Abdul Jalloh, MD, MMed (Psych), PGDip, MSc, FCPS

As we reflect on #WorldMentalHealthDay, @AfricaCDC reaffirms that mental health is essential to public health and fundamental to human dignity. Across the continent, countries are working to reform outdated laws and strengthen mental health systems, ensuring that care protects the rights, inclusion, and well-being of all people. Together with @_AfricanUnion Member States and global partners, Africa CDC is advancing efforts to integrate mental health into national health priorities, building systems that leave no one behind. 💚 There is no health without mental health. #AfricaCDC #NewPublicHealthOrder

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Breaking the Silence: Voicing the Mental Health Challenges in Sierra Leone #SierraLeone, a country marred by the scars of civil war, the #Ebola epidemic, and, more recently, the #Covid_19 #pandemic, is grappling with a mental health challenge of urgent proportions. Despite efforts to rebuild its healthcare infrastructure, #mentalhealth remains one of the most neglected areas, with less than 1% of those affected receiving proper care. The time has come for Sierra Leone to break the silence surrounding mental health, confront the deep-rooted #stigma, and take decisive steps to address this pressing issue. A Country Facing Mental Health Challenges Sierra Leone's history of conflict and disease has left lasting #psychological effects on its population. The 1991-2002 civil war alone displaced thousands and left many citizens suffering from post-traumatic stress disorder (#PTSD). Similarly, the Ebola epidemic (2014-2016) exacerbated mental health problems, with survivors reporting 22% prevalence of #depression and 10.7% of #anxiety. These challenges have been compounded by #poverty, #unemployment, and limited mental health resources. The burden of mental health conditions in Sierra Leone is staggering. It is estimated that 715,000 people in the country suffer from mental health conditions, a number that continues to grow as issues like substance abuse worsen. Between 2020 and 2023, the Sierra Leone Psychiatric Teaching Hospital recorded 5,775 cases of #psychoactive substance abuse, with 91% of those affected being male and most under the age of 34. The use of "#Kush" and #Tramadol has surged, leading to more cases of substance use disorders and mental health conditions. A Need to Strengthen Mental Health System Despite the growing need for mental health care, Sierra Leone's mental health system remains critically underdeveloped. The country has only two psychiatrists serving over 8 million people. Mental health professionals, including clinical psychologists and mental health nurses, are in short supply, especially outside the capital, Freetown. Compounding the issue, many healthcare workers lack specialised training in mental health. Mental health services are further hampered by outdated legislation. The #Lunacy Act of 1902, still in effect, fails to address modern mental health challenges or protect the rights of those affected. While a revised Mental Health Act is in the pipeline, awaiting government approval, its delay continues to impede progress in service delivery. Stigma remains a critical barrier to accessing care. Many in Sierra Leone view mental illness as a sign of weakness, divine punishment, or spiritual possession. As a result, individuals with mental health conditions are often isolated, preventing them from seeking help. Traditional and spiritual healers dominate mental health care, but their practices are unregulated, sometimes causing more harm than good. The Global Context and National Response Mental health is not just a national issue but a global one. According to the World Health Organization @WHOSierraLeone, mental, neurological, and substance use #MNS disorders contribute to 10% of the total global disease burden and account for 28% of years lived with disability #YLDs. The WHO World Mental Health Surveys reveal a 76% to 85% treatment gap in low-income countries like Sierra Leone. However, Sierra Leone's response to the mental health crisis has been slow. The 2018 Mental Health Policy made