Sierra Leone urged to adopt alternative therapies for mental illness – Updated version

By Kemo Cham

Sierra Leone should consider incorporating alternative ways of treating mental illness, an uncharted health crisis in the country, an expert has warned.
Clinical Art Psychotherapist, Amélie van den Brink, said a lack of political will to tackle mental health, which is relegated to the bottom of the healthcare priority, is worsening the situation for the country struggling to deal with recurrent traumatic events – namely the civil war, the recent Ebola epidemic and mudslide tragedy. Alternative therapies like art, music and dance, she said, could be useful treatments for the myriad of
people who have been affected by these events.
“Globally, treatment of mental health issues has gone beyond talk therapy because people often cannot find the words to express what they are feeling. Feelings in fact are complex yet important entities to understand, especially in cases where people have suffered trauma. Using art in therapy for example, a non-intrusive approach, can help people navigate those complex feelings because it does not rely entirely on words. It also has the capacity to benefit anyone of any age and background, including people who often say ‘I can’t draw, paint or sculpt,’” she said.
Art therapy is a form of psychotherapy that involves the creative process of art making to address various types of mental issues.
A Burkinabé-Dutch national, van den Brink was raised in a village in Koudougou, Burkina
Faso for the first 9 years of her life, before relocating to various corners of the world, including the US where she went through the American International School system and did her BA and Master’s degrees in Psychology, with a focus on Art Psychotherapy. She said the [1991-2002] civil war, the 2014-2016 Ebola epidemic, and last August’s deadly flooding and mudslide disasters have all left in their wake a lot of people vulnerable to mental health issues in Sierra Leone.
Van den Brink first came to the country in 2015 when she was involved with the Ebola epidemic response. Working alongside an Israeli-based NGO, she helped to provide psychosocial support to survivors of the heamorrhagic fever disease which devastated part of the West Africa region. This was when she came across issues of mental health and
realized the sector has been neglected.
When she came back to Sierra Leone in 2017 to conduct research on the collective identities of the gender and disability movements in order to understand the success factors for lobbying and advocacy, van den Brink had the opportunity to co-author an article with a local journalist after investigating depression in the after math of the Ebola epidemic. Published on a local tabloid called Concord Times, the article revealed how survivors were battling to secure basic care services, such as shelter and work. Since being in the country for six months now to conduct her research, she has realized the issue of mental health has not drastically improved since she left in 2015.
“You don’t have to look far…Even when people approach you, they often don’t seem Ok. Cognitively there is something impaired. It is right in your face, at your door step,” she told me in an interview.
“When you don’t have political will, how can your people be well? If you do not invest in their wellbeing or treatments of their health, how do you expect anyone to be Ok?,” she added.
The sight of mad people is a common phenomenon in the streets of Freetown, Sierra Leone’s capital: on the sidewalks, in the middle of the highways – they sit and lie in their own feces.
It’s also common to see young men walking and talking to themselves on the streets.
In 2017, the World Health Organisation (WHO) estimated that some 240,
000 people in the country suffered from depression every year.
Until last year, Sierra Leone’s 7 million population relied on only one trained psychiatrist, Dr Edward Nahim, who up to 2016 estimated that at least half a million people had some form of mental illness. He attributed this to substance abuses, in addition to the war and Ebola.
The war left multitudes of people in the country mentally incapacitated due to prolong exposure to hard drugs as young combatants.

And some 15 years after the war, drug abuse is still rampant. And Freetown is home to some of the cheapest alcoholic drinks, like mostly homemade gin and whisky, contained in sachets you can buy freely from the streets.
The Ebola epidemic killed over 11, 000 people mainly in the three neighboruing countries of Sierra Leone, Liberia and Guinea, with Sierra Leone alone accounting for about 4, 000 of the fatalities. Nearly the same number of people survived the disease.

The effect of the virus in survivors, plus the effect of losing loved ones and livelihoods as a direct result of the epidemic, culminated in a surge in the rate of people suffering from depression, anxiety and post-traumatic stress disorder, according to experts.
The Sierra Leone Association of Ebola Survivors says many of its members battling trauma and other psychological breakdown resulting from their experiences have been left to fend for themselves.
The Sierra Leone Psychiatric Hospital, the only such facility in the country, is constantly overwhelmed by the inmate population. Located in the east end of Freetown, the center hardly provides services beyond a daily dose of antipsychotic drugs. Some reports indicate that doctors administer expired drugs to the inmates who are kept mostly
chained.
The government recently announced some changes to the management of mental health, with the training of about two dozen nurses who were deployed at hospitals across the country under a WHO-aided programme.
But part of the problem with the country, van den Brink said, is that the relevant officials are out of tune with the reality on the ground. And that, she said, is why they are not putting enough money into the mental health sector. She said officials need to visit the psychiatric center and talk to those trying to help the mentally ill in order to get the real picture of the situation.
Van den Brink also argued that the belief that people seen as beyond redemption, as is the case with many of the mad people found in the streets of Freetown, was an erroneous idea perpetuated by the ill-treatment of these people by society because people do not understand what mental illness is or how to deal with it.
Like in almost all health and social issues, many Sierra Leoneans tend to rely on traditional healing measures, which often tend to add to the problems of the patients, mainly because of the unconventional and painful procedures they are subjected to.
Lack of psychosocial support and understanding of its benefits adds to the problem.
In Sierra Leone, psychosocial support is available only on short term basis, like during the immediate aftermath of disasters like was seen in the Ebola outbreak and the mudslide.
Van den Brink said this reality calls for a long term psychosocial support. She said there was also the need for a multidisciplinary team, including a dedicated core of social workers, psychologists, expressive therapies, as well as an inter-departmental engagements, including in the health and education sectors to raise awareness about mental health issues.
International bodies and NGOs also need to think in the long term of how to address mental health issues, she added. This also includes investing into research to understand the impact of the psychosocial support and other avenues of treatment on clients.
“We need to combine the qualitative and the quantitative measures to understand a person’s mental problem and how to best help him or her to cope afterwards,” she said.
“Social workers play a big role. They interact with people a lot. Tap into that and start with them. All they need is opportunity, training and supervision.”

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