World Mental Health Day was established in 1992 by the World Federation for Mental Health. In some countries around the world, it forms just one part of the larger mental illness awareness week.

Mental health problems, ranging from issues like depression and anxiety disorders to conditions like schizophrenia, affect millions of people around the world. In fact, according to current statistics, 1 in 4 people will experience some kind of mental health problem during their lifetime and many more will see friends of family members affected.

The purpose of world mental health day is to raise awareness of mental health issues, increase education on the topic and attempt to eliminate the stigma attached. It is hoped that this, in turn, will encourage sufferers to seek help and support.

Mental health in the workplace is the theme of world mental health day 2017, with the overall objective of raising awareness of mental health issues and mobilizing efforts in support of better mental health.

In the case of Sierra Leone, mental health workers are very few with a single psychiatrist, few 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 stigmatized in all African countries.

In an exclusive interview with Sierra Leone’s sole consultant psychiatrist, Dr. Edward Nahim, he explained that one million Sierra Leoneans are suffering from mental illness and need treatment with traditional healers, churches and mosques and hospitals and clinics.

He said drug abuse is a serious problem leading to mental illness. Marihuana (jamba) is grown nationwide and widely abused and exported. Heroin (brown brown) forms the golden triangle of Laos, Burma, Cambodia and cocaine from South America transits through Freetown to Europe and America. Some of these drugs stay in Freetown and abused. Drug abuse is out of control.

He also explained that due to the past civil conflict and the Ebola outbreak in Sierra Leone, mental health has caused serious psychocological problem like traumatic stress disorder, depression, drug abuse, poverty, discrimination, and 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 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.

Dr. Nahim mentioned 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,” Alusine Bangura, 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.

He pointed 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 Ebola outbreak in the country is another factor that caused serious psychosocial problem.

“Can you imagine? There are lots of psychiatric patients roaming on the streets, but nobody cares about them because there are insufficient drugs in the hospital”, a psychiatric nurse at the Kissy mental hospital added.

Abdul Nahim Koroma, community Psychiatric nurse, confirmed that drug abusers are 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 mental health status quo. 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 adding that psychoactive drugs will only worsen rather than better the trauma or guilt.

Sierra Leone with an approximate population of more than seven 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. Majorities of Sierra Leoneans neglect people with mental health conditions and this mental health people in any way are not respected and they experience deprivation of dignity in a variety of ways.

In his words, a father whose son 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-losing their jobs, losing social prestige and becoming isolated from their families and societies,” he opined.

But how can the government authorities solve this problems 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 need 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 and among others.