Community Mental Health Journal

, Volume 49, Issue 5, pp 615–624 | Cite as

Who Cares for Former Child Soldiers? Mental Health Systems of Care in Sierra Leone

  • Suzan J. Song
  • Helene van den Brink
  • Joop de Jong
Original Paper


While numerous studies on former child soldiers (FCS) have shown mental health needs, adequate services are a challenge. This study aimed to identify priorities, barriers and facilitators of mental health care for Sierra Leonean FCS. Thematic analysis was done on 24 qualitative interviews with participants from diverse sectors. Priorities of mental distress, substance abuse, and gender-based violence were common among FCS clients. Barriers were governmental support and communication with other providers. Perceived facilitators of care were primary- and secondary-level interventions. A public mental health model would feasibly build upon local, culturally embraced interventions, targeting local priorities and reducing barriers to care.


Mental health Child soldiers War Systems of care Psychosocial 


  1. Amnesty International. (1998). Sierra Leone: 1998—A year of atrocities against civilians. London: Amnesty International.Google Scholar
  2. Asare, J., & Jones, L. (2005). Tackling mental health in Sierra Leone. British Medical Journal, 331(7519), 720.PubMedCrossRefGoogle Scholar
  3. Baasher, T. (1982). The healing power of faith. World Health, 9(10), 5–7.Google Scholar
  4. Bannerman, R. B., Buton, J., & Wen-Chieh, C. (1983). Traditional medicine and health care coverage. Geneva: World Health Organization.Google Scholar
  5. Bayer, C., Klasen, F., & Adam, H. (2007). Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers. Journal of the American Medical Association, 298(5), 555–559.PubMedCrossRefGoogle Scholar
  6. Betancourt, T., Agnew-Blais, J., Gilman, S., Williams, D., & Ellis, H. (2010a). Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science and Medicine, 70(1), 17–26.PubMedCrossRefGoogle Scholar
  7. Betancourt, T. S., Borisova, I., de la Soudiere, M., & Williamson, J. (2011). Sierra Leone’s child soldiers: War exposures and mental health problems by gender. Journal of Adolescent Health, 49(1), 21–28.PubMedCrossRefGoogle Scholar
  8. Betancourt, T. S., Brennan, R. T., Rubin-Smith, J., Fitzmaurice, G., & Gilman, S. (2010b). Sierra Leone’s former child soldiers: A longitudinal study of risk, protective factors, and mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 49(6), 606–615.PubMedGoogle Scholar
  9. Betancourt, T., Simmons, S., Borisova, I., Brewer, S. E., Iweala, U., & Soudiere, M. (2008). High hopes, grim reality: Reintegration and the education of former child soldiers in Sierra Leone. Comparative Education Review, 52(4), 565–587.PubMedCrossRefGoogle Scholar
  10. Central Intelligence Agency World Fact Book. (2010). Sierra Leone Demographics Profile 2011. Available at Last Accessed on May 1, 2011.
  11. Coalition to Stop the Use of Child Soldiers (CSC). (2001). Child soldiers global report 2001. London.Google Scholar
  12. De Jong, J. (2011). (Disaster) Public mental health. In D. J. Stein, M. J. Friedman, & C. Blanco (Eds.), Trauma and mental health: Resilience and posttraumatic disorders. Oxford: Wiley-Blackwell.Google Scholar
  13. De Jong, L., & Kleber, R. J. (2007). Emergency conflict-related psychosocial interventions in Sierra Leone and Uganda: Lessons learned from Medecins Sans Frontieres. Journal of Health Psychology, 12(3), 485–497.PubMedCrossRefGoogle Scholar
  14. De Jong, J., Komproe, I., Spinazzola, J., van der Kolk, B., & van Ommeren, M. (2005). DESNOS in four post conflict settings: Cross-cultural construct equivalence. Journal of Traumatic Stress, 18(1), 13–23.PubMedCrossRefGoogle Scholar
  15. De Jong, J., & Van Ommeren, M. H. (2002). Toward a culture-informed epidemiology: Combining qualitative and quantitative research in transcultural contexts. Transcultural Psychiatry, 39, 422–433.CrossRefGoogle Scholar
  16. Denov, M. (2010). Coping with the trauma of war: Former child soldiers in post-conflict Sierra Leone. International Social Work, 53(6), 791–806.CrossRefGoogle Scholar
