Mental illness a crisis in Sierra Leone

Tall concrete walls topped with spiralling razor wire and pointy shards of glass enclose a crumbling dark concrete building on a narrow and busy Freetown street. On the other side of the heavy blue doors a woman sits on a hard step repeatedly combing her grey hair, a man with a sad face is resting his elbows on his knees; chains are wrapped around his ankle.

It doesn’t look like a sanctuary but it is considered a safe place, a refuge for those battling mental illness in Sierra Leone. Patients can either be admitted to the country’s only psychiatric hospital or they can come here to City of Rest. It is a privately- run care and rehab center started by a Christian Pastor who had a calling to serve.

Sierra Leone only has one registered psychiatrist and he has technically been retired for ten years. But Dr. Edward Nahim says the government keeps signing him on for one year contracts and he can’t refuse, simply because there is nobody else to replace him. The doctor has become legendary in the country. “Mental illness is the number one emergency facing the country,” he stresses.

In 2002, following the brutal civil war, the World Health Organization estimated up to 500,000 Sierra Leoneans suffered from some form of post traumatic stress disorder, depression, or substance abuse but 99.5% would never receive treatment. Finding a psychologist or even a psych nurse outside Freetown is pretty much impossible. Patients go to traditional healers and witchcraft doctors to seek treatment. Nahim says these groups are doing a great job providing support and counselling in communities where there are few places to turn. One man we interviewed at City of Rest says he doesn’t believe in witch doctors. He is here for his drug addiction and says those that go to traditional healers often come back with the same problems.

I ask about the chains around the one man’s ankle. The Pastor tells me it weighs the residents down and stops them from running away. He assures me they are never tied to the wall and it is for their own good. Padded restraints are not available here, and there are few pharmaceuticals.

A Canadian therapist, working in Freetown with groups like City of Rest, says while living conditions and chaining are unpleasant, the people running the facility truly mean good. The NGO she works for is helping to train more psych nurses and encourage better practices within care facilities and the hospital.

City of Rest has just acquired a new building with green space and more beds. It’s a step in the right direction in battling a problem that is only growing more dire.