by Dr Helen Thomson, Psychiatry Specialist Trainee Doctor
‘Le wi tok’ is the Krio for ‘let’s talk’: one of the key messages being spread in Sierra Leone about depression for World Health Day 2017. However, in Sierra Leone, you are very unlikely to hear anyone talking about depression.
As part of my work as mental health coordinator for King’s Sierra Leone Partnership, I have been providing clinical supervision for the 19 trained mental health nursing staff working in each district. A large and essential part of these nurses’ work is community sensitisation, efforts to reduce stigma and mental health awareness raising. Without these efforts, they would not have any patients in their clinics.
Depression in Sierra Leone is a large, but mostly completely unrecognised problem. The country has experienced a devastating civil war and more recently also the largest Ebola outbreak in history, not to mention flooding, civil unrest and widespread poverty. Rates of mental health problems in the country are high.
However, mental health awareness is extremely low. The strength of the local population’s cultural beliefs varies throughout the country but even in Freetown, where the public are relatively more trusting of Western medicine, the majority of patients attending clinics have more visible disorders such as psychosis. Of the very few patients presenting with depression, most seem to have healthcare staff as relatives. Even in these cases, almost all patients have visited a traditional or religious healer before coming to the clinics. When people consider mental illness here, they only think fearfully of the ‘craze yard’. They are thinking of the Sierra Leone Psychiatric Hospital, the only inpatient facility in the country.
There is a perception here that depression is simply laziness and the vast majority of people would never consider it to be a treatable medical condition. However, I have seen cases of very severe and disabling depression treated very simply and effectively. It is not a difficult condition to treat, even with the extremely limited resources available here. Sometimes simple psycho-education is enough to make a huge difference, explaining to patients’ families that the condition is not the person’s fault.
We are trying to spread the message that people should consider going to see a healthcare worker if they have symptoms of depression; but the reality is that there are very few staff with sufficient training available in the country, and these messages are complex ones to understand for people who trust traditional medicine so completely and are so unaware about mental health problems. I am cautiously optimistic about the future of mental health services in country, but the treatment gap for depression – the number of people with depression who need treatment but do not get it – will be challenging to close.
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