Mental Health Innovation in Africa Blog Series: Sustainable Advocacy and Leadership

In this blog Joshua Abioseh Duncan (Program Manager) writes about the Mental Health Coalition of Sierra Leone, an initiative that has brought meaningful engagement of people with lived experience of mental health conditions into discussions around policy and planning for mental health within the country as well as the capacity-building of mental health leadership. He shares the program's learning around what made their project successful and sustainable.

Mental health care in sub-Saharan Africa started in Sierra Leone with the establishment of the 'Kissy Lunatic Asylum' . The facility was the first established in colonial Sub-Saharan Africa since 1820. Since then, different approaches to care and services, structural development and governing principles and practices including laws and policies have shaped the course of mental health care in the country. A major contributor to this great achievement is the Mental Health Leadership and Advocacy Programme (mhLAP).

mhLAP is ultimately designed to scale-up appropriate mental health services in five operational countries: Nigeria, Ghana, Sierra Leone, Liberia and the Gambia. This is done through the training of mental health leaders, supporting them to better plan and advocate for improved community-based services and inclusion through appropriate policy, planning and resource allocation. The mhLAP coordinating office is based at the Department of Psychiatry, University of Ibadan. It is a partnership program between the University of Ibadan and Australian Aid and is led by Prof. Oye Gureje.

Key strategies employed by mhLAP to achieve its program’s goal are:

  1. Situational analyses
  2. Regular workshops and training
  3. Empowerment of locals for effective campaigns and services including study and assessments

The programme's initial focus was to tackle attitudes associated with myths and assumptions around causes of mental health disorders resulting in stigma, discrimination and exclusion. In Sierra Leone, culture and religion proposes that mental health disorders have a supernatural undertone - the work of witchcraft, demonic activities, curses placed on individuals or reparations for evil acts by perpetrators. Family and community members therefore blamed the mentally ill for their mental health disorders. In its response to this misnomer mhLAP focused on “Why such negative perceptions” and not just “How to Change community perceptions”. The 2012 Situational Analysis was an appropriate survey that helped to better inform campaigners respond to these negative attitudes towards persons with mental health disorders.

mhLAP also fostered effective collaborations for better services among care providing institutions. Special attention was placed on the formal (the Psychiatric and General Hospitals) and informal (traditional and faith healers) sectors. For mhLAP, evidence refers to the basis for belief or disbelief; it tells of proven facts/knowledge on which a belief is based. Through the Mental Health Coalition – Sierra Leone which also doubled as mhLAP’s stakeholder’s council, the Ministry of Health and Sanitation, WHO Mission in Sierra Leone, Building Back Better Project, experts from Ibadan, Nigeria and other mental health development partners, the mhGAP Intervention Guide Manual (Version 1.0) was contextualized and in subsequent sessions trainers were trained for its rollout. Key participants were medical doctors, pharmacists and other senior health care providers.

The impact of this training was not restricted to addressing the human resource gap but also had an effect on the perspectives of non-mental health care providers who use to hold the concept of: “not a hospital sickness” or “it is not an illness for the hospital” and would rather refer to traditional or faith healers after conducting physical examinations on patients because their ability to check for mental health problems were weak. mhLAP helped redefined the faulty social construct on mental health issues as it was the cause for the corresponding faulty social approach to care.

Additionally, mhLAP trained key stakeholders for effective campaigns at all levels. Up until 2017, there was only one psychiatrist in country for a population of about six million. This was not only due to the weak political will but also a false information maligning the practice and claiming that once an individual becomes a worker, that individual must consider him/herself already mentally ill. 

mhLAP’s annual Leadership and Advocacy training and workshop influenced the change of the status quo as the present psychiatrist in the country was motivated to specialize in psychiatry during his training in Ibadan, Nigeria. The 22 Sierra Leoneans who benefitted from this training are also strong advocates who have contributed to the present enabling environment in the country.

Key campaign achievements includes:

  • The launching of the Mental Health policy in 2011 and subsequently 2019
  • Developing annual operational plans to translate policies to action
  • A lobby to review the mental health act with support from WHO for their technical and financial support
  • Successful implementation of the "no restraining policy" at the Sierra Leone Psychiatric and Teaching Hospital, a key impact of the Quality Right Study and training
  • Establishment of a directorate and recruitment of a national coordinator for mental health

WHO’s 2002 survey after Sierra Leone’s ten year long civil war shows the increased burden of mental health disorder in the country and government’s weak response. The subsequent Ebola Virus Disease Outbreak and the Mudslide and Flash Flood Crisis also took the country unprepared, but for the intervention of mhLAP, CBM's Enabling Access to Mental Health programs, WHO and many other development partners, we are slowly able to bring key actors together to make a meaningful transformation in improving the way mental health is approached and delivered in the country.

Cover image: Sierre Leone's Country Facilitator briefs the Director and the National Mental Health Coordinator on mhLAP next steps © Mental Health Leadership and Advocacy Programme.

Families and carers
Minority populations
Primary care
Specialist care
Human rights
Empowerment and service user involvement
Detection and diagnosis
All disorders
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