Mental Health and Addiction in Sierra Leone by Paulina Taylor

In the early 1800’s Sierra Leone was considered the “citadel” for West Africa, opening Sierra Leone Psychiatric Hospital in 1820 and the first university Fourah Bay College in the region in 1827. However, since then, there has been little progress improving or extending these facilities. Sierra Leone Psychiatric Hospital remains the only mental health institution in the whole country for a population over 6 million compared to neighbouring countries like Nigeria where there is at least 1 mental health institution in each state.
The psychiatric hospital was renamed from Kissy Mental health hospital in 2006 due to stigmatisation of patients and staff and even up till now, it is still referred to as “Kissy Crase Yard” by some locals meaning “place for crazy people.” The hospital has a capacity of 200 patients with only 3 doctors; 2 consultants and 1 psychiatrist. I was able to interview the matron/ the mental health nurse in charge Mr. Ibrahim who studied in Nigeria because there are no recognised mental health courses in Sierra Leone. My initial assumption was that the lack of development of mental health services in the country was due to lack of financial support. However, Mr Ibrahim highlighted that a bigger issue is that mental health is not prioritised in the country because it’s not recognised as an important issue. The hospital currently houses 68 patients with severe mental health issues like schizophrenia and depression. Despite the high workload, 2 of the doctors are currently on leave waiting to see if their contracts will be renewed in the upcoming new year (2019).
A positive of the Sierra Leone Psychiatric Hospital is that all the services they provide including prescription and food are currently free for inpatients. The facilities being free and easily accessible is purposed to encourage clients to seek treatments. However, some people abuse this by resisting treatment to stay for the maximum term for free food and a cosy bed. Hence, the hospital only provides up to 2 months maximum stay and its very unlikely to be readmitted. My source Mr Ibrahim also mentioned that some families abandon their mentally unwell relatives at the hospital with no further contact.
A bigger issue is that once clients leave the hospital, there is limited control and follow up of treatment plans. Even more shocking, is that there are no community-based practitioners or facilities to support clients once they leave the hospital. Therefore, it is very rare to see positive outcome of treatment where clients have successfully been reintegrated to society. Mr. Ibrahim stresses that the revolving door effect is the typical outcome of treatment.
I asked Mr. Ibrahim about his opinion of what he believes is a major underlying cause of mental health issues in Sierra Leone. He answered that there are currently 68 patients in the hospital, 80% of which are aged between 18 to 25 and almost 100% of those cases are due to recreational drug use of cocaine, heroin and tramadol which is a growing problem in the country.

Luckily, there are a few universities in Sierra Leone. I was able to speak to students and lecturers from Farouh Bay College, Milton Margai and Institute of Public Administration and Management. Experimentation with drugs across the campuses was a common issue and a big part of the hazing culture at university. A lecturer from Farouh Bay College even gave an example of a student under the influence of drugs that physically assaulted him. Dr Kenny, a lecturer from Farouh Bay college explained that drug use on campus was mostly due to peer pressure and stress; from workload, students suffering to pay tuition fees and homelessness.
Although Farouh Bay College in SL has Applied Sciences and Social Sciences departments, Psychology and related mental health courses are not offered. Some lecturers like Dr Kenny however did Psychology modules as part of an Education postgraduate but it was almost alien to study straight Psychology.
My final interview was with a Pharmacist from Emzor Pharmaceuticals. Similarly, the Pharmacist also mentioned drug use as an underlying factor of ill mental health in Sierra Leone. The pharmacist emphasised that he sees many clients who are addicted to recreational drugs as previously mentioned and prescriptive drugs like benzodiazepines and tramadol. The addiction issue in Sierra Leone is seen and felt by many professionals and local citizens. Many are left unsure on how to tackle and minimise this issue. The pharmacist suggested that more should be done in education to inform young people about the harmful effects of drugs. However, Sierra Leone is still a long way off because there are no accredited courses or modules in drugs and addiction. Some lecturers like Dr Kenny do offer mentoring and informal support to their students. Some students in Farouh Bay college have created SLDC Sierra Leone Debating Council to discuss and tackle these very real issues facing students. However, the impact is limited because there are no ways to track progress and lecturers are not rewarded for the extra support they offer.
Farouh Bay College and Sierra Leone psychiatric institution are currently both under renovation to improve their facilities. The future for development at the hospital is the PRH Boston transformation. Farouh Bay College was allocated a 13 million dollars loan by the local government from the US government to modernise the facilities.
In conclusion my research project was very informative and has revealed key areas to tackle when discussing mental health in Sierra Leone. However, it has brought up bigger questions on how to practically tackle these issues. Funding for tackling these issues and what is the future of mental health in Sierra Leone?




















