In Sierra Leone, PIH provides mental health and substance abuse care during national emergency

In Sierra Leone, PIH provides mental health and substance abuse care during national emergency

As the synthetic drug Kush spreads across Sierra Leone, Partners In Health (PIH)-supported Koidu Government Hospital (KGH) continues to see an increase in patients seeking help for addiction. In recent months, many adolescents and adults have sought emergency care, mental health services, and other assistance because of the highly addictive drug, which is a mixture of drugs that includes cannabis, fentanyl, and tramadol, among others.

The rise in Kush use and drug addiction in general prompted the country’s president to declare a national state of emergency in April, leading to the creation of a national task force. At KGH, staff work together to holistically treat patients with co-occurring substance use disorders and mental health conditions, like Abdulai, 28.

While he was regularly consuming Kush, marijuana and alcohol, Abdulai’s behaviour began to change and he started having frequent seizures, which led to him being stigmatized by his community. The self-awareness led him to seek help for the first time in 2019. Since then, he has been receiving continuous care at KGH, the only public hospital in Kono Rural District.

“The hospital has provided me with counseling, consultations and psychosocial education. Every time I come to the hospital, my medications are available and free,” says Abdulai. “In addition to the medications, the psychoeducation, counseling and advice I receive are very helpful.”

Education is a powerful tool to raise awareness and reduce stigma around mental health issues and their treatment. Between hospital visits, a community health worker visits Abdulai at home to check on him and make sure he is doing well.

“The community health worker visits me twice a week and helps motivate and encourage me,” says Abdulai.

Many patients with substance use disorders have co-occurring mental health conditions, such as anxiety disorders or personality disorders, that also require treatment. However, having both a substance use disorder and a mental health condition does not mean that one causes the other, as the National Institute of Mental Health points out.

At KGH, 80% of patients receiving treatment for drug addiction are also diagnosed with a mental health disorder.

Intensive care, resources

The KGH Mental Health Unit addresses substance abuse, including kush use, by providing psychosocial education in the community while highlighting the harmful effects of substance use. In hospital, the unit uses an evidence-based program called Common Elements Treatment Approach (CETA), which combines treatments for many conditions, including depression, anxiety, substance abuse, trauma, and stress-related disorders. After assessing the patient’s symptoms, individual therapy is provided and, if necessary, medication is prescribed. At the same time, mental health is addressed through psychotherapy and social support, including transportation stipends, food to help with medication, and housing assistance.

In 2019, under the leadership of PIH, clinical psychiatrist Dr. Mawuena Agbonyitor trained Cathy Conteh, Community Health Officer (CHO) and other CHOs, who oversee the KGH Mental Health Unit, on the assessment, diagnosis and support of patients in mental health crisis. This training also extended to community health workers who began conducting outreach to identify individuals in need of mental health support. From 2019 to June 2024, patient care increased by 80% with a success rate of 70%. Success means that patients adhere to their treatment, are responsive to treatment and are successfully reintegrated into their families and communities.

Cathy Conteh, community health officer at PIH-supported Koidu Government Hospital in Kono District, Sierra Leone, March 18, 2024. Photo by Sabrina Charles/PIH

The current Kono District Mental Health Team comprises 14 community health workers and four community health workers, who support KGH and the Wellbody Clinic. The country’s first mental health helpline is run by a team of six, including two psychosocial rehabilitation technicians, an assistant and three counsellors. For substance abuse-related calls, the team uses the CETA approach and refers patients to the hospital for in-person treatment.

Dispelling myths and giving hope

One of the unit’s major challenges has been to change the misconceptions about mental health that exist in Sierra Leone. Many conditions are attributed to the belief that mental illnesses are caused by spiritual or demonic forces and cannot be treated in a hospital. Community engagement initiatives led by community health workers, including health talks, interactive radio programs, and informative media campaigns, aim to demystify mental health issues and promote hospital-based care. The health talks and outreach efforts create a space for community members to ask questions and serve as a referral pathway to the KGH Mental Health Unit.

Abdulai still sometimes faces stigma from his community, but he overcomes this by educating people about the facts about mental health.

“Friends who know about my illness help me recover. Since I learned to recognize the signs of mental illness, I encourage my friends who are struggling to go to the hospital or call the mental health helpline,” says Abdulai.

Stigma also persists for clinicians; yet staff remain committed to providing lifesaving care.

“Although I have been stigmatized for my work in this unit, I love changing people,” Conteh says. “Most of the time, when you see someone in crisis, you don’t know right away if the patient’s condition will improve with the medications they are given. But with ongoing monitoring and support, people can recover and thrive. That’s the best part about it.”

Conteh has seen firsthand, through Abdulai and others, how patients can recover. When she first met him, Abdulai was aggressive, violent and reluctant to talk to staff, Conteh says. Today, Abdulai calls Conteh for advice and support. “I’m proud of how far he’s come,” she says.

Reflecting on his experience with the mental health team, Abdulai says, “The mental health program is one of the best. Coming here motivates me and allows me to think clearly. I have a future now. I want to make music and become an artist.”