By Bai-Bai Sesay, Freetown, Sierra Leone.
Sierra Leone, like all other nations in the world, will be observing World Mental Health Day and the theme for this year is "Dignity in mental health."
World Mental Health Day was first celebrated in 1992 as an initiative of the World Federation for Mental Health, a global mental health organization with members and contacts in more than 150 countries.
Each year on October 10, thousands of supporters celebrate this annual awareness programme as an important programme bringing attention to mental and psychological illness and its major effects on people’s lives worldwide.
Today, thousands of people with mental health conditions around the world are deprived of their human rights. They are not only discriminated against, stigmatized and marginalized but are also subjected to emotional and physical abuse in both mental health facilities and the community. Poor quality care due to a lack of qualified health professionals and dilapidated facilities lead to further violations.
This year, we are expecting WHO to raise awareness of what can be done to ensure that people with mental health conditions continue to live with dignity through a human rights oriented policy and law, training of health professionals, respect for informed consent to treatment, inclusion in decision-making processes and public information campaigns.
In some countries, this day is part of the larger mental illness awareness week. The reality is that financial and human resources allocated for mental health are inadequate especially in low resource countries. The majority of low- and middle-income countries spend less than two percent of their health budget on mental health.
Many countries have less than one mental health specialist per one million population. To make matters worse, even a considerable part of the limited resources is never spent on large mental hospitals but rather on services delivered through community and primary health care.
Countries need to increase investment for mental health and to shift the available resources towards more effective and more humanitarian forms of services.
In the case of Sierra Leone, mental health workers are very few with a single psychiatrist, two psychiatric nurses, and a handful of social workers and counsellors. There is therefore a desperate need for more mental health workers in Sierra Leone, but the situation is compounded by the fact that it is extremely difficult to recruit students into psychiatry which is frowned upon and stigmatised in all African countries.
With a decade of one of the most brutal wars ever and the Ebola outbreak, Sierra Leone is facing an unprecedented mental health ’crisis’ with thousands of trauma cases across the country.
In an exclusive interview with Sierra Leone’s sole psychiatrist, Dr. Edward Nahim (pictured), he explained that due to the past civil conflict and the Ebola outbreak in Sierra Leone, mental health has caused serious psychological problem like traumatic stress disorder, depression, drug abuse, poverty, discrimination, stigmatization. These, he said, might increase the level of mental problems, lawlessness in Sierra Leone.
He noted that mental Health remains a public health concern in Sierra Leone and appropriate needs and resource assessment need to be created as a turning point.
The consultant psychiatrist said the main goal is to establish substantial data to allow for future planning for comprehensive mental health delivery.
"Mental health problems fall into two main categories with a certain overlap", he explained.
"The first category," he said, includes traditional mental health/psychiatric problems seen in any country, rich or poor and in peace or conflict.
"The second group includes special problems related to conflict, post conflict context with exposure to potentially traumatic events and lack of protective factors to contain these events due to severe social distress caused by poverty, general hardship, bad nutrition and physical health problems," he added.
Based on a joint Ministry of Health and Sanitation and WHO survey, Dr. Nahim says in Sierra Leone "more than 700,000 people are with severe mental health problems needing medical treatment, there are more than 350,000 psychotic patients induced by drugs and alcohol abuse as well as by severe infections like cerebral malaria, more than 20,000 with severe bipolar manic depressive disorders. More than 175,000 are mentally retarded and more than 175,000 epileptics and schizophrenics.
Dr. Nahim noted that the present decentralization of the health sector in the country is “one step forward,” explaining that “mental health would be one of the major beneficiaries”.
The efforts being made by the health ministry, with the country office of the WHO undertaking a completion of the national mental health policy and putting in place a Human Resources Development plan is something to be commended”, the doctor observed.
"There are a lot of psychiatric or health issues that need urgent attention, but the existing facilities in the country cannot cope with them as up to 80% of the hospitals and health centres were destroyed by the rebels," Abu Bakarr Sankoh, a former student at the College of Medicine and Allied Health Sciences opined.
"Most people are either direct victims of the war or have witnessed atrocities committed on their loved ones; also, most of those who are rape victims and limb amputees have been left with psychological trauma which may be with them for the rest of their lives," the former student said, pointing out that “the bulk of the population has suffered various psychological illnesses and disturbances caused by post-traumatic stress disorder in the country. And the recent Ebola outbreak in the country is another factor that caused serious psychosocial problem.
