Living with mental illness has been a harrowing ordeal for Safiatu Kondeh. The 34-year-old, who lives in Kabala, northern Sierra Leone, with her mother and two children, has had to endure conditions almost worse than the disease.

Starvation, abuse, shackles, homelessness, and a series of costly yet ineffective traditional remedies were Safiatu’s daily realities for more than a decade. Save for a brief stint in Guinea during which she was treated with psychotropic medication, she says, the experience has been unremittingly traumatic.

“My greatest fear is of a relapse,” she says.

Mental health services are limited in Sierra Leone and largely centralized in the capital, Freetown. There are only five psychiatrists in the country with a population of 7.5 million people.

There are many misconceptions around mental health disorders in the country. The causes of the illness are often attributed to sorcery, family curse or strife, with many blaming the illness on the deeds of those afflicted.

World Health Organization (WHO) is supporting the Government of Sierra Leone through the Ministry of Health and Sanitation to replace the 1902 Lunacy Act with a Mental Health Act that addresses contemporary mental health issues. The WHO Mental Health Action Plan 2013-2030 highlights the steps required to provide appropriate interventions for people with mental disorders including depression.

“Negative attitudes towards people living with mental illness, perpetrated mostly out of ignorance, are leading to massive neglect, abuse and stripping people of their dignity and fundamental human rights,” says Dr Steven V. Shongwe, WHO Representative in Sierra Leone.

For those who push past the stigma to seek treatment, traditional medicine is often the first recourse. Public confidence in traditional healers is high. But the practice of traditional medicine is unregulated, leaving patients vulnerable to unscrupulous providers.

“Some [traditional healers] feign the power to cure by administering conventional psychotropic drugs acquired from unofficial channels to their unsuspecting patients,” says Susan Arthurtina Stephen, a mental health nurse at the Kabala Government Hospital.

Nurse Stephen is now supporting Safiatu and others in the district with mental health services, provided through the Mental Health Coalition of Sierra Leone, one of the civil society advocacy groups working to transform mental health services in the country. The Coalition augments the psychosocial services it provides with livelihood support to people recovering from mental illness.

“Mental health response requires supporting service users to reintegrate into society and productively contribute to their communities. This helps restore their dignity and change the perception about mental illness and the recovery process,” says Joshua Duncan, Country Director of the Mental Health Coalition. “We do not want our beneficiaries to be seen as burden on their families and the community after recovery.”

Fina Marrah, a mother of two who lost her husband in 2018 during the mudslide disaster in the capital Freetown that claimed hundreds of lives, suffered deep distress that led to deep depression and anguish.

Like Safiatu, Fina and many others who recovered following the psychosocial support provided by the Mental Health Coalition, are being trained in livelihood skills to support themselves and families. The two are using the sewing skills and machine they were offered to generate income. For Safiatu, the ambitions for her children hearken back to her own struggles.

“My greatest wish is for them to be educated to provide mental health care to people suffering from the condition,” she declares.