Improving mental health care in Sierra Leone

Although we’ve been quiet on the blog, the Connecting People Intervention project in Sierra Leone has been evolving over the past several months.

Since Meredith’s visit to Sierra Leone in July, we have been working on developing a model of practice rooted in the CPI and training programme for community-based nurses. The project considers how social interventions, developed in partnership with community members involved in mental health care, might increase the chance of recovery.

Meredith and Martin are now making plans to visit in May to meet with stakeholders in the Ministry of Health & Education, the Mental Health Coalition, the Ethics and Scientific Review Committee, and leaders at the University of Makeni. The purpose of this visit will be two-fold; firstly to continue developing our partnerships and ensure the projects meets equally defined needs, secondly to facilitate creative sessions to develop the culturally-relevant training programme. We will then return to Sierra Leone to pilot the training programme with community-based nurses and involving local research students.

This video was produced by The Centre for Chronic Diseases and Disorders (C2D2), based at the University of York. C2D2 is supported by a Wellcome Trust ‘Institutional Strategic Support Fund’ award, and funded the first phase of the Sierra Leone project, the feasibility study. The next stage of the project, including the development of a model of practice and the nurse training programme, is funded by the Maudsley Charity.


Connectedness as a component of recovery

Social connections are important to most of us. We need people around us to share our lives with – the blossoming of online social network sites in the last decade is visible evidence of this.

When people experience mental health difficulties they frequently also experience a shrinking in their networks. People ebb away due to the stigma of mental health difficulties and individuals’ own problems in maintaining their social connections.

Mental health social workers have an important role to play in supporting people experiencing mental health problems to maintain their social connections. On 27th February, Making Research Count are organising a seminar in York for social workers and social care workers to discuss and engage with three research projects which explore the role of workers in enhancing the networks of people with mental health problems:

  • The Connecting People study has developed and is piloting an intervention model for mental health services to help people to enhance their social connections. It is funded by the NIHR School for Social Care Research.
  • The Community Health Networks study has mapped the networks of people with severe mental illness to explore the importance of people, places and activities in supporting recovery and investigate the (potential) role of primary care and secondary mental health services in community network maintenance and development. It is funded by the NIHR Health Services and Delivery Research programme.
  • Connected Communities is an action research programme that explores social network approaches to social and economic challenges and opportunities. It focuses on understanding, mapping and mobilising networks of support and co-producing action with local communities in a way that takes into account what is already there. It is funded by the Big Lottery.

The seminar will provide practitioners with an opportunity to engage with the emerging findings of these studies and to reflect on what they mean for social work and social care practice with people with mental health problems.

A final plenary session will be chaired by Dr Ruth Allen, Director of Social Work at South West London and St George’s Mental Health NHS Trust and Chair of the Faculty of Mental Health at the College of Social Work, which will explore the implications of these studies for mental health practice.

Practitioners will take away intervention models they can use in their practice to help individuals engage with their networks or  communities. They will have an enhanced understanding about the role of communities and networks in an individual’s life and how they can assist recovery. Community and asset-mapping techniques will be discussed to provide practitioners with tools they can use in their practice.

For more information and details about how to book a place, please visit the Making Research Count website.

Intoducing our Latest Team Member

A belated welcome and blog post is due for Sam Treacy who has joined the study and is a researcher at the University of York, but is based full-time in the Social Care Workforce Research Unit at King’s College London. Sam will be involved in conducting the follow-up interviews with both the service users and staff from within the agencies that have been involved in the Connecting People Study.

Sam’s background is in psychology, having worked predominantly with adults with mental health problems across community, inpatient and forensic settings. She has previously worked on research projects looking at substance misuse services across England, an RCT into the impact of Joint Crisis Plans, an international study looking at the stigma and discrimination experienced by mental health service users, and most recently a study looking at the outcomes and implementation of personal budgets for mental health service users in England.

We are sure that Sam will prove to be a great asset to the team and we look forward to working with her over the coming months.

Connecting People on Film

The NIHR School for Social Care Research has funded the creation of short films to accompany training materials for the Connecting People Intervention.

The films have been created by Trafford Community TV, a social enterprise spun-off from the Trafford well-being centre blueSCI who are participating in the Connecting People Study.

The films have been developed to assist training sessions about the Connecting People Intervention model. They feature practitioners talking about aspects of their practice within the context of the model. The different opinions expressed by them are certain to provoke discussion in training sessions when workers explore what they think about the practice involved in supporting people to develop or maintain their social connections.

All the films can be viewed via the menus on this website.

An introduction to the films can be found by clicking ‘training‘ in the menu above.

