Sierra Leone is a country with an approximate area of 72 thousand sq. km. (UNO, 2001). Its population is 5.169 million, and the sex ratio (men per hundred women) is 97 (UNO, 2004). The proportion of population under the age of 15 years is 44% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 45% for men and 18% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 4.3%. The per capita total expenditure on health is 26 international $, and the per capita government expenditure on health is 16 international $ (WHO, 2004). The main language(s) used in the country is (are) English. The largest ethnic group(s) is (are) African. The largest religious group(s) is (are) Muslim, and the other religious group(s) are (is) indigenous groups and Christian. The life expectancy at birth is 32.4 years for males and 35.7 years for females (WHO, 2004). The healthy life expectancy at birth is 27 years for males and 30 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Sierra Leone in internationally accessible literature. Lacoux et al (2002) reported on the experience of 40 upper limb amputees (11 bilateral) with regard to stump pain, phantom sensation and phantom pain. All the patients lost their limbs as a result of violent injuries and were assessed 10-48 months after the injury. All amputees reported stump pain in the month prior to the interview and ten of the 11 bilateral amputees had bilateral pain. Phantom sensation was common (92.5%), but phantom pain was only present in 32.5% of amputees. Problems in translation and explanation may have influenced the low incidence of phantom pain and high incidence of stump pain. In the bilateral amputees, phantom sensation, phantom pain and telescoping all showed bilateral concordance, whereas stump pain and neuromas did not show concordance. There is one study on the problems of refugees from Sierra Leone living in camps in Gambia, which has been included in studies from Gambia.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is absent. A Mental Health Coordination Group has been formed with the participation of various stakeholders, e.g. inter-governmental organizations, NGOs and the Government. This group is chaired by the Ministry of Health and seconded by WHO. It is charged with the responsibility of developing a Mental Health and Substance Abuse Policy, a modern mental health legislation and national mental health programme including a plan of action for short and long term initiatives. It is also responsible for developing models for decentralized community-based services and human resource development for all levels of care.
Substance Abuse Policy A substance abuse policy is absent.
National Mental Health Programme A national mental health programme is absent.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is absent. Both, the national therapeutic drug policy and the essential drug list are in the process of being developed.
Mental Health Legislation The Sierra Leone Mental Health Act is present. Details about the year of enactment of the mental health legislation are not available.
Mental Health Financing There are no budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is tax based. The country does not have disability benefits for persons with mental disorders.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. Regular training of primary care professionals is not carried out in the field of mental health. There are no community care facilities for patients with mental disorders. Some traditional healers and general practitioners provide mental health care in the community setting.
Psychiatric Beds and Professionals
psychiatric beds per 10 000 population
beds in mental hospitals per 10 000 population
beds in general hospitals per 10 000 population
beds in other settings per 10 000 population
- Number of
psychiatrists per 100 000 population
- Number of
neurosurgeons per 100 000 population
- Number of
psychiatric nurses per 100 000 population
- Number of
neurologists per 100 000 population
- Number of
psychologists per 100 000 population
- Number of
social workers per 100 000 population
There are 200 psychiatric assistants.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in treatment and rehabilitation.
Information Gathering System There is no mental health reporting system in the country. Details about data collection system or epidemiological study on mental health are not available. The first Systematic Needs Assessment on Mental Health and Substance Abuse Survey in post-conflict Sierra Leone was undertaken in October 2002 with the support of WHO under the direction of the MOH. In the random sample, 2% of subjects had psychosis, 4% had severe depression, 4% had prominent substance abuse, 1% had mentally retardation and 1% had epilepsy. Almost 85% of the population never took alcohol (97% of secondary school students) and even fewer had experimented with/abused drugs.
Programmes for Special Population The country has specific programmes for mental health for refugees.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: phenobarbital, chlorpromazine, diazepam, haloperidol, biperiden.