title: Child mental health in Sierra Leone: a survey and exploratory qualitative study.
abstract: BACKGROUND
  This study complements the growing amount of research on the psychosocial impact of war on children in Sierra Leone by examining local perceptions of child mental health, formal and informal care systems, help-seeking behaviour and stigma.
  
  
  METHODS
  The study combined: (1) a nationwide survey of mental health care providers, with (2) exploratory qualitative research among service users and providers and other stakeholders concerned with child and adolescent mental health, with a particular emphasis on local explanations and stigma.
  
  
  RESULTS
  Formal mental health care services are extremely limited resulting in an estimated treatment gap of over 99.8 %. Local explanations of child mental health problems in Sierra Leone are commonly spiritual or supernatural in nature, and associated with help-seeking from traditional healers or religious institutions. There is a considerable amount of stigma related to mental disorders, which affects children, their caregivers and service providers, and may lead to discrimination and abuse.
  
  
  CONCLUSIONS
  Child and Adolescent Mental Health (CAMH) care development in Sierra Leone should cater to the long-term structural effects of war-violence and an Ebola epidemic. Priorities for development include: (1) the strengthening of legal structures and the development of relevant policies that strengthen the health system and specifically include children and adolescents, (2) a clearer local distinction between children with psychiatric, neurological, developmental or psychosocial problems and subsequent channelling into appropriate services (3) supplementary CAMH training for a range of professionals working with children across various sectors, (4) specialist training in CAMH, (5) integration of CAMH care into primary health care, education and the social welfare system, (6) further research on local explanations of child mental disorders and the effect they have on the well-being of the child, and (7) a careful consideration of the role of religious healers as care providers.
authors.affiliation: University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hélène N C
authors.initials: HN
authors.lastname: Yoder
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
authors.forename: Wietse A
authors.initials: WA
authors.lastname: Tol
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands ; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands ; The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands ; Boston University School of Medicine, Boston, USA.
authors.forename: Joop T V M
authors.initials: JT
authors.lastname: de Jong
keywords: Adolescents; Children; Healing; Mental health; Services; Sierra Leone