Drop-down menus from this link take you to the following 12 pages:

Question 1. How should I view the person that I am working with?

Question 2. How can I manage boundaries with an individual?

Question 3.How can I keep building on my own community knowledge?

Question 4. How do I overcome barriers faced by working in this way?

Question 5. How do I identify in what areas I can best help an individual?

Question 6. How can I get someone to try something new?

Question 7. How can I help someone to move on?

Question 8. How can I link an individual to someone new?

Question 9. How can I help the individual to overcome barriers?

Question 10. What kind of environment works best?

Question 11. How does this fit with our existing practice?

Question 12. How can our agency form better links with our community?

Each page has a short film and a PDF document with some suggested exercises for use in the training session. They can be used in sequence or dipped in to as required.

Additionally, we created videos, animations and case studies to illustrate what the Connecting People model is all about. These can be accessed via ‘the model‘ link in the above menu. For example, the film below features workers talking about their thoughts about the model:

Finally, the research team talk through what the model is all about:

Click this image to watch the connecting people intervention model

Click image above to watch the Connecting People Intervention model video

We are keen to hear what you think about the films. Please leave us a comment to let us know what you think about them.

Connecting People Study presentations

Dr Martin Webber gave two presentations about the Connecting People study at an NIHR School for Social Care Research mental health research seminar on Thursday 5th December 2013 in London.

The seminar heard presentations from:

  • Jerry Tew on family approaches to reablement
  • Julia Stroud on service user and practitioner experiences of Community Treatment Orders
  • Eva Cyhlarova on direct payments for people who lack capacity
  • Rich Watts on employment supports for people with mental health problems

Slides from the event will be posted on the NIHR School for Social Care Research in due course. However, in the meantime here are the two presentations he gave on the Connecting People Study:

Presentation #1: Developing a social capital intervention for people with psychosis: an ethnographic study of social capital generation and mobilisation

Presentation #2: Social care interventions that promote social participation and well-being: A mixed methods study

To get a flavour of the discussion during the event, please click on the link below to take you to the twitter stream:


International Centre for Mental Health Social Research Seminar

We are pleased to announce details of an upcoming seminar presented by Meredith Newlin to be held on Thursday 26 September 2013, 4:00 to 5:00pm at the University of York.

Developing social interventions for people with mental health problems in Sierra Leone

ICMHSR September 2013 Seminar

Recent estimates from the World Health Organisation (WHO) report an increase in the global burden of disease attributable to mental disorders. However, about four out of five people in low- and middle-income countries (LMIC) in need of mental health services do not receive them. Social interventions can help to fill the treatment gap for people experiencing mental distress in low and middle income countries. They have the potential to improve the quality of life and community engagement, as well as positively impact the social functioning of people with mental health problems.
To address this need we have conducted a feasibility study identifying needs in resource-limited mental health services in Sierra Leone. Early iterations of the adapted model alongside results from the feasibility study will be presented and discussed in this seminar.
All are welcome to attend. For further information or to express an interest in attending please contact Tracey Hawkes.
Further information about the event can also be found online at The University of York website.

Taking Learning Forward – Engagement Events September 2013

The Connecting People Study team are pleased to announce three engagement events being held this September across the country.

Taking Learning Forward

These events will give people the chance to;
• Find out more about the Connecting People Intervention
• Receive feedback on baseline findings from the study
• Have opportunities to network with other
agencies participating in the study
• Find out about what is happening next in the study

The event details are as follows.
• Tuesday 10th September held at Grapevine , Coventry

• Monday 23rd September held at UCLan, Preston

• Tuesday 24th September held at Kings College London

The events all commence at 10:30am and will finish at 2:00pm. Lunch will be provided.
These events are all free of charge but places are limited. For more details or to book a place please contact Tracey Hawkes.

International perspectives on Connecting People

Sierra Leone Flag

Sierra Leone Flag

Krio proverb meaning: one tree does not make a forest

Researcher Meredith Newlin has just returned from a two-week visit to Sierra Leone where she was evaluating the feasibility of adapting the Connecting People Intervention model to address the mental health treatment gap in low and middle-income countries we first spoke about here.

Funded by the Wellcome Trust and the University of York via the Centre for Chronic Diseases and Disorders (C2D2), this visit allowed Meredith and colleague  Dr Susie Whitwell from King’s Centre for Global Health, to visit Sierra Leone in July 2013 to explore how social interventions can help to meet the needs of people with mental health problems. During their visit, Meredith and Susie conducted interviews, focus groups and observations in a variety of mental health service settings and with a number of key stakeholders in the three largest cities, Freetown, Makeni, and Bo.

