post by Meredith Newlin
Martin Webber and I have been in Sierra Leone to follow-up from my last visit in July 2013 when I conducted a feasibility study to explore the potential for developing social interventions with mental health workers. The initial visit, funded by the Centre for Chronic Diseases and Disorders (C2D2), was an opportunity to meet with a variety of stakeholders to better understand current practice and explore the extent to which principles social capital are relevant to the communities in Sierra Leone. The second visit, funded by Maudsley Charity, was focussed on co-producing a culturally appropriate social model and training programme for the nurses with local partners, as well as exploring the acceptability of this model of practice.
Findings from the feasibility study indicate enthusiasm for the potential of social interventions to promote meaningful involvement for adults with mental health problems, aiding in their recovery and enhancing social inclusion. Mental health services on the whole are extremely under-resourced and there is significant need for training in low-cost psychosocial approaches to mental health care at both the district and community levels. Findings from the feasibility study were developed into a short film, which can be viewed here.
Based on reflections from the feasibility study, we identified 21 trained psychiatric nurses as the most appropriate group to work with in future training, as they have strong mental health experience but are still limited in how they might be able to apply the biomedical model in which they were largely trained. Through conversations with our partners, King’s Sierra Leone Partnership (KSLP), EU-funded Enabling Access to Mental Health (EAMH), and the Sierra Leone Mental Health Coalition (MHC), we recognise gaps in their current practice around the social aspects of mental health, particularly the capacity for nurses to engage with service users social support networks such as family members and the wider community.
The 21 nurses received extensive training from the College of Medicine and Allied Health Sciences (COMAHS) and EAMH over the past two years. We acknowledge that new skills must fit into the training they have received, and this not meant to be replacement training but rather supplemental. It’s important that training modules and activities for interactive learning also serve as refresher to what they have already learnt. For example, nurses were trained in the MHGap Intervention Guide, the World Health Organization’s (WHO) flagship programme on mental health for scaling-up interventions by general health practitioners in low- and middle-income countries. The nurses have a strong foundation in diagnosing mental illness but what we suggest is an extension of their initial training in which we integrate practical application of social methods, enabling nurses to work in the most under resourced settings.
We heard from stakeholders the importance of teaching nurses about other community-based models of mental health services in African contexts. We will use the limited evidence available to ensure the training programme is in-line with strategies found to be effective in other West African countries. Also in regards to sharing good practice, we recognise the challenges faced by the nurses as they have been posted across the country in all 14 districts, thus peer support approaches are important to ensure the nurses learn from one another.
It is our hope that is in the future the model and training programme could be a useful tool and product for cross-disciplinary training. From the conversations we’ve had, the capacity for its use in other health sectors has been made clear; it might be useful in future training of social workers, PHU staff, CHO’s or primary care doctors. We plan to make the training bespoke for the variety of contexts the nurses are working in. For example, the nurses from the Sierra Leone Psychiatric Hospital in Freetown have different challenges and capacities to an outpatient hospital in Bo, and a community-based clinic in Kono District, but there are ways to take this approach to all these contexts.