Take Five with Col. Dr. Stephen Sevalie (Sustainable Health Systems, Sierra Leone)

1. What fuels your strong interest in mental health? 

I lived through the civil war in Sierra Leone. At some point, there was a lot of bizarre behavior and mental health problems amongst the combatants and non-combatants in the community. Their behavior was mainly associated with superstition, the effect of wrongdoing and the blood of innocent souls. 

 On completing medical school, I realized that there is a group of patients that is highly stigmatized and no one wants to associate with– mental health patients. Since I have always been curious about mental health, I became even more curious about mental health patients. I finally decided to pursue mental health (psychiatry) as a career when a family member experienced acute psychosis and access to treatment became almost impossible. This experience firmed up my decision as a young doctor, straight out of medical school, that this was a worthy path that would bring relief to the mentally ill. 

2. In your view, what are the top three issues that drive poor mental health issues in Sierra Leone?

 There are several issues, but unfortunately, most people in my society will attribute mental health issues to supernatural causes. However, mental illness, like any other disease, has a biological origin and has associated risk factors. Therefore, I would say that the top causes of mental illness in Sierra Leone include familial or genetic factors, substance abuse and psychosocial stressors. 

3. As one of less than a handful of mental health experts in Sierra Leone, you are in a very special yet difficult position. How are you working to raise the next generation of mental health professionals?

 I am working in several ways to improve the mental health situation in Sierra Leone. 

 I am building a military facility in Bo District to provide mental health services using telemedicine. This development will also provide, in addition to treatment, an environment where we can train and mentor mental health nurses, psychologists, and doctors, as well as improve service delivery. 

 I also founded a nonprofit organization, Sustainable Health Systems (SHS), Sierra Leone, that envisions equitable health service delivery by generating scientific evidence to identify gaps and intervene accordingly. Of the areas we cover, mental health is one of the prime areas of our work. We are also developing local research capacity in mental health and translation of evidence to policy. 

 Further, since I oversee medical services in the Armed Forces of the Republic of Sierra Leone, I have been developing my staff. We now have a mental health nurse, a clinical psychologist and several more are in training. 

4. You have been working on the mental health study with APHRC for some months now. What have been some of the things that have stood out for you from the findings?

 The mental health system in Sierra Leone has been chronically deprived. To get to where we are now has taken a lot of effort and advocacy. What is emerging in this work with APHRC is that there are many problems, such as policy gaps, lack of capacity, lack of resources, stigma and lack of evidence. Today, however, there are more opportunities than before and the environment is ripe for innovation and momentum.

 Many youth organizations and leaders are ready and willing to work on mental health. For the first time in our history, there is a presidential taskforce on mental health, which the Vice President leads. This is an indication of political commitment, buy-in and potential for sustainability of interventions. As an organization, SHS has the capacity to generate evidence and evaluate interventions. We have the right conditions to use technology like telemedicine to reduce the treatment gap. 

5. In your opinion, what are some of the low-cost, scalable interventions that can be implemented to improve mental health situation at the community level?

 We can leverage technology, like telemedicine, to provide services for severe mental illness in remote areas. This would cater for many more people across a wider area. We can train midwives using the World Health Organization (WHO) validated mental health gap action plan intervention guidelines (mh-GAP-IG) to provide services for maternal mental health. We can also train community health workers on identification and referral pathways for mental health problems and expand the scope of free healthcare medication and HIV medication to include drugs for mental illness. There is a lot we can do with local and international commitment.

The environment is ripe and eager for our intervention. 

Col. Dr. Stephen Sevalie is the founder of Sustainable Health Systems (SHS), Sierra Leone and Head of Medical Services at 34 Military Hospital in Freetown, Sierra Leone. APHRC and SHS are working together on the Catalyze– Mental Health project, which seeks to establish the mental health and wellbeing drivers and needs of young people in Senegal and Sierra Leone.