  17. Derluyn, I., Broekaert, E., Schuyten, G., & De Temmerman, E. (2004). Post-traumatic stress in former Ugandan child soldiers. Lancet, 363(9412), 861–863.PubMedCrossRefGoogle Scholar
  18. Drew, N., Funk, M., Tang, S., Lamichhane, J., Chavez, E., Katontoka, S., et al. (2011). Human rights violations of people with mental and psychosocial disabilities: An unresolved global crisis. Lancet, 378(9802), 1664–1675.PubMedCrossRefGoogle Scholar
  19. Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., et al. (2011). Scale up of services for mental health in low-income and middle-income countries. Lancet, 378(9802), 42–53.CrossRefGoogle Scholar
  20. Goodman, L. (1961). Snowball sampling. Annals of Mathematical Statistics, 32(1), 148–170.CrossRefGoogle Scholar
  21. Gupta, L., & Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. British Journal of Psychiatry, 192(3), 212–216.PubMedCrossRefGoogle Scholar
  22. Herman, J. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391.CrossRefGoogle Scholar
  23. van De, V., & Niekerk, J. P. (2012). Traditional healers formalised? South African Medical Journal, 102(3), 105–106.Google Scholar
  24. Human Rights Watch. (2005). Youth, poverty, and blood: The lethal legacy of West Africa’s regional warriors. Available at: Last Accessed November 1, 2011.
  25. Inter-Agency Standing Committee (IASC). (2007). Guidelines on mental health and psychosocial support in emergency settings. Geneva: Inter-Agency Standing Committee. Available at: Last Accessed January 2, 2011.
  26. Jacob, K., Sharan, P., Mirza, I., Garrido-Cumbrera, M., Seedat, S., Mari, J., et al. (2007). Mental health systems in countries: Where are we now? Lancet, 370(9592), 1061–1077.PubMedCrossRefGoogle Scholar
  27. Klasen, F., Oettingen, G., Daniels, J., & Adam, H. (2010). Multiple trauma and mental health in former Ugandan child soldiers. Journal of Traumatic Stress, 23(5), 573–581.PubMedCrossRefGoogle Scholar
  28. Kohrt, B., Jordans, M., Tol, W., Speckman, R., Maharjan, S., Worthman, C., et al. (2008). Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. Journal of the American Medical Association, 300(6), 691–702.PubMedCrossRefGoogle Scholar
  29. McKay, S., & Mazurana, D. (2004). Where are the girls? Girls in fighting forces in Northern Uganda, Sierra Leone, and Mozambique: Their Lives During and After War. Montreal: International Centre for Human Rights and Democratic Development.Google Scholar
  30. Medeiros, E. (2007). Integrating mental health into post-conflict rehabilitation: The case of Sierra Leonean and Liberian ‘child soldiers’. Journal of Health Psychology, 12(3), 498–504.PubMedCrossRefGoogle Scholar
  31. Minas, H. (2012). The Centre for International Mental Health approach to mental health system development. Harvard Review of Psychiatry, 20(1), 37–46.PubMedCrossRefGoogle Scholar
  32. Mussema, Y. (2006). A historical overview of traditional medicine practices and policy in Ethiopia. Ethiopian Journal of Health Development, 20(2), 127–134.Google Scholar
  33. National Reference Centre for African Traditional Medicine (NRCATM). Available at: Last Accessed on June 22, 2012.
  34. Okello, J., Onen, T. S., & Musisi, S. (2007). Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: A comparative study. African Journal of Psychiatry, 10(4), 225–231.PubMedGoogle Scholar
  35. Patton, M. Q. (2002). Qualitative research and evaluation methods. Thousand Oaks, CA: Sage.Google Scholar
  36. Peters, K., & Richards, P. (1998). Why we fight: Voices of youth combatants in Sierra Leone. Africa: Journal of the International African Institute, 68(2), 183–210.CrossRefGoogle Scholar
  37. Petersen, I., Ssebunnya, J., Bhana, A., Baillie, K., & Mental Health and Poverty Program Research Programme Consortium. (2011). Lessons from case studies of integrating mental health systems into primary health care in South Africa and Uganda. International Journal of Mental Health Systems, 5, 8–20.PubMedCrossRefGoogle Scholar
  38. Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M., et al. (2007). No health without mental health. Lancet, 370(9590), 859–877.PubMedCrossRefGoogle Scholar
  39. Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., et al. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet, 37(9593), 1164–1174.CrossRefGoogle Scholar
