By Kemo Cham
Sierra Leone should consider incorporating alternative ways of treating mental illness, an uncharted health crisis in the country, an expert has warned.
Clinical Art Psychotherapist, Amelie van den Brink, said a lack of political will to tackle mental health, which is relegated to the bottom of the healthcare priority, is worsening the situation for the country struggling to deal with recurrent traumatic events – war, epidemic and natural disasters. Alternative therapies like art, music and dance, she said, could be useful treatments for the myriad of people who have been affected by these events.
“The world over, treatment of mental issues have gone beyond just talk therapy. It’s not always that people can talk about their feelings, and art being a non-intrusive approach, have the propensity to benefit everyone,” she said.
Art therapy is a form of psychotherapy that involves the creative process of art making to address various types of mental issues.
A Dutch-Burkinabe, Van den Brink was raised in a village in Burkina Faso for the first 10 years of her life, before relocating to the US where she went through the US International school system and did her BA and Master’s degrees in Psychology. She said the [1991-2002] civil war, the 2014-2016 Ebola epidemic, and last August’s deadly flooding and mudslide disasters have all left in their wake a lot of people vulnerable to mental health issues in Sierra Leone.
Van den Brink first came to the country in 2015 when she was involved with the Ebola epidemic response. Working alongside an Israeli-based NGO, she helped provide psychosocial support to survivors of the heamorrhagic fever disease which devastated part of the West Africa region. This was when she came across issues of mental health and realized how the sector had been neglected.
During that visit, Van den Brink co-authored an article with a local journalist after investigating depression in connection to the epidemic. Published on a local tabloid, Concord Times, that article revealed how survivors were battling the aftermath of the epidemic due to the absence of basic care.
Very recently, she spent six months in the country on a research mission on the collective identities of gender and disability movements, in light of the ongoing electioneering process. “You don’t have to look far…Even when people approach you, they don’t seem normal. It’s rampant. Cognitively there is something impaired. It is right at the door step,” she told me in an interview.
“When you don’t have political will, how can your people be well? If you do not invest in the treatment of their health, how do you expect anyone to be ok? If you don’t fix the sanitation, how do you expect to prevent the spread of diseases…? That, in itself, can produce a lot of mental instability,” she added.
The sight of mad people is a common phenomenon in the streets of Freetown, Sierra Leone’s capital: on the sidewalks, in the middle of the highways – they sit and lie in their piss and toilet.
It’s also common to see young men walking and talking to themselves on the streets. Until last year, Sierra Leone’s 7 million population relied on only one trained psychiatrist, Dr Edward Nahim, who up to 2016 estimated that at least half a million people had some form of mental illness.
He attributed this to substance abuses, in addition to the war and Ebola.
The war left multitudes of people in the country mentally incapacitated due to prolong exposure to hard drugs as young combatants.
And some 15 years after the war, drug abuse is still rampant. And Freetown is home to some of the cheapest alcoholic drinks, like mostly homemade gin and whisky, contained in sachets you can buy freely from the streets.
The Ebola epidemic killed over 11, 000 people mainly in the three neighboruing countries of Sierra Leone, Liberia and Guinea, with Sierra Leone alone accounting for about 4, 000 of the fatalities.
Nearly the same number of people survived the disease. The effect of the virus in survivors, plus the effect of losing loved ones and livelihoods as a direct result of the epidemic, culminated in a surge in the rate of people suffering from depression, anxiety and post-traumatic stress disorder.
The Sierra Leone Association of Ebola Survivors says many of its members battling trauma and other psychological breakdown resulting from their experiences have been left to fend for themselves.
In 2017, the World Health Organisation (WHO) estimated that some 240, 000 people in the country suffered from depression every year. The Sierra Leone Psychiatric Hospital, the only such facility in the country, is constantly overwhelmed by the inmate population. Located in the east end of Freetown, the center hardly provides services beyond a daily dose of antipsychotic drugs. Some reports indicate that doctors administer expired drugs to the inmates who are kept mostly chained.
The government recently announced some changes to the management of mental health, with the training of about two dozen nurses who were deployed at hospitals across the country under a WHO-aided programme.
But, said Van den Brink, part of the problem with the country is that the relevant officials are out of tune with the reality on the ground.
And that, she said, is why they are not putting enough money into the mental health sector. She said officials need to visit the psychiatric center to get the real picture of the situation.
Van den Brink also argued that the belief that people seen as beyond redemption, as is the case with many of the mad people found in the streets of Freetown, was an erroneous idea perpetuated by the ill-treatment of these people by society.
Like in almost all health and social issues, many Sierra Leoneans tend to rely on traditional healing measures, which often tend to add to the problems of the patients, mainly because of the unconventional and painful procedures they are subjected to.
Lack of psychosocial support adds to the problem. In Sierra Leone, psychosocial support is available only on short term basis, like during the immediate aftermath of disasters like was seen in the Ebola outbreak and the mudslide disaster.
Van den Brink said this reality calls for academic intervention. She said there was also the need for a whole lot of multidisciplinary team, including a dedicated core of social workers, psychologists, art therapists, as well as an inter-departmental engagement in the health and education sectors to raise awareness about mental health issues.
International bodies and NGOs also need to step up their game in helping in the sector, she added.
“We need to combine the qualitative and the quantitative measures to understand the problem,” she said. “Social workers play a big role. They interact with people a lot. Tap into that and start with them. All they need is opportunity, training and supervision.”