Between tradition, faith and biomedicine: Caregivers' perceptions of child and adolescent mental health services in Sierra Leone.

In 2016, the Ola During Children's Hospital (ODCH) in Freetown, Sierra Leone, introduced the country's first and only Children and Adolescent Mental Health (CAMH) service with treatments based on a biomedical understanding of mental illness. The service at ODCH contrasts with the prevailing traditionally defined mental health landscape in and around Freetown, Sierra Leone, which largely relies on supernatural and spiritual explanatory models. The study investigates how service-users perceive the biomedical treatment practices and makes a first attempt at examining how the different services relate to each other. Semi-structured interviews were conducted with eight female caregivers of children and adolescents with mental illness (aged 6-19), as well as with two traditional healers, two religious healers, and five mental health nurses. The interviews were thematically analysed following Braun and Clarke's six-phase approach, with Arthur Kleinman's concept of "explanatory models" (EMs) serving as the primary analytical lens to examine how understandings of illness shape perceptions and help-seeking behaviour. The study concludes first that biomedical explanations about children's mental health conditions were well received by care seekers and help to improve their understanding of the condition and ways to deal with it; second, the concept of EMs can be helpful to understand different help-seeking behaviours of caregivers of children with mental illness in Sierra Leone, however, this concept has to be taken as flexible and people adapt to what they are exposed to; and third, a scale-up of CAMH services should include awareness-raising among health practitioners and show itself open to cooperate with non-biomedical practitioners under certain conditions.