Sierra Leone not long ago still chained mental health patients. A transformation is underway

Abdul Jalloh was the only practicing psychiatrist in Sierra Leone when he took over the country’s sole psychiatric hospital on the outskirts of the capital. Now six years later, the young doctor is leading a transformation of mental health services in the West African nation.

He abolished the practice of chaining patients to their beds, and has worked hard to attract new talent with the help of a U.S.-based nonprofit that has invested millions of dollars, along with Sierra Leone's government.

The hospital now has three fully qualified psychiatrists and seven doctors in a new residency training program, the first in the country’s history. The hospital has also added nine specialized mental health nurses, along with addiction professionals, clinical psychologists and occupational therapists for a total of 135 staff.

During a recent Associated Press visit, an Afrobeats song played during a young men's football game in the courtyard. All were patients, many undergoing treatment for drug addiction.

The scene would have been unthinkable before Jalloh took over.

The hospital was once known among locals as the “Crase Yard," or yard for crazy people. Now it's known as the Sierra Leone Psychiatric Teaching Hospital. It has helped give the facility, the oldest of its kind in sub-Saharan Africa, a new reputation.

“We have been able to change the face of this infrastructure,” Jalloh said in an interview. “From a place that people were ashamed to bring their family members, a place that even health workers were afraid to come and work ... to a place that the country is proud of.”

The transformation has been backed by the U.S.-based health nonprofit Partners In Health that has invested millions in rehabilitating the hospital including providing training, equipment and services. A new building opened in mid-June as a rehabilitation center for drug users.

But there is little professional medical help for those living in the rest of the country beyond Freetown. The Ministry of Health established units for mental health in all 14 districts of the country almost a decade ago, but few function as intended due to a lack of trained staff and other resources.

Many people still go to traditional healers or religious figures for help, as many mental health conditions are associated with spiritual or demonic forces.

Sierra Leone's population is still scarred from a more than decade-long civil war that began in the 1990s. Widespread unemployment, poverty and other hardship also takes a toll on mental health, helping to contribute to soaring rates of addiction to a locally produced drug known as kush.

There are also wider systemic challenges to mental health services.

Joshua Abioseh Duncan, the head of the Mental Health Coalition of Sierra Leone, a group that advocates for mental health, said the long overdue review of the country’s 1902 Lunacy Act that stigmatizes mental health issues — and strips people of basic rights — is contributing to the low level of funding and resources.

“The current law treats people with mental health issues as deviants in society who should be kept out of sight,” he said.

Few medical students in Sierra Leone consider psychiatry because of the lack of training opportunities and the limited earnings associated with the career, he added.

The government is taking some steps in coordination with international organizations. The health ministry is implementing a World Health Organization training program that aims to help healthcare workers identify and manage common mental health problems like depression, substance abuse and post-traumatic stress. The first 50 workers took the four-day course in June.

Sierra Leone’s director of mental health at the ministry declined to comment to the AP.

“Transforming mental health is a long game, it takes time,” said Giuseppe Raviola, a director at Partners In Health, which also set up a mental help line in Sierra Leone last year for counseling and advice. “Part of what takes time is not only building local capacity, but also making sure services are aligned with cultural beliefs and practices, and that things are driven locally.”

Jalloh first came to the psychiatric hospital for training during his fourth year of medical school and was shocked by its conditions.

He told his friends he would become a psychiatrist, which they thought was a joke. The profession is known to make little money and often fails to treat its patients. But after three years, he returned to the hospital and vowed to turn it from a place of suffering to sanctuary.

Despite the transformation of the hospital, Jalloh said soaring rates of addiction had taken a toll on his own mental health. The hospital continues to face challenges including a lack of security personnel to stop patients from scaling the walls to buy drugs.

“As you can see me, I am not feeling well. There are a lot of challenges. We don’t have the capacity to handle the (kush) crisis, considering human resources, infrastructure, medication,” he said. “It’s a big challenge and a huge burden on us.”

___

Associated Press writer Jessica Donati in Dakar, Senegal, contributed to this report.

___

The Associated Press receives financial support for global health and development coverage in Africa from the Bill & Melinda Gates Foundation Trust. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.