishment of a separate directorate for non-communicable diseases and mental health within the Ministry of Health. In addition, 21 mental health nurses have been trained and deployed around the country to help provide basic care...


Comment (Neil PW): We see a similar picture in many other low-income countries. HIFA member Vikram Patel and others have shown that community health workers can be trained to deliver basic mental health care in the absence of higher-level health professionals. I have written to Rebecca Esliker to invite her to join us.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: