The Burden of Mental Disorder in Sierra Leone: an Evaluation of Programmatic Data From the Roll Out of Decentralised Nurse-led Mental Health Units

Abstract Background: In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98·0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. Methods: We evaluated the roll out of MHU using summary data from all units between 1st January 2015 and 1st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. Results: We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25-34 (23·4%). The prominent diagnoses were epilepsy (43·5%, associated with children) and psychosis (17·5%, associated with males). Reported depression (8·6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24·7% of cases where medication was required, it was not accessible.Conclusions: Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.