Freetown, Sierra Leone, has long been synonymous with struggles surrounding mental health, but recent changes at the country’s only psychiatric hospital are beginning to rewrite this narrative. Dr. Abdul Jalloh, who once found himself shocked by the abysmal conditions of the Sierra Leone Psychiatric Teaching Hospital, has now devoted six transformative years to reshaping mental health services across the nation.
Taking the reins of this hospital, situated just outside of the capital, Dr. Jalloh commenced what many would call nothing short of a revolution. Chaining patients to beds—a practice deeply rooted in stigma and neglect—has been abolished. Where there once lurked despair and stigma, there is now hope. An Afrobeats tune fills the air, ringing out from the courtyard where young men, all patients, enjoy a football game. This is not merely entertainment; it represents the progress being made.
Once referred to colloquially as “Crase Yard,” or the yard for crazy people, the hospital has rebirthed itself as the Sierra Leone Psychiatric Teaching Hospital, gaining respect as a place of care and recovery. “We have been able to change the face of this infrastructure,” Dr. Jalloh noted during his interview. “From a place people were ashamed to bring their family members, to one the country is proud to have.”
This revamped reputation does not happen overnight; it has required significant investment and support, particularly from the U.S.-based nonprofit Partners in Health. Over recent years, they have pumped millions of dollars not only to renovate the hospital but also to train medical staff, purchase new equipment, and expand services. A new rehabilitation center for drug users saw its doors open just last month, highlighting the focus on addiction treatment as part of broader mental health care.
Despite these strides, the state of mental health care beyond Freetown remains bleak. Though the Sierra Leone Ministry of Health made attempts nearly ten years ago to set up mental health units across the nation’s 14 districts, very few offer the services they were intended to provide, often due to shortages of trained personnel and inadequate resources. A significant part of the country’s population continues to turn to traditional healers or religious leaders for help, reflecting enduring cultural perceptions linking mental illness with spiritual or demonic forces.
The scars left behind by over a decade of civil conflict also weigh heavily on the nation’s psyche. The lingering effects of the war, coupled with widespread unemployment and poverty, have exacerbated mental health issues, leading to high addiction rates, particularly to a locally produced substance known as kush. This drug crisis complicates the situation for mental health services. Dr. Jalloh acknowledges this burden: “There are many challenges... We don’t have the capacity to handle the kush crisis,” he admitted, succinctly summing up the obstacles still faced.
On the systemic front, mental health care has been stymied by outdated legislation. Joshua Abioseh Duncan, leading the Mental Health Coalition of Sierra Leone, points out how the 1902 Lunacy Act still casts shadows on how mental health is perceived and treated within society. “The current law treats people with mental health issues as deviants who should be kept out of sight,” he highlighted, linking this stigma with reduced funding and support.
The spotlight on psychiatry as a career also dims because of this stigma; few medical students venture down this path due to the lack of training opportunities and low financial returns. Yet, there are initiatives at play to change this. Coordinated efforts between the government and international organizations aim to revitalize mental health education. A recent World Health Organization program took the first steps toward training healthcare workers to identify and address common mental health issues, conducting its first training session just last month.
“Transforming mental health is a long game, it takes time,” said Giuseppe Raviola, another figure from Partners in Health. The aim is not just to build healthcare capacity but to align these services with cultural practices and needs. This is no small feat, as mental health carries varied interpretations and beliefs among the populace, often rooted deeply within the local culture.
Braving these challenges daily, Dr. Jalloh expressed his commitment to seeing the hospital evolve from ‘a place of suffering to sanctuary.’ When he first trained at the psychiatric hospital during his medical schooling, he made it known to his friends—often jokingly—that he would be pursuing psychiatry. Given the profession's reputation for low financial returns and the stigma surrounding mental health, many did not take his aspirations seriously.
Upon returning to the hospital three years later, his dedication was palpable. He sought to not merely manage but inspire change for those suffering from mental illness. The hospital’s progress shows how dedication, partnerships, and community support can lead to remarkable changes, yet the struggles are painfully visible. Dr. Jalloh confronts personal challenges daily, feeling overwhelmed by the needs and crises, “A big challenge and huge burden on us.”
Nonetheless, the light of transformation shines brightly at the Sierra Leone Psychiatric Teaching Hospital, where healthcare staff, supported by dedicated organizations, strive to carve out spaces of care within the turbulent waves of challenges.
Though the road is long and fraught with hurdles, the promise of providing appropriate mental health care has only just begun. Dr. Jalloh and his team remain undeterred, taking firm steps toward reshaping not just treatment at the hospital, but the broader conversation about mental health nationally.
Often, real transformation begins with small changes, but it needs the backing of policy, education, and cultural shifts to maintain momentum. If the efforts at the Sierra Leone Psychiatric Teaching Hospital are any indication of what’s possible, there’s every reason to hope for more healing, wholeness, and empowerment for Sierra Leone’s vulnerable populations.