Where there is no psychiatrist: A mental health programme in Sierra Leone

Abstract

Background. For most low- and middle-income countries, mental health remains a neglected area, despite the recognised burden associated with neuropsychiatric conditions and the inextricable link to other public health priorities.

Objectives. To describe the results of a free outpatient mental health programme delivered by non-specialist health workers in Makeni, Sierra Leone between July 2008 and May 2012. 

Methods. A nurse and two counsellors completed an 8-week training course focused on the identification and management of seven priority conditions: psychosis, bipolar disorder, depression, mental disorders due to medical conditions, developmental and behavioural disorders, alcohol and drug use disorders, and dementia. The World Health Organization recommendations on basic mental healthcare packages were followed to establish treatment for each condition. 

Results. A total of 549 patients was assessed and diagnosed as suffering from psychotic disorders (n=295, 53.7%), manic episodes (n=69, 12.5%), depressive episodes (n=53, 9.6%), drug use disorders (n=182, 33.1%), dementia (n=30, 5.4%), mental disorders due to medical conditions (n=39, 7.1%), and developmental disorders (n=46, 8.3%). Of these, 417 patients received pharmacological therapy and 70.7% were rated as much or very much improved. Of those who could not be offered medication, 93.4% dropped out of the programme after the first visit. 

Conclusions. The identification and treatment of mental disorders must be considered an urgent public health priority in low- and middle-income countries. Trained primary health workers can deliver safe and effective treatment for mental disorders as a feasible alternative to ease the scarcity of mental health specialists in developing countries.