By the time Sierra Leone's decade-long civil war was finally brought to an end in 2002, the psychological toll on the population had been huge. In a survey of women conducted by Physicians for Human Rights in August 2011, 94% rated their mental health as 'poor' or 'fair' and 28% reported experiencing suicidal thoughts or feelings. The World Health Organisation (WHO) meanwhile found that over 100,000 of Sierra Leoneans over twelve were severely depressed, 50,000 had demonstrated psychotic behaviour, and 200,000 reported some form of substance abuse. Furthermore, the country had just one psychiatrist and only two psychiatric nurses.
It has been over a decade since then, but progress has been slow. Despite efforts by international organisations and aid agencies to channel funding towards mental healthcare, there is still only one hospital in the country equipped to treat patients with mental health issues, meaning many have to rely on traditional healers. Meanwhile awareness campaigns aimed at educating people about mental health also still have a long way to go. A study of Sierra Leoneans' perceptions of mental health in 2002 found that 25% thought psychological problems were due to substance abuse, 16% cited "God's will" and 10% believed such conditions were associated with “spirits, curses or demons.” Many of these understandings and many of the stigmas around mental health still remain today.
Mussu Kamara, a business woman from Freetown, for instance, believes mental illness is a person's own fault. “It is as a result of the person's past actions which led them into trouble in the present," she says. "For example, if you steal something from someone, even if no-one notices it at that moment, [the victim] can go to the witch doctor and wish something bad on whoever stole it and the witch will make that person mad. The problem is that this doesn't happen only to criminals − anyone with a personal feud can wish it on an innocent person."
Amadu Bah, a taxi driver from Freetown, echoes the idea that curses lie at the root of mental health issues.“There are so many different types of sweh [curses],” he says, “but the most dangerous type is bom sweh which can affect innocents just because they are close to the person who received the curse, for example, unborn children.
“I know a man who was present at a scene where a couple of men were stealing but he just saw it happen and didn't steal anything. The shop owners decided to go to a witch doctor and curse the thieves, the people who were present at the scene but did not report it to the police, and anyone who bought their stolen property.”
Finally, 26-year-old tailor Arnold Wilson recalls: “I know a woman who sells cooked rice on the street. She used to have lots of customers coming to her because her meals were so good, but the neighbours who do the same business were jealous and went to a witch doctor to make the woman lose her memory and therefore her recipes.”
“I have been to a witchdoctor one time when I was sick to seek help," he says. "While in consultations to receive my medicines another visitor entered the place and told the witch doctors that they wanted to make someone else suffer from the same thing that I was being cured of. I believe I was only cured from the trouble I was having through the help of a witch doctor.”
Tackling Sierra Leone's mental health issues and stigma will be a major task, not least because many of the true roots of mental illness lie in the population's experience of brutal violence, ongoing poverty, alcohol and drug abuse, and other forms of social disruption.
However, there are hopes that the landscape is slowly beginning to shift. In 2011, the Mental Health Coalition of Sierra Leone was established bringing together a wide range of government organisations, NGOs, religious groups, campaigners, mental health service providers, medical specialists and traditional healers. Jointly, these groups aim to raise awareness, push for a greater national commitment to mental health issues, and are currently petitioning the government to review the Lunacy Act of 1902 and offer greater protections for people with mental illnesses.
Some of their campaigns have already had some success. “One of our biggest achievements was to get the government to include mental health medicine in their list of drugs that are imported to the country every year," explains Ansinu Lamin, project coordinator of the Community Association for Psychosocial Services (CAPS), a local NGO which is part of the Mental Health Coalition.
Lamin, however, believes the need the reduce stigma around mental health is crucial. On this front, Lamin chairs the coalition's Awareness Raising Committee and explains that his team is currently working to educate people in the cities of Makeni, Kenema and Freetown and that they are preparing to work across all of Sierra Leone eventually. "We have recently released two posters which have been distributed all over the country, we are mapping the local institutions such as schools who can help us send our message, and we are also working with radio stations. This will get the message across to the general public,” he says optimistically.
Sierra Leone desperately needs greater mental health services and perhaps ought to follow the WHO's recommendations for low-resource countries of focussing on establishing and improving mental health services within primary care settings, using specialist services as a backup. But at the same time, underpinning many of the country's difficulties with mental health is the continuing stigma associated with people suffering from mental illness, which will also need to tackled.
"I would like to tell everyone that mental health can affect anyone, so the people suffering from mental illness should not be blamed for their state," says Lamin. "It's our job to help them seek medical attention and if they are our family they need us around them to support them and take them to the nearest care centre.”
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