In a cramped office in the capital, I sit with a 17-year-old girl whose eyes dart nervously as she speaks. She tells me of sleepless nights, of a weight she can’t name pressing on her chest, a legacy of a childhood shadowed by Sierra Leone’s brutal civil war and the Ebola outbreak that followed. After 12 years as a social worker and mental health researcher here, I’ve heard versions of her story countless times. But the numbers tell a starker truth: 98% of Sierra Leoneans lack access to mental health care, according to the World Health Organisation. For the nation’s youth—over a third of its 8 million people—this gap is a crisis hiding in plain sight.
Sierra Leone is no stranger to trauma. A decade-long conflict that ended in 2002 left scars on its people and its systems, compounded by Ebola’s devastation in 2014 and recurring natural disasters. Economic hardship grinds on, with over half the population living on less than £1 a day. Yet, amid these visible burdens, the mental toll on adolescents and young adults has gone largely unnoticed—until now. As a trained social impact leader, I’ve spent years advocating for the wellbeing of girls and women. What I’ve found is a generation buckling under pressures the country is ill-equipped to address.
A System Overwhelmed
At the Sierra Leone Psychiatric Teaching Hospital, Dr. Elizabeth Allieu runs the country’s only adolescent mental health unit. It’s a beacon of progress, supported by groups like Partners in Health, but it’s an outpatient facility with limited beds and a trickle of age-appropriate medications. “We’re doing what we can,” Dr. Allieu told me, her voice steady but weary. “But the need outstrips us every day.” With just 2% of the population able to access mental health services, young people are left to navigate their struggles alone—struggles sharpened by a new menace: Kush.
The Kush Scourge
Over the past three years, this cheap, synthetic drug has flooded Sierra Leone’s streets, hooking adolescents with its promise of escape. Made from a mix of cannabis and chemicals, Kush has triggered a wave of addiction, displacement, and death. In Freetown’s slums, I met a 20-year-old man, gaunt and shivering, who said he’d lost his family to the drug’s grip. President Julius Maada Bio has declared it a national emergency, rallying government agencies and NGOs to fight back. Yet, rehabilitation remains patchy, and prevention lags. The toll on youth mental health is incalculable.
Violence’s Lasting Echoes
For young women, the risks compound. An estimated 62% of Sierra Leonean women aged 15 to 49 have faced gender-based violence, a statistic borne out in the stories I’ve collected: rape, domestic abuse, forced marriage. The mental fallout—anxiety, depression, post-traumatic stress disorder—festers without treatment. “You can’t heal what you don’t see,” a survivor told me, her voice breaking. Girl-centred, trauma-informed care is desperately needed, but resources are thin.
A Policy Frozen in Time
The nation’s mental health policy, last updated in 2012, gathers dust. There’s no dedicated budget, though the Ministry of Health has trained nurses with help from international partners and stationed them in hospitals. It’s a start, but sustainability is a mirage without funding. “We’re running on fumes,” a health official admitted off the record. For a country where youth are the majority, this stasis is a betrayal of their future.
Searching for Solutions
There’s a path forward, if Sierra Leone can muster the will. The intergenerational trauma of war and the grinding stress of unemployment—over 60% of youth lack jobs—demand collective healing. Community-based initiatives could ease the strain, training laypeople to offer basic support in a “task-shifting” model that’s worked elsewhere. Faith leaders, often the first port of call for the distressed, could be equipped with mental health training, bridging cultural gaps. A revised policy, backed by real money, is non-negotiable. So is tackling Kush with robust rehab programmes and building services that reflect Sierra Leone’s unique needs.
In Freetown, the girl I spoke with still haunts me. She’s one of millions whose minds are at stake. Sierra Leone has rebuilt from ashes before—its people are resilient. But resilience alone won’t save this generation. Policymakers, peering from their offices, must see what I see: a crisis that, left unchecked, will shape the nation’s tomorrow. The question is whether they’ll act before the silence breaks them.
Moiyattu Banya-Keister is a social worker and mental health researcher.