By Millicent Senava Mannah
In Sierra Leone, stress is no longer just an emotional strain, it is fast becoming a major public health concern. With widespread poverty, food insecurity, trauma from war and disease, and a lack of mental health infrastructure, many citizens are silently grappling with psychological and physical consequences that remain largely unaddressed.
Mental illness is alarmingly prevalent across the country. Studies estimate that around 15% of the population lives with some form of mental disorder, ranging from depression and anxiety to substance use and psychosis. Yet nearly 99% of those affected receive no formal treatment. Experts attribute this gap to stigma, inadequate public funding, and the country’s outdated 1902 Lunacy Act, which still governs mental health legislation.
Sierra Leone has just one psychiatric hospital, the Sierra Leone Psychiatric Teaching Hospital in Kissy, Freetown, serving over 8 million people. Fewer than five psychiatrists are practicing nationwide. Between January and October 2023 alone, the hospital recorded more than 2,000 new cases of mental health conditions, a figure health professionals believe represents just a fraction of the national burden.
Stress in Sierra Leone is driven by a web of interconnected factors. Poverty and hunger remain the most pressing triggers. As of 2024, the World Food Programme reports that 82% of households in Sierra Leone suffer from food insecurity, with 18% facing severe levels. In some regions, more than half of households report insufficient food consumption.
Unemployment and limited access to basic services further compound the problem. The World Bank notes that over 50% of the population lives below the national poverty line. These harsh living conditions create chronic stress that often goes unspoken and untreated.
Gender-based violence, relationship instability, and family conflict are also major contributors, particularly among women and youth. The trauma of the 11-year civil war, the Ebola outbreak, and recent disasters like flooding have left lasting psychological scars. Research shows that by 2009, at least 400,000 Sierra Leoneans had suffered from war-related trauma, with high rates of post-traumatic stress disorder (PTSD) still lingering across the country.
Prolonged stress can severely damage the body and mind. Physically, it increases blood pressure, suppresses immune function, disrupts digestion, and can lead to chronic fatigue, headaches, and sleep disorders. In Sierra Leone, where infectious diseases like malaria and typhoid are already widespread, this additional physical toll often goes undiagnosed.
On the mental health front, stress is closely linked to anxiety, depression, suicidal thoughts, memory loss, and in extreme cases, psychosis. According to mental health advocates, suicide rates in Sierra Leone stand at approximately 9.7 per 100,000 people, a figure exacerbated by a lack of support systems and the continued criminalization of suicide attempts.
Formal mental health services in Sierra Leone remain scarce, and those available are mostly centralized in urban areas. Many rural communities turn to traditional healers or religious institutions for help. Others simply suffer in silence due to stigma or fear of being labeled “mad.”
However, non-governmental organizations and health partners, including the World Health Organization, are stepping in. Community health workers are now being trained in basic psychological first aid, and efforts are underway to integrate mental health support into primary healthcare services. These grassroots interventions are helping to reach those in remote or underserved areas, but coverage remains far from adequate.
Health professionals recommend practical coping strategies: engaging in regular physical activity, maintaining healthy sleep and eating habits, practicing mindfulness or deep breathing techniques, and fostering supportive social networks. For those who can access them, talking therapies and peer support groups have proven effective in managing stress.
Experts agree that more needs to be done at the policy level. The Ministry of Health and Sanitation has developed a Mental Health Policy and Strategic Plan, which includes proposals to decentralize services, pass a new Mental Health Act, and train more professionals. Yet implementation remains slow.
To break the cycle of stress and poor health, stakeholders are calling for increased investment in mental health care, stronger anti-stigma campaigns, legal reforms, and the integration of mental health into broader poverty-alleviation and education initiatives.
Chronic stress in Sierra Leone is more than an individual struggle, it is a collective crisis. As economic pressures deepen and social support systems fray, stress-related illnesses are quietly damaging lives and communities. Confronting this crisis requires not only medical attention but also a shift in national priorities, towards mental well-being, human dignity, and equitable access to care.