"Can you imagine? There are lots of psychiatric patients roaming the streets, but nobody cares about them because there are insufficient drugs in the hospital, " a psychiatric nurse at the Kissy psychiatric hospital added.
Abdul Nahim Koroma, community Psychiatric nurse, confirmed that drug abuse is now on an increase among the youths adding that “drug abuse has serious repercussions on mental health in the country.
The most commonly abused drugs in our country are Marijuana (Diamba) cocaine “Brown Brown” etc. As a result of the abuse of these drugs, psychiatrists are now in high demand,” Koroma revealed.
He attributed the past rebel war and the Ebola outbreak as a contributory factors to the current health situation. Many residents were victims, perpetrators and/ or witnesses of the brutal and gruesome events of the war. It is undeniable that some people may now use illicit drugs to drown their sorrows but, he said, that psychoactive drugs will only worsen rather than better the trauma or guilt.
Cannabis, the popular name given to the leaves, resin and flowers of the cannabis sativa plant has psychoactive chemicals. There are different preparations of the plant resulting to various names --- Marijuana (leaves); hashish (resin); sensemilla (female flowers) and cannabis oil (alcoholic extraction of the resin).
The plant has 60 cannabinoids (chemicals) with a different proportion to the different preparation but the most potent one is the THC (tetrahydrocannabinol). The new hybrids of cannabis such as skunk, big bang, white widow etc have high levels of THC.
Sierra Leone with an approximate population of more than six million or more has people with psychosis (2%); depression (4%); substance misuse disorder(4%);learning disabilities(1%) and epilepsy(1%).
In a brief chat, a mental health patient, who prefers anonymity, explained that some of the social problems in post war Sierra Leone and that of the Ebola outbreak are that “the dignity of many people with mental health conditions is not respected. People with mental health conditions around Sierra Leone and the world in particular experience stigma, discrimination and wide-ranging violations which strips them of their dignity.
The mental health patient who has recovered from the illness further said that many of this mental health people are subjected to physical, sexual and emotional abuse and neglect in hospitals and prisons, but also in the communities.
This is a serious problem, because they need the help of psychiatrists to help combat some of the social problems which emanated from trauma of war and the Ebola outbreak in the country, he concluded.
The majority of Sierra Leoneans neglect people with mental health conditions and these mental health patients are not in any way respected and they experience deprivation of dignity in a variety of ways.
In his words, a father whose son is faced with mental health condition says any person with mental health problems seriously faces high levels of stigma and discrimination.
"They are tagged as having a mental health problem, they experience social deprivation, lose their jobs, lose social prestige and become isolated from their families and societies, " he said.
But how can the government authorities solve this problem of stigmatization and discrimination in order to promote the rights and dignity of people with mental health conditions in the country?
Dr. Nahim says in the health-care system, the health ministry needs to provide better support and care for people with mental health conditions by providing community based services, respecting people’s autonomy, including their right to make their own decisions about their treatment and care and ensuring access to good quality care which promotes human rights.
When asked what the World Health Organisation is doing to promote dignity with mental health conditions globally, Dr. Nahim says WHO is committed to ensuring that the dignity of people with mental health conditions is respected around the world.
But a retired civil servant, Abu Kamara, is of the opinion that the dignity of many people with mental health conditions is not respected.
He said people with mental health conditions around the world experience stigma, discrimination and wide-ranging violations which strips them of their dignity among other abuses.
Article 1 of the Universal Declaration of Human Rights affirms that: “All human beings are born equal in dignity and in rights”
The Preamble of the UN Convention on the Rights of Person with Disabilities states that: “...discrimination against any person on the basis of disability is a violation of the inherent dignity and worth of the human person”
Abu Kamara pointed out that this UN Declarations are just on paper, not applicable or implemented in Africa especially in Sierra Leone.
"If you have mental problems, you are labelled. At home, you have got a label and you are labelled in the system, so there is not a great deal of dignity for you, " he pointed out.
Here is a short video clip of the Kissy psychiatric hospital in the capital of Sierra Leone, Freetown:
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