Connecting People in Sierra Leone
It is estimated that around four out of five people experiencing mental health problems in low and middle-income countries do not receive any formal support. In Sierra Leone the mental health treatment gap is estimated at over 95%. The limited capacity of mental health services in Sierra Leone has been compounded by the effect of the Ebola outbreak; the nature of the virus caused communities to mistrust health services and broke down social supports.
This study aimed to promote resiliency and recovery from mental distress using core strategies that foster social participation through interpersonal and communal trust. By providing mental health workers with training to enhance knowledge and skills of mobilising existing social networks, this project uniquely addressed the challenges of resource-limited care in Sierra Leone.
The Connecting People model was adapted to address the unique challenges facing Sierra Leone during the Ebola outbreak. An intervention model and training programme was developed, Sababu, meaning 'connections that may bring benefit'. A key aspect of the study was engagement with local stakeholders throughout the research design and implementation, thus enhancing long-term sustainability of its outcomes.
First, a feasibility and acceptability study examined stakeholder perceptions using brief ethnographic methods.
Second, the evidence base and feasibility findings were modelled and validated in focus groups with Sierra Leone stakeholders and members of the UK Diaspora community.
Third, a pilot study assessed the impact of the adapted intervention on district level mental health nurses’ knowledge, skills, attitudes, and behaviour using qualitative data and a training evaluation tool developed co-productively with stakeholders. The intervention model endured several iterations as the context in the country changed due to the Ebola outbreak.
The pilot study found improvements in the nurses’ skills of communicating and building relationships with service users, identifying assets and linking to community resources. Barriers such as stigma, reluctance to change from district health managers and policy makers, and significant financial and time constraints to embed the model into nurse practice were identified.
This study suggests that it is important to harness local understanding of mental disorders, build capacity of the existing workforce and enhance community engagement with services for mental health social intervention strategies to be effective.
The study was undertaken by Meredith Fendt-Newlin and supervised by Professor Martin Webber (University of York).
Partners in this study included the King’s Sierra Leone Partnership, King’s College London and Enabling Access to Mental Health Sierra Leone.
Funding was provided for this study in part by the International Centre for Mental Health Social Research, University of York; Wellcome Trust through the Centre for Chronic Diseases and Disorders at the University of York; the Maudsley Charity; the American Association for University Women and the Centre for Learning and Teaching, University of York.
Fendt-Newlin, M. & Webber, M. (2015). Effectiveness of knowledge translation of social interventions across economic boundaries: a systematic review. European Journal of Social Work, 18(4), 543-568.
Fendt-Newlin, M. & Webber, M. (2015). One size does not fit all, but we can offer a framework for alterations: tailoring mental health social interventions for diverse contexts. Forum, 39, 20-21.
Fendt-Newlin, M. (2015) ‘As Sierra Leone waits for Ebola all-clear, its emotional scars will take longer to heal’, The Conversation: 26 August