On November 10th, we will be celebrating World Mental Health Day with the theme of ‘Mental Health in the Workplace’. The concept of mental health in Sierra Leone is poorly understood by many and often highly stigmatised. Discrimination against mental illness is common and I imagine that conversations about mental health at work are almost non-existent. Any opportunities to raise awareness need to be embraced.
A large amount of my time in Sierra Leone is spent working with the national team of twenty Mental Health Nurses. These nurses run mental health clinics throughout the country, often working in isolation in their respective units but together they form a vital work force.
On the 14th August 2017 Sierra Leone experienced a deadly mudslide and widespread flooding. Over 500 people lost their lives and an estimated 8000 people were displaced. On the morning of the disaster the mental health nurses had all travelled to Freetown for a training week. Anticipating that the mental health needs of the affected population could rise, the Ministry of Health and Sanitation called upon these nurses to work directly at the worst affected sites as part of the disaster response efforts. My work at KSLP suddenly altered from delivering a teaching week to assisting with the coordination of this response.
Over the following weeks the team worked tirelessly to provide psychological support to thousands of individuals. The environment on the ground was initially very chaotic, with many distressed individuals still searching for loved ones. I heard tragic stories of individuals losing their entire families as they had left the house early to go to work while the rest of the family slept. I witnessed many people sheltering in half-built houses that were not fit for human habitation, with people sleeping directly on dirty floors and with poor sanitation. It was so overwhelming I found it hard to emotionally comprehend the enormity of it all. The burden of carrying out this work on the mental health nurses was vast. They spoke directly with many affected individuals each day, showing continued compassion and empathy. It was almost impossible not to become emotionally invested.
In the wake of this tragedy I must remind myself to focus on the positives so that we can move forwards in a meaningful way. Despite the devastating circumstances there have been moments of relief; children laughing and playing together in the half-built houses, people singing and dancing while sheltering in a church, a young female smiling after receiving potentially lifesaving epilepsy treatment when she had been left untreated for over ten years, and a lone child reunited with family members who they thought had been lost. This, in no way makes up for the enormous losses but has given me a new sense of hope and recovery for these affected individuals.
It has been a privilege working closely with the mental health nurses over this time. There seems to be a renewed enthusiasm within the team for the delivery of mental health support in spite of the daily challenges they face. The nurses have been able to spend more time together, strengthening their bond as a team and building their confidence. It has been inspiring to watch the team grow over this time, despite being stretched to their absolute maximum.
I have been inspired by one health worker in particular who often talks of her passion for mental health and wanting to raise awareness. She lost family members in the mudslide but worked together with the nurses to deliver psychosocial support. Her input on the ground with knowledge of the area was crucial for the success of the intervention, particularly while the environment was so chaotic. I hope that this passion continues and we can harness it to drive forward this outreach service that will now be vital so for this devastated community.
For me personally, this experience has also been a reminder that any of us can be affected by mental health issues at any time. Life can suddenly be altered in ways we cannot predict and potentially trigger mental illness. Even as a mental health worker I am not immune and will acknowledge that this has been a stressful time for everyone involved. Some of the group work carried out in the response has involved talking with the nurses, psychosocial support workers and domestic staff at the camps to raise awareness of stress and its management. The sense of team work, with a sharing of experience and burden has been vital to maintaining each other’s mental health. This can be said of almost any circumstance.
Unfortunately, as a result of the disaster and prioritisation of the response, events to commemorate World Mental Health Day in Sierra Leone may not be as large as previously hoped. At Connaught Hospital the team of Mental Health Link Nurses will visit each ward to raise awareness. At the Ministry level and nationally we are seeing greater recognition of mental health issues. This progress has been achieved as the result of many years of advocacy work by multiple organisations, plus a willingness within the government to improve mental health services. It will take time for this progress to filter outwards to the wider population, when mental illness may be openly talked about in the work place but I believe this is something that will happen. It is exciting to be in Sierra Leone at a time when we have a real opportunity to continue this momentum and build on what has already been achieved.