BRAMPTON, Ontario — Only 2,000 of the 715,000 people living with mental illnesses in Sierra Leone receive treatment. Since the end of the civil war in 2002, Sierra Leone has been trying to repair itself socially and economically. In 2007, Sierra Leone trailed at the end of the U.N. Human Development Index, a report that ranks nations based on factors affecting quality of life. Now, Sierra Leone sits 11 spots from the bottom.
The mental health treatment gap in Sierra Leone is deplorable, but unfortunately not surprising. There are many factors that are a driving wedge between mental health treatment and those seeking it.
Social stigma is a hateful barrier that repels proper attention to mental health issues. Education on mental health in many African nations is nearly nonexistent, and many African languages lack the appropriate mental health terminology. For instance, in Uganda, Yo‘kwekyawa, meaning “hating oneself,” or Okwekubagiza, meaning“pitying oneself,” are used in place of “depression.”
This stigma puts people with mental illness at risk of emotional and physical victimization. These people also see restrictions in their right to access health care, restrictions in seeking education and employment opportunities and restrictions in their participation in government programs. This exclusion and oppression perpetuates a cycle. There is no progress when these victims and their stories slide under the radar.
People living in dismal conditions are subject to feeling insecure and are vulnerable to violence and poor health. These mental stressors weigh heavily and lead to a deteriorating state of mind. People already living with mental illness are unable to pull themselves out of poverty due to social restrictions and their own unwillingness to participate in society.
During Sierra Leone’s civil war, many children were forced into becoming child soldiers. They witnessed abuse and were abused. Upon returning home, many were shunned for the acts they committed. Girls who were victims of sexual violence were accused of being impure. Feelings of shame and guilt plague these former child soldiers as they grow up and are increasingly ostracized from society. Finding a future for these former child soldiers proves difficult when they struggle with finding understanding from society.
The primeval state of the current mental health system is also discouraging. The Sierra Leone Psychiatric Hospital is the only psychiatric hospital in the country and is minimally staffed. There is a retired psychiatrist, two psychiatric nurses and some auxiliary nurses. Since there is only one formal psychiatric facility, only so many patients can be accommodated. Patients who experience physical complications from their mental illness, such as insomnia, may seek a local health center. Otherwise, they may approach their religious leaders to help what they believe are spiritual problems.
When combating poverty, emphasis is usually placed on what are believed to be more pressing issues pertaining to the Millennium Development Goals such as education, HIV/AIDS treatment and maternal health. However, general and mental health are one and the same. Mental health underlies many of these issues and it deserves much overdue attention.
– Carmen Tu