Mental, neurological, and substance use (MNS) disorders are a serious public health concern, making up 13% of the global burden of disease1. Despite accounting for the same proportion of disease burden as cardiovascular disease, mental health routinely receives less than 1% of development aid funding and government health spending, if there is a dedicated budget line for it at all2. In addition to a lack of funding, low- and middle-income countries have scarce and unequally distributed specialist mental health professionals3. In Sierra Leone, this amounts to 2 psychiatrists based in Freetown and 20 mental health nurses dispersed across the district hospitals for a population of 7 million people. King’s Sierra Leone Partnership has been supporting this small but dedicated workforce. However, the scarcity of mental health specialists means that over 98% of people with serious mental disorders in Sierra Leone still do not receive the care they need4.
That’s why last week the KSLP Mental Health Team ran an mhGAP training week for 22 Community Health Officers (CHOs) representing 11 different districts across the country. mhGAP, or the Mental Health Gap Action Program, was launched by the World Health Organization (WHO) in 2010 in order to enable non-specialists in primary healthcare to detect, treat, and when necessary, refer people with priority MNS disorders5. CHOs are often in-charge of Peripheral Health Units in Sierra Leone, making them an ideal cadre of health workers to serve as catalysts for change at the primary healthcare level.
In collaboration with Hege Lind of Handicap International, Dr. Abdul Jalloh from Sierra Leone Psychiatric Hospital, and Mental Health Nurses Jennifer Duncan (Connaught Hospital) and Richard Fatoma (34 Military Hospital), CHOs received training on using the mhGAP Intervention Guide to assess and manage depression, psychosis, child and adolescent mental health, epilepsy, substance use disorders, dementia, self-harm/suicide, and other mental health complaints such as PTSD. Interactive presentations, discussions, videos, and roleplays were used throughout the week to strengthen understanding of concepts, practice clinical skills, and explore topics such as stigma and discrimination, human rights, and local expressions and understandings of distress and mental illness. The CHOs were also given an opportunity to spend a morning at either Connaught or 34 Military Hospital practicing their newly acquired clinical assessment skills.
I’m happy to say that following the training, participant scores on the pre- and post-training test increased significantly. Participants reported that the week was highly relevant and helpful to their work, with feedback that they learned “how to take a full history for mental health and how to treat different mental health disorders”, “good communication skills and psychoeducation skills”, and the importance of “giving more time for mental health patients”. Many talked about carrying out community sensitization work in the future to decrease stigma around mental illness and showed interest in further training, even going as far to say they would like to get a diploma in mental health once it becomes available to them in the future. The CHOs expressed interest in working more closely with their district mental health nurses and were given contact information to get in touch with them as well as with the Sierra Leone Psychiatric Hospital.
Mental Health Nurses at the secondary level of healthcare serve as the backbone of the country’s mental health system. But with the new Mental Health Policy and Strategic plan on the horizon, CHOs will play an increasingly important role in reducing the mental health treatment gap in Sierra Leone by increasing the availability of services at the primary healthcare level. Spending the past week with this highly engaged group of CHOs gives us a great deal of hope that, with the right support, they will play their part in improving mental health in Sierra Leone well.
As ever, many thanks to our supporters – this project is funded by USAID and supported by JSI.
- Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. The Lancet Psychiatry. 2016 Feb 1;3(2):171-8.
- Mackenzie J, Kesner C. Mental health funding and the SDGs: what now and who pays. ODI. 2016.
- Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, Sridhar D, Underhill C. Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet. 2007 Sep 29;370(9593):1164-74.
- Alemu W, Funk M, Gakurah T, Bash-Taqi D, Bruni A, Sinclair J, Kobie A, Muana A, Samai M & J E. WHO profile on mental health in development (WHO proMIND): Sierra Leone. Geneva: WHO. 2012.
- Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van Ommeren M, Yasamy MT, Ayuso-Mateos JL, Birbeck GL, Drummond C, Freeman M. Evidence-based guidelines for mental, neurological, and substance use disorders in low-and middle-income countries: summary of WHO recommendations. PLoS Medicine. 2011 Nov 15;8(11):e1001122.