Innovation summary

In Sierra Leone, mental health services are limited and outdated, despite the great need for mental health care.  For example, there is no working psychiatrist, and the first psychiatric nurses in the country were only trained recently. People with psychosocial disabilities are often ostracized from their communities, and human rights violations are common.1

The Mental Health Coalition - Sierra Leone (MHC) was established to work towards raising the profile of mental health in Sierra Leone, to advocate for improved access to mental health services, and to improve the quality of life of people with psychosocial disabilities.

The programme is innovative in its bottom-up approach to identifying stakeholders, and creating structures that allow people with psychosocial disabilities to provide an authentic voice for the first time. Though supported by external partners initially, the programme has been led in a unique direction by its members, and established itself as an important organisation facilitating the strengthening of mental health care and social protection in the country.

Impact summary

  • 48 members representing 23 organisations (local and international NGOs, government bodies, service providers), including 27 (ex)-service users and family members
  • 3 annual National Mental Health Conferences hosted with 415 national and international delegates attending over 3 events
  • $111,338 USD (100,000 Euro) funded over 5 years 

“You see, the Mental Health Coalition has actually injected fresh blood into activities of mental health in Sierra Leone”

– Government Official

Innovation details

In response to the ongoing challenges in mental health in Sierra Leone, the Mental Health Coalition-Sierra Leone (MHC) was founded in August, 2011. A national consultative meeting was facilitated for individuals and organizations directly or indirectly affected by mental health issues.2 It was at this meeting that these stakeholders agreed that there was a need to confront the ongoing mental health issues in Sierra Leone. A three day training workshop followed, coordinated to prepare interested stakeholders for the founding of the MHC. An Executive Committee (EXCO) was elected by attendees and the MHC was born.

The MHC’s stated purpose is to create a national body that empowers stakeholders to advocate for their needs, thus raising the profile of mental health in Sierra Leone. Since its inception, the MHC has actively developed as an advocacy movement with a constitution highlighting the organization’s goals:

  • Advocate with government bodies to pay more attention to mental health issues and work systematically to improve services for people with mental illness
  • Coordinate activities between NGOs and governmental agencies, allowing space for and facilitating networking
  • Empower stakeholders, particularly service users so that they can clearly voice their own priorities
  • Spread awareness about mental health and promote mental health in the general population
  • Support the empowerment of service users in Sierra Leone
  • Act as an advisory and monitoring body for the national mental health programme (strategic plan implementation, implementation of this project), and for other organisations requiring advice and information on mental health issues in Sierra Leone

The MHC has since matured and is now seen as the main reference point for mental health in the country. Within the MHC itself, there are subcommittees addressing: special events, research, medicines, training, awareness raising, WHO’s QualityRights Tool Kit,3 legislation and, most recently, Ebola. Regular quarterly meetings take place with all members to share the progress of the subcommittees. Annual meetings also take place to review the Terms of Reference, to build organizational capacity and to elect EXCO members. In 2012, the MHC registered as a non-profit organization with the Government of Sierra Leone and is now able to independently run programmes.

From the time of the MHC’s launch in September 2011, the group has made significant progress in its aims. Under the group’s influence, key national mental health milestone have been achieved, including: launching the National Mental Health Policy,4 integrating mental health into the national Poverty Reduction Strategy Paper (PRSP) II: Agenda for Prosperity and establishing a national Mental Health Steering Committee at the Ministry.

During the Ebola disease outbreak (2014-2015), the MHC demonstrated the ability to support Government initiatives during challenging times. The MHC became one of the key partners of both the Ministry of Health & Sanitation and the Ministry of Social Welfare, Gender & Children’s Affairs in advocating for the inclusion of a mental health & psychosocial support activities within the broader emergency response. Together, with government, the MHC Ebola Subcommittee coordinated new initiatives with resources already available in country while promoting the inclusion of psychosocial care in the country’s emergency recovery phase plans.    

