Sierra Leone’s president, Julius Maada Bio, recently announced the creation of a national mental health task force. What may be routine in other countries is big news here. For the first time, the government is prioritizing mental health alongside issues like education and social welfare. It’s a major step forward in a country that still has The Lunacy Act of 1902 on the books, categorizing people with mental health issues as criminals, or victims of witchcraft or demonic possession. These perspectives can have impacts that reach far beyond mental health alone. 

Soon, the Lunacy Act will be replaced with a new Mental Health Review Bill which recognizes the growing mental health needs in Sierra Leone. It’s equally important to acknowledge and address the ways that psychological challenges are inextricably linked with social challenges. 

In a May 2022 survey by Action Against Hunger, the inability to meet basic needs, notably food insecurity, was found to be the primary cause of mental health distress among respondents, leading to frequent changes in mood, such as sadness and anger. 

With hunger as a top driver of mental health challenges, consider that a staggering 81% of Sierra Leone’s population--more than 6 million people–lack reliable access to nutritious and affordable food. Local food production has decreased dramatically due to high input prices and extreme weather, leading to a 46% increase in food costs over the past year. It can be hardest for people to afford healthy, diverse diets, which has a knock-on effect since food is medicine and nutrition is key to health.

These are interlocking issues: chronic food insecurity can impact physical and mental well-being, even as some psychological challenges, such as depression, can make it harder for people to engage in income-generating activities that can reduce food insecurity.  

The situation is particularly alarming among young people. Seventy percent of youth in Sierra Leone are underemployed or unemployed and many are homeless and hungry, which contributes to stress, anxiety, and depression. Some resort to negative coping mechanisms including drug and alcohol abuse; and 80% of adolescent girls are involved in risky sexual behaviors, including transactional sex. 

Action Against Hunger’s assessment found that gender-based violence and domestic violence have been normalized across the country. There is a fear of reporting due to shame, stigmatization, potential violent repercussions, and the impunity of perpetrators. 

This contributes to Sierra Leone having one of the highest rates of teenage pregnancy in the world: 28% of girls between the ages of 15 - 19 have children. Adolescent mothers can face stigma, rejection, and chronic poverty. Less than 2% of married girls between 15 and 19 attend school, worsening their future prospects. These young women also have a higher risk of intimate partner violence, which over half of all women in Sierra Leone have experienced. 

All of these factors can lead to the double burden of malnutrition and psychological distress, including depression and anxiety. This combination can have long-lasting consequences on the girls’ health and nutritional status, and that of their children. 

To address these complex interconnected problems, and with the growing awareness of the need to address mental health in the country, Action Against Hunger launched a new kind of program in both urban and rural parts of Sierra Leone. Building on the school health club model, we piloted  “Adolescent Friendly Spaces,” wondering whether adolescents would voluntarily show up and spend their free time hanging out in a health center. 

Stigmas around mental health issues often prevent people from reaching out for the help they need. Despite the benefits of individual and group counseling sessions in promoting health and well-being, many are hesitant to seek external support. Therefore, our team had to be thoughtful and intentional about the gender-related topics we prompted young people to consider, especially in co-ed groups.  

The program’s popularity surprised us, with adolescents showing a strong interest in psychosocial support, sexual and reproductive health education, and referrals for other services.  The peer-to-peer model also proved effective with young people trained to support one another building a sense of community around more positive social norms. Tellingly, we saw improved well-being not only for 95% of the adolescents involved but also positive impacts at the household level. 

We see several key takeaways from the program. Our research suggests a strong link between hunger and mental health, one that should be further explored with broader populations and in additional contexts. Hunger is both a cause and a symptom of wider issues.

To make progress on Sustainable Development Goal 2, zero hunger, we also must promote gender equality and address mental health as part of a broader agenda to advance well-being. This project shows that grassroots demand for support is there, even in a country with longstanding taboos around mental health. 

It also underscores the need to focus on chronic issues as well as acute crises and to spotlight a country’s strengths as well as its challenges. 

Sadly, many in the global community haven’t paid much attention to Sierra Leone since the Ebola outbreak, which ended in 2016. Despite strong progress in health, many gaps still need to be addressed. We need reliable investments to promote mental health, end gender-based violence, advance sustainable agriculture – and address the food insecurity that is so closely linked to these concerns. 

After years of struggle and countless obstacles, it’s now more essential than ever to prioritize the Mental Health Review Bill and give it the attention it needs to advance its mission. Once we take mental health seriously--especially for those facing stigmas, such as women and young girls - we can build a platform for further policy and progress.