strides in recognising the importance of mental health care, but the country continues to lag in implementation. With mental health accounting for less than 5% of the national health budget, there is a dire need for increased investment to address this growing challenge. Solutions for a Healthier Future To tackle the mental health challenges, Sierra Leone must implement a range of solutions outlined in the 2024-2030 Mental Health Policy and Strategic Plan. These include reforms to decentralise services, address the shortage of professionals, and reduce the stigma surrounding mental illness. A key recommendation from the WHO is to integrate mental health care into primary health care services, disease-specific programs (e.g. #HIVAIDS, #TB, #Noncommunicablediseases), and maternal and child health initiatives. Currently, mental health services are concentrated in Freetown, and community-based care is almost non-existent. By decentralising mental health services and training community health workers using the WHO's Mental Health Gap Action Programme (#mhGAP), Sierra Leone can make care more accessible, especially in rural areas. Task-sharing is critical—non-specialist health workers can be trained to provide basic mental health care and help close the treatment gap. Sierra Leone must expand its mental health workforce by investing in the education and training of new mental health professionals. Programmes like postgraduate psychiatry training have already begun, but more is needed. Partnerships with international bodies and institutions should be strengthened to provide more training opportunities for nurses, social workers, and psychologists. Furthermore, retaining skilled professionals will require better working conditions and clear career progression paths. The outdated Lunacy Act must be replaced with the revised #MentalHealthAct, which incorporates modern mental health care approaches and human rights considerations. This new law is expected to regulate traditional and faith-based healers and ensure that mental health care is provided in a dignified, rights-based manner. Legal reforms will also facilitate the inclusion of mental health services in universal health coverage and ensure access to psychotropic medications. Stigma and misconceptions are among the biggest obstacles to mental health care in Sierra Leone. The government, in collaboration with civil society organisations (CSOs), should prioritise nationwide anti-stigma campaigns that focus on public education about mental health conditions. Such campaigns should highlight the fact that mental illness is not a personal failing or spiritual curse but a medical condition that can be treated. The rise in substance abuse, particularly among young people, requires immediate attention. The establishment of drug treatment and rehabilitation centres and targeted interventions for youth are crucial. Addressing substance abuse will not only improve mental health outcomes but also reduce crime rates and boost workforce productivity. The mental health crisis in Sierra Leone demands urgent action. The country cannot achieve its development goals without addressing the mental health needs of its people. With the right investments in community-based care, professional training, legal reform, and public mental health awareness, Sierra Leone can break the cycle of #stigma and neglect. Now is the time to prioritise mental health as a critical component of national development and ensure that every citizen has access to the care they need. Let us break the silence on mental health and work towards a brighter, healthier future for Sierra Leone. Dr Abdul Jalloh @abdulpjalloh is a Consultant Specialist Psychiatrist and Hospital Care Manager at the Sierra Leone Psychiatric Teaching Hospital under the @mohs_sl Sanitation. He is also a @CheveningScholar (2021/2022) and a dedicated lecturer at the College of Medicine & Allied Health Sciences, University of Sierra Leone. In addition, Dr Jalloh serves as an Honorary Clinical Lecturer at the School of Health & Wellbeing, College of Medical, Veterinary & Life Sciences, @UofGlasgow, UK. sierraeyemagazine.com/breaking-the-s…