Key drivers

Technical and Financial Support

  • The MHC originally was founded as part of the Enabling Access to Mental Health in Sierra Leone programme. It also receives funding as part of the CBM/University of Ibadan mhLAP programme. Being part of these 2 programmes has provided the MHC with the technical and financial support to develop as an organization. 
  • From the beginning, both programmes have been clear about how long they could offer financial support. This transparency has allowed for the MHC to plan for their own fundraising and ensure long term financial sustainability

Diverse Membership and Growth

  • A diverse membership includes traditional healers, (ex-) service users & family members, thus drawing support from a broad range within the community
  • The structure of the organization allows for feedback from its members thus creating opportunities to represent their concerns
  • The MHC took a step-by-step approach to growing as a group

Note: These drivers and challenges are based on research carried out by the MHC with CBM

Challenges

  • Local cultural beliefs about mental health create challenges in raising awareness and advocacy
  • Freetown based, making it a challenge to accurately represent mental health stakeholders nationwide (though efforts are in place to change this)
  • The Ebola Virus Disease epidemic has created a challenge in continuing regular meetings and activities
  • Increasing the proportion of members who are themselves services users has been challenging, in part due to self-stigma that tends to reduce their confidence to speak and identify publicly as service users

Continuation

Plans are in place to scale up membership of the Coalition nationwide. This is likely to happen during a second phase of the Enabling Access to Mental Health programme, and will depend upon the country’s recovery after the Ebola Virus Disease outbreak. 

Specific focus will also be put on strengthening the voice of service users themselves.

It is likely that after the Ebola crisis, there will be a need for mental health and psychosocial support programming, which the Coalition will support.

Partners

Funders

Evaluation methods

The project was evaluated with a qualitative study: Factors for Success. The aim of Factors for Success study was to investigate factors associated with successful mental health advocacy in a low-income country (Sierra Leone) using community-based participatory research (CBPR) methodology.

Focus groups were held with mental health stakeholders, and key informant interviews were conducted with advocacy targets. The data was analysed collaboratively using qualitative data coding techniques informed by Grounded Theory. The analysis unpacked a series of successes and challenges of the MHC’s advocacy efforts, factors contributing to both outcomes, and environmental factors that relate to mental health advocacy in Sierra Leone.

The Factors for Success final report is included in the Resources section under Reports. It highlights the study’s findings in depth.

Cost of implementation

Total direct cost of MHC: Approximately $111,338 USD (Euro 100,000) over 5 years.

There is significant added value to this due to the voluntary work done by members and in-kind support for office space. The MHC has also started to raise funds independently. For example, the MHC raised funds for three conferences, which were not funded by external donors.

Impact details

Some of the successes that would not have taken place without the MHCs influence include:

  • Promoting the launch of the National Mental Health Policy4
  • Establishing a national Mental Health Steering Committee in the Ministry of Health and Sanitation
  • Integrating mental health into the national Poverty Reduction Strategy Paper (PRSP) II: Agenda for Prosperity
  • Holding annual conferences bringing together stakeholders from within the country, and international participants
  • Hosting 4 annual World Mental Health Day events with an average number of 150 individuals participating

An additional success is that the Mental Health Coalition’s Research Sub-Committee was formed in 2013. Within the Coalition, the Sub-Committee supports capacity building in research methods and uses opportunities to gain experience by conducting research within the Coalition’s areas of interest.  The Sub-Committee’s focus is on community-based participatory research and action research. It supports training sessions, research involvement, and mentorship of its members as well as development of research questions for the EXCO. The Research Sub-Committee has received financial support from CBM International and research advisory support from Dr Julian Eaton.

During the Ebola Virus Disease outbreak of 2014/2015, the Coalition was a central reference point for the many new organisations coming to Sierra Leone for mental health and psychosocial support (MHPSS) work. They were able to support efforts at coordination of the emergency response in MHPSS, and were officially represented in cluster meetings.

References

  1. WHO ProMIND Report for Sierra Leone, Accessed: June 10, 2015
  2. Consultative Meeting Report, MHC Sierra Leone, 2011, Accessed: June 10, 2015
  3. WHO QualityRights Tool Kit, Accessed: June 10, 2015
  4. Mental health Policy for Sierra Leone 2010-2015, Accessed: June 10, 2015
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Country

Sierra Leone

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