Content area
Full Text
Community Ment Health J (2013) 49:615624
DOI 10.1007/s10597-013-9597-3
ORIGINAL PAPER
Who Cares for Former Child Soldiers? Mental Health Systems of Care in Sierra Leone
Suzan J. Song Helene van den Brink
Joop de Jong
Received: 7 November 2011 / Accepted: 15 January 2013 / Published online: 22 January 2013 Springer Science+Business Media New York 2013
Abstract 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.
Keywords Mental health Child soldiers War Systems
of care Psychosocial
Introduction
Sierra Leone endured over a decade-long civil war, with the conscription of an estimated 7,000 children into the armed
forces (Coalition to Stop the Use of Child Soldiers 2001). Commonly referred to as child soldiers, these children are dened as those under age 18 who are part of any kind of regular or irregular armed force or armed group in any capacity, including, but not limited to: cooks, porters, messengers and those recruited for sexual purposes and for forced marriage (United Nations Childrens Fund 2001, 2007). For Sierra Leone, the rebel armies reported a desire for social justice, but were well known for brutal mutilations and amputations (Shepler 2005; Wessells 2006). In addition to serving in armies as domestic workers and military support (McKay and Mazurana 2004), some child soldiers were forced to inict violence and humiliation on loved ones as a way of damaging family and community relationships, fostering dependence on the ghting forces, and hence molding children as tools of war (Amnesty International 1998; Human Rights Watch 2005; Peters and Richards 1998).
Longitudinal studies on the reintegration and rehabilitation of former child soldiers (FCS) in Sierra Leone have shown mental health difculties with both internalizing (anxiety and depression) and externalizing (hostility) problems (Betancourt et al....