Living in Chains: Sierra Leone's Mentally Ill

A patient is restrained at the mental hospital in Freetown, Sierra Leone.

The only psychiatric hospital in Freetown, Sierra Leone, is in deplorable condition and needs resources to make significant improvements. The mentally ill represent a vulnerable population worldwide, and in Sierra Leone, they do not have an advocate. As such, the state of the hospital and its patients is not a priority.

Dr. Mandy Garber is a Sierra Leonean psychiatrist living in Pittsburgh, Pennsylvania. She spent the month of April volunteering at the Kissy Psychiatric Hospital in Freetown. The following is Garber's assessment.

There are garlands strewn on electric poles. Young men on street corners are hawking memorabilia celebrating Sierra Leone's 50 years of Independence. Numerous citizens are decked in clothes, hair ornaments, necklaces and bracelets featuring green, white and blue, the national colors.

Atop a hill in Kissy, at the Sierra Leone Psychiatric Hospital, commonly referred to as Kissy Mental, a whole population exists marginally with little to get excited about. These are some of Sierra Leone's mentally ill citizens. Some have lived there for decades. Most of them have been abandoned by their families, who attribute their illness to witchcraft, a curse or even attribution for past wrongs. Very few have much to look forward to.

Life for the mentally ill in Sierra Leone is incredibly hard. Due to their illness, most of the mentally ill have minimal earning power. They cannot hold a job; people on the street mock and harass them; and at worst, they are physically or sexually abused by the so-called saner members of society. Life as a patient at Kissy Mental Hospital is equally hard. If they could, most of the hospitalized patients would leave. Some cannot leave because they have been chained. Others simply have nowhere to go because family members no longer want them around. Very few patients come to Kissy Mental willingly.

Most report that family members either restrain them to bring them to the hospital or mislead them into believing they are headed elsewhere. If they try to resist admission, they are held down and administered a tranquilizer. Then come the chains, which may stay on for days or months on end, wrapped around the individual's foot, looped around the bed frame and secured with a padlock. The patient must learn to survive within this harsh new reality in the midst of his or her sadness, delusions, neuroses or psychoses.

Some of the long-timers make a life for themselves at the hospital. They leave intermittently, go into town and earn a pittance, which allows them to get by from day to day. But for the majority of patients at Kissy, the prognosis is very dark.

Services at the hospital are bare-bones. Patients receive two or three small meals a day. Visitors are repeatedly accosted by patients asking for money to buy food. The hospital's medication formulary is scant. Most patients do not get effective medication that would give them a chance at a somewhat functional, semi-independent existence.

Utilities are in exceedingly poor condition. The perimeter wall and gates have been damaged in various parts, rendering the premises insecure. Instead of repairing the wall in order to prevent patients from absconding, the chains are used. For many years the facility has not had any running water and must rely on a weekly supply of a bowser of water from the Guma Valley Water Company. This supply is grossly inadequate, and the kitchen is given a priority. As a result, maintaining personal hygiene is a challenge. Electric power is supplied by a fuel-powered generator. Electricity, when it is available, is rationed to a few hours daily.

Who is to blame? It would be easy to point fingers at the government, the Ministry of Health and the staff at the hospital. There is definitely enough blame to go around. Sierra Leone has been a welfare state for as long as I have been alive. The country has never been able to utilize its resources towards improving the lives of its citizens. Instead, decades of ongoing corruption have left the country's coffers bankrupt. The Ministry of Health and the Freetown City Council have little means to create the change that is needed at Kissy Mental Hospital. Yet the needs are dire.

So much is needed. Individuals are needed who can envision an improved and clinically effective environment for Sierra Leone's mentally ill citizens. Lobbyists are needed to encourage others to contribute and insist that the government pass laws that are sensitive to the welfare of the mentally ill. Healthcare managers are needed to advise and design strategies for effectively running a hospital that depends exclusively on disbursements and donations for its survival. Skilled, ethical and honest laborers are a must in order to provide clinical care in an empathetic manner to these vulnerable and marginalized individuals.

View the Worldpress Desk’s profile for Roland Bankole Marke.