Like many post-conflict societies, Sierra Leone lacks capacity in its health and social care workforce. Where an estimated 13 per cent of the adult population suffers from a mental disorder and there exists only one trained psychiatrist for a population over 4 million, the mental health treatment gap is great.
In July University of York Research Fellow, Meredith Newlin, visited Sierra Leone to to evaluate the feasibility of adapting a UK psychosocial intervention model to meet these mental health needs. She conducted interviews, focus groups and observations in a variety of mental health service settings and with a number of key stakeholders. Feedback from stakeholders with regard to adapating the intervention model was positive and it was agreed that training in psychosocial approaches is greatly needed both at district and community levels in order to strengthen the care available to adults with mental health problems.
The Research team are continuing to collaborate with partners on the ground in Sierra Leone to develop a model of a practice and training programme for community-based nurses. This model considers how social interventions, developed in partnership with patients' families and friends, and other members of the community such as traditional healers, might increase the chance of recovery.
More recently the research team helped train a group of 20 nurses, the first cohort to ever receive mental health training in Sierra Leone. The Sababu Training Programme offers techniques for training mental health workers within a social intervention framework. In Krio, the local language, ‘sababu’ means connections with other people.These nurses are now placed in 14 districts to lead mental health services across the country.
Robust evidence exists to support links between enhanced social capital and improved health and wellbeing for vulnerable populations. However, there is little evidence for health and social care interventions that promote social engagement, particularly in low- and middle-income countries where health services are limited. The World Health Organization and the UK Government recognise the vital need to expand global health partnerships and mental health services to vulnerable adults in low- and middle-income countries through wide dissemination of scientific evidence-based interventions. The Connecting People Intervention, which supports enhanced social networks for individuals with mental health problems, is currently being piloted in the UK. C2D2 funding was awarded to evaluate the feasibility of piloting the Connecting People Intervention in low-resource settings of Sierra Leone. Using systematic reviews and ethnographic methodology, the ambition is to gain an understanding of mental health service delivery and identify needs of service users in Sierra Leone.
Meredith Newlin visited Sierra Leone in July 2013 to gain an understanding of existing mental health service needs and to evaluate the feasibility of adapting the Connecting People Intervention to meet those needs. Meredith and her colleague Dr Susannah Whitwell, consultant psychiatrist from King’s College London, met with stakeholders in the three largest cities: Freetown, Makeni, and Bo.
With only one trained psychiatrist and a population over four million, the lack of mental health training and supervision represents a significant barrier to addressing mental health needs. Although training has begun for twenty-one psychiatric nurses, focus has been placed on the medical model, which is problematic in a country with poor access to medications. Upon graduating this autumn, the nurses will be based in district hospitals across the country with referral pathways reaching into the rural communities. Training in psychosocial approaches is greatly needed both at the district and community levels in order to strengthen the care available to adults with mental health problems.
Feedback from stakeholders on the adaptation of a psychosocial intervention model was positive and provided the research team with an understanding of specific elements of social capital on which to focus in the development of a training programme. For example, elements that resonated within the cultural context include the building of trusting relationships between the mental health worker and service user, the salience of deepening connections in the community, and enhancing public awareness of mental health and thereby minimising stigma.
From the data collected during this initial visit, it is evident that further research is needed and feasible through continued collaboration with stakeholders in Sierra Leone. The research team have been awarded follow-on funding from the Maudsley Charity to help with adapting a psychosocial intervention model to fit mental health practice in Sierra Leone and develop a training programme to enhance the psychosocial skills of the psychiatric nurses and build research capacity with local university students.