Building back better for children Developing relevant and sustainable systems of care for children with mental health problems in Sierra Leone

This dissertation presents four studies related to the development of a contextually relevant and sustainable Child and Adolescent Mental Health (CAMH) care system in the post-emergency, low-resource environment of Sierra Leone. The first study describes priorities, barriers and facilitators of mental health care for former child soldiers from the perspective of local service providers. The second study gives an overview of formal and informal mental health care systems for the general child and adolescent population, and explores local perceptions of child mental health, help-seeking behavior, and stigma. The third study describes child witchcraft as an idiom of distress, with implications for mental health interventions. The fourth study uses the Interactive Systems Framework to analyze the apparent lack of success in developing a CAMH care system for Sierra Leone in the context of two humanitarian crises. A concluding chapter discusses issues of context and sustainability, using findings from across the four studies, with references to literature on current knowledge and practices. It also discusses two areas that warrant further exploration (diagnostics and epidemiology, and interventions) and closes with some thoughts on the contributions of this dissertation to the general field of global CAMH: first, the value of an interdisciplinary approach to global CAMH research, second, the demonstrated effectiveness of a Rapid Qualitative Inquiry to deepen our understanding of child idioms of distress, and third, the usefulness of the Interactive Systems Framework as both an analytic and prescriptive tool for the development of a CAMH care system in a low-resource setting.