[#WHD2017 Africa Blog Series] Inspiring innovations: Facilitating MHPSS in the Ebola Crisis, Sierra Leone

This blog is part of our series celebrating World Health Day 2017. This year's theme is Depression: Let's Talk and we're showcasing inspiring innovations addressing depression across Africa.

MHIN Africa innovation on depression 5: Facilitating MHPSS in the Ebola Virus Disease Crisis

Facilitating MHPSS in the Ebola Virus Disease Crisis, a 3-part model strengthening governmental systems, was implemented to provide decentralized mental health and psychosocial support​ (MHPSS) services during the Ebola Virus Disease (EVD) outbreak.

Tell us about your country’s context and the circumstances that inspired your innovation

This innovation was implemented in Sierra Leone, a country with very limited resources for mental health services and numerous challenges. Before 2013, the country had only one retired psychiatrist and one under-resourced and precarious psychiatric hospital for the whole population. Outside of the capital town, not only that there were no services, but a very limited road network, poverty, traditional beliefs and other factors made it extremely difficult for the majority of the population to access support.

In 2013, Enabling Access to Mental Health (an EU-funded programme implemented by GIP, CBM, University of Makeni and the Mental Health Coalition) graduated 21 psychiatric nurses and continued supporting their supervision and training.

It was in this context that the Ebola outbreak of 2014-2015 disrupted the already weak health system, creating one of the worse humanitarian crises experienced in West Africa, and increasing the need for mental health and psychosocial support.

What aspect of your project are you most excited about? How is the project innovative or unique?

The most unique and relevant aspect of this innovation is that, in a humanitarian context where there is typically a great need for funding and interventions are costive as they require bringing in many human resources, we could prepare and deliver a MHPSS emergency response with a very small budget, by re-training the nurses and expanding our own activities to provide support to the Ebola Treatment centres, the front-line responders and the survivors. This response wasn’t only more affordable, it was also more effective as the support was given by members of the same country, with the same cultural background and the same language, building up on local expertise.

Through this innovation we decentralized services and made them available in all 14 districts of the country.

Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?

We could witness the impact on the ground at many different levels: the most obvious one was the number of persons with psychosocial disabilities in the provinces that were able to travel to their regional hospital, instead of having to go to the far capital. But there were many others, such as those members of the health system that started to acknowledge the relevance of the MHPSS services, due to the extent of the outbreak and the severe impact on the whole population. Before this time, there was a common belief that mental health is something that only affects a few people, and it shouldn’t be a priority or something that general hospitals can deal with. But the Ebola outbreak made everybody talk about mental health, especially stress-related conditions and depression. The First Lady of Sierra Leone said in a meeting with this innovation’s team, “We all need psychosocial support. We all are touched by this tragedy.” One Ebola survivor eloquently talked in one of the cluster meetings, “We need support, we need professionals to talk to. We have lost everything and now we can’t sleep or concentrate, we have lost the appetite… We need support for our health and our mental health problems.”

What’s next?

Having 14 units in 14 districts, with one or two nurses each, is clearly not enough. This innovation provided much needed care in a moment of extreme necessity and the units continue to service persons with psychosocial disabilities, but for a population of 7 million inhabitants, many more services are needed and closer to the remote communities.  Since this innovation was implemented, a programme called “Building Back Better: Supporting Early Systems Recovery and strengthening permanent mental health services across Sierra Leone” has been implemented, with the financial support of a German development agency Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – Translated to English, this means “German Federal Enterprise for International Cooperation”, by the same partners that implemented this innovation. Together, we continue looking at ways of supporting Sierra Leone in the path to strong mental health services for all.

What is the one message about depression you want people to take away from your innovation?

We know that over 300 million people are estimated to suffer from depression in the world. This innovation highlights that, on top of these numbers, extraordinary circumstances are going to continue happening and putting entire populations at higher risk: natural disasters, war and conflict, diseases outbreaks and epidemics will continue to have an impact on depression, and only by securing the existence of services and breaking the stigma around it, we can be efficient in talking it in these circumstances.

For more African innovations featured in this series, please visit the [#WHD2017 Africa Blog Series].