Mental health service provision in Sierra Leone is poor. In 2009 an estimated 2,058 people received some form of mental health treatment out of about 102,000 people (3% of the 3.4 million adult population) who had a severe mental disorder2. There is one specialist psychiatric hospital in the country, located in the capital Freetown, to serve the population of 7 million.
During the Ebola virus outbreak, the Sierra Leone psychiatric hospital was closed to admissions to prevent disease transmission. Existing government plans to create new decentralized mental health units3 across the country were brought forward as part of the emergency response. Mental health nurses who had received 12–18 months’ mental health training in 2012–2013 from a bespoke nursing curriculum were deployed to general hospitals in various districts4. This innovation describes the experience of establishing one of the new units ‒ a nurse-led mental health and psychosocial support service at Connaught hospital in Freetown, the largest government hospital in the country with approximately 300 beds.
The service was launched in March 2015 and was available to those living within the Freetown city area (about 1 million people) or anyone admitted to Connaught hospital. The partnership devised a standard operating procedure. Individuals of any age with a known or suspected mental health problem or psychosocial need met the referral criteria. A service level agreement with the Sierra Leone psychiatric hospital allowed transfers for inpatient care. In keeping with hospital protocol, a registration fee was levied and waived if service users were unable to pay. A single mental health nurse provided the service, with prescribing of medication carried out by a link hospital medical physician. A range of treatments were provided. Psychological interventions were the most common, comprising basic counselling and problem-solving therapy. The WHO Mental Health Gap Action programme (mhGAP) intervention guide informed the model of care used5,9.