Our own Dr. Jalloh is proudly representing #MoH, @DembyAustin, @DrJalika at the ongoing @CarterCenter's Mental Health Program Review Meeting in Atlanta, in the #UnitedStates. Jalloh advocated for support to strengthen mental health care services in 🇸🇱. #WeWillBeatMentalHealth

Our latest publication! Identifying core global mental health professional competencies: A multi-sectoral perspective | Cambridge Prisms: Global Mental Health | Cambridge Core - bit.ly/49J1YMW

A fantastic evening to welcome back our #Chevening 22/23 scholars, along with #Commonwealth alumni. Their ambition to support the 🇸🇱 journey, act as "change makers" & work collectively to tackle some of the country's challenges is inspiring. We wish them every success!

The active engagement of the Lumley/Juba bridge community amplifies our collective efforts to tackle illicit drug use. Together, we can create a healthier society. @mohs_sl @DembyAustin @DrJalika @CharlesSenesie @MoiceComm #DrugFreeSierraLeone #CommunityEngagement

Happening now in the Kissy Community! We continue with the #CommunityEngagement to #educate our people on the harmful effects of illicit drug use/misuse with community stakeholders. Say NO to illicit drug use! Join us to tackle this problem! Thank you @DembyAustin @mohs_sl

@mohs_sl, under the leadership of @DembyAustin, partnered with @MoiceComm, NDLEA, and MoSW to tackle illicit drug misuse in Sierra Leone, focusing on community engagement. Join us on this journey to make a difference! @DrJalika @CharlesSenesie #CommunitySensitization

@michaelkanuSL @PresidentBio @UN Congratulations 🎊

An honour of a lifetime: It was a distinguished honour and great privilege to take formal leave of Sierra Leone’s Chief Diplomat, H. E. @PresidentBio following my appointment and approval as Permanent Representative of Sierra Leone to the @UN. His Excellency was gracious to me in the ceremony and also for the kind consideration, confidence and trust for the second time. For 5 years I served as Sierra Leone’s Deputy Permanent Representative for Legal Affairs at the UN, where, as part of the team, we delivered on President Bio’s commitments and promises to the people of Sierra Leone. As I received my charge, I committed to perform my representational functions with the utmost professionalism, dedication, loyalty, and diplomacy.

After completing my MSc Global Mental Health at the @UofGlasgow on a @CheveningFCDO , I was formally welcomed by @LisaJChesney, British High Commissioner to Sierra Leone. Thanks to @UKinSierraLeone. @CheveningAA @UofG_Alumni @AlumniLeone @pihsierraleone @mohs_sl

⁦@abdulpjalloh⁩ presenting @ #RCPsychIC on community mental health workers’ perceptions of depression and barriers to care. Well done! ⁦@rcpsych⁩ ⁦@rcpsychAfrica⁩

#RCPsychIC Lovely to finally meet ⁦@abdulpjalloh⁩ from ⁦@rcpsychAfrica⁩ … lots of shared learning with colleagues from Sierra Leone ⁦@rcpsychINTL⁩

At this year's #RCPsychIC, I presented my #UofG MSc #GMH research findings, shared experiences and established professional and social contacts. @rcpsychINTL @rcpsychAfrica @CheveningFCDO @UKinSierraLeone @CheveningAA @UofG_Alumni @UofGMVLS @UofGlasgow @pihsierraleone

@blackpsych_UK @NHS_ELFT @rcpsychGAP @gmcuk @ak411cam @seunranti @DrLisaK2021 RIP Dr Ademola

With great sadness, the warm & selfless Dr Ade Ademola aka PsychorBust died suddenly on 23 December. He will be profoundly missed by friends and colleagues. Our thoughts are with his family. RIP Ade ! @NHS_ELFT @rcpsychGAP @gmcuk @ak411cam @seunranti @rcpsychGAP @DrLisaK2021

@blackpsych_UK @rcpsychAfrica @Gl_Psych @rcpsychINTL @BlackInMH Thank you

Congratulations @abdulpjalloh on your MSc Global Mental Health @rcpsychAfrica @Gl_Psych @rcpsychINTL @BlackInMH

@pihsierraleone @wacpagsm2021 Amazing! It shows how far we have come to change the mental health narrative in Sierra Leone. Thanks @PIH @pihsierraleone and @mohs_sl for the partnership.

PIH Sierra Leone is thrilled at the news that the West Africa College of Physicians @wacpagsm2021 has formally awarded the Sierra Leone Psychiatric Teaching Hospital a full 5-year accreditation to roll out the first-ever psychiatry residency program in Sierra Leone.

@blackpsych_UK @rcpsychAfrica @rcpsychINTL @BlackInMH @BlackThrive @Gl_Psych Thank you @blackpsych_UK

#MakingaDifference #BHM @abdulpjalloh Consultant Psychiatrist at #SLPTH Freetown. Established first CAMH & Drug Treatment Services & changing narrative of mental health in #SierraLeone Int Associate @rcpsychAfrica @rcpsychINTL @BlackInMH @BlackThrive @Gl_Psych