  40. Saxena, S., Sharan, P., Garrido, M., & Saraceno, B. (2006). World Health Organization’s Mental Health Atlas 2005: Implications for policy development. World Psychiatry, 5(3), 179–184.PubMedGoogle Scholar
  41. Saxena, S., Sharan, P., & Saraceno, B. (2003). Budget and financing of mental health services: Baseline information on 89 countries from WHO’s project atlas. Journal of Mental Health Policy and Economics, 6(3), 135–143.PubMedGoogle Scholar
  42. Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: Scarcity, inequity, and inefficiency. Lancet, 370(9590), 878–889.PubMedCrossRefGoogle Scholar
  43. Shepler, S. (2005). The rites of the child: Global discourses of youth and reintegrating child soldiers in Sierra Leone. Journal of Human Rights, 4(2), 197–211.CrossRefGoogle Scholar
  44. Sierra Leone Mental Health Policy. (2009). Available at: Last Accessed on June 22, 2012.
  45. Stark, L. (2006). Cleansing the wounds of war: An examination of traditional healing, psychosocial health and reintegration in Sierra Leone. Intervention, 4(3), 206–218.CrossRefGoogle Scholar
  46. Stepakoff, S., Hubbard, J., Katoh, M., Falk, E., Mikulu, J., Nkhoma, P., et al. (2006). Trauma healing in refugee camps in Guinea: A psychosocial program for Liberian and Sierra Leonean survivors of torture and war. American Psychologist, 61(8), 921–932.PubMedCrossRefGoogle Scholar
  47. Sunkel, C. (2012). Empowerment and partnership in mental health. Lancet, 379(9812), 201–202.PubMedCrossRefGoogle Scholar
  48. Tabuti, J. R. S., Dhillion, S. S., & Lye, K. A. (2006). Traditional medicine in Bulamogi County, Uganda: ITS practitioners, users and visability. Journal of Ethnopharmacology, 85(20), 127–134.Google Scholar
  49. Terr, L. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148(1), 10–20.PubMedGoogle Scholar
  50. Tomlinson, M., Rudan, I., Saxena, S., Swartz, L., Tsai, A., & Patel, V. (2008). Setting priorities for global mental health research. Bulletin of the World Health Organization, 87(6), 438–446.CrossRefGoogle Scholar
  51. UNICEF. (2007). Paris principles: Principles and guidelines on children associated with armed forces or armed conflict. New York: UNICEF.Google Scholar
  52. United Nations Children’s Fund (UNICEF). (2001). The State of the World’s Children 2001. New York: United Nations.Google Scholar
  53. Van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401–408.Google Scholar
  54. Van Duijl, M., Cardena, E., & de Jong, J. (2005). The validity of DSM-IV dissociative disorders categories in South-West Uganda. Transcultural Psychiatry, 42(2), 219–241.PubMedCrossRefGoogle Scholar
  55. Wessells, M. (2006). Child soldiers: From violence to protection. Cambridge: Harvard University Press.Google Scholar
  56. WHO. (2008). Mental Health Gap Action Programme (mhGAP): Scaling up care for mental, neurological and substance abuse disorders. Geneva: WHO.Google Scholar
  57. WHO. (2010). mhGAP Intervention Guide for mental, neurological and substance abuse disorders in non-specialized health settings. Geneva: WHO.Google Scholar
  58. Wickrama, K. A., & Kaspar, V. (2007). Family context of mental health risk in Tsunami-exposed adolescents: Findings from a pilot study in Sri Lanka. Social Science and Medicine, 64(3), 713–723.PubMedCrossRefGoogle Scholar
  59. Williamson, J. (2005). Reintegration of child soldiers in Sierra Leone. USAID. Available at: Last Accessed on June 22, 2012.
  60. Williamson, J. (2006). The disarmament, demobilization and reintegration of child soldiers: Social and psychological transformation in Sierra Leone. Intervention, 4(3), 185–205.CrossRefGoogle Scholar
  61. World Health Organization (WHO). (2005). Sierra Leone. Mental Health Atlas 2005. Geneva: WHO.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Suzan J. Song
    • 1
  • Helene van den Brink
    • 2
  • Joop de Jong
    • 3
  1. 1.Asian Americans for Community Involvement/Center for Survivors of TortureSan JoseUSA
  2. 2.City of RestFreetownSierra Leone
  3. 3.Department of Cultural and International PsychiatryVU University Medical Center, AmsterdamAmsterdamThe Netherlands

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