University of Makeni

University of Makeni


Like many post-conflict societies, Sierra Leone lacks capacity in its health and social care workforce. Where an estimated 13 per cent of the adult population suffers from a mental disorder and there exists only one trained psychiatrist for a population over 4 million, the lack of mental health training and supervision represents a significant barrier to addressing mental health needs.

Although training has begun for 21 psychiatric nurses, focus has been placed on the medical model, which is problematic in a country with poor access to medications. Upon graduating this autumn, the nurses will be based in district hospitals across the country with referral pathways reaching into the rural communities. Training in psychosocial approaches is greatly needed both at district and community levels in order to strengthen the care available to adults with mental health problems.

Psychiatric nurse training at Enabling Access to Mental Health (EAMH)

Psychiatric nurse training at Enabling Access to Mental Health (EAMH)

Meredith and Susie joined the psychiatric nurses for three days of training where they discussed principles of social capital and strategies they currently use to build relationships with patients, and spent time reviewing difficult cases. This gave us an opportunity to analyse the difference between actual symptoms of mental disorders and stereotypes associated with unusual behaviour in a context where people with mental health problems are highly stigmatised and vulnerable. Time spent with the nurses also enabled us to better understand the manifestations of illness from a sociocultural perspective. For example, the nurses explained they see young women suffering more from “frustration” (Krio for depression) due to the immense pressure placed on them to marry and have children, which may be over-diagnosed as psychosis given the prevalence of stigma in the community.

Susie discussing case studies with the psychiatric nurses

Susie discussing case studies with the psychiatric nurses

Feedback from stakeholders on the adaptation of an intervention model was positive, highlighting specific elements of social capital within the cultural context:

  • Building of trusting relationships between the health worker and service user
  • Deepening connections in the community, particularly with family members
  • Enhancing public awareness of mental health thereby minimising stigma
  • Traditional beliefs of mental illness impacting perceptions of recovery
Sierra Leone Psychiatric Hospital in Kissy

Sierra Leone Psychiatric Hospital in Kissy

From the data collected in this feasibility study, the research team will continue to collaborate with stakeholders in Sierra Leone to enhance the psychosocial skills of mental health workers through adaptation of the intervention model and development of a training programme.

Training Community Health Officers in Bo

Training Community Health Officers in Bo

Social work perspectives on Connecting People

Earlier this year the Connecting People study team successfully obtained an additional grant from the NIHR School for Social Care Research (who are funding the study) to produce training materials and short films about the Connecting People intervention model. The films and training package will be made available on the this website in the early autumn for anyone to use.

In the course of the filming, we have captured the perspectives of practitioners and service users about how the Connecting People intervention process works and what its outcomes are. We are finding out more about this in the study itself, but the films vividly capture individuals’ experiences of the impact of the model on their work and lives. The first of these films will be uploaded shortly to YouTube as a taster of what’s to come.

Anticipating the release of these film clips, The College of Social Work interviewed Rob Goemans (Professional Social Work Lead) and Jackie Stallard (Mental Health Social Worker) for the July edition of their online magazine Social Work Matters. Rob and Jackie both work for the Lincolnshire Partnership NHS Foundation Trust where they are piloting the Connecting People intervention model.

Rob described Connecting People as “more than just an intervention. It’s an overall framework of how social workers, other professionals and services work with people with mental health needs”. He went on to speak about his hopes for the model in providing an overarching framework for mental health social work backed up by research evidence.

Jackie spoke about how the model provides hope to mental health social workers who, in many places, have become disillusioned by mental health trusts obsessed with targets and squeezing out social perspectives. “My priority is the person I’m working with and helping them achieve the best quality of life they can,” she said.

The full article and clips from the interview can be viewed online in Social Work Matters (flash is required).

Alternatively, a PDF version of the magazine can be downloaded here.


Social Work Matters is a magazine for members of The College of Social Work, but is reproduced here with the kind permission of its editor, Mark Ivory.

Connecting People cartoon strip

Today I presented some information about the Connecting People Intervention model to a conference of mental health social workers in Hertfordshire Partnership University Foundation NHS Trust. There was considerable interest in the model, though the practitioners were aware of the institutional barriers they are facing which make it unlikely that it can be implement there just yet.

There was a conference cartoonist who expertly documented the presentations in pictorial format. The full range of pictures and my thoughts about the day are on my blog, but here are the ones about the Connecting People study:

20130719_142751 20130719_142836 20130719_153857Please let us know what you think about them. If you have a cartoon or experience about the Connecting People study to share, please drop us a line. Thank you!