Implications for Global Mental Health Policy and Practice
ACT, as a therapy rooted in functional contextualism, may offer broadly applicable behavioral principles that can be applied across a variety of different issues and thus may have merit in culturally diverse contexts. Applying cultural knowledge to ACT procedures and processes may enhance this approach within the Sierra Leonean context (e.g., by modifying metaphors so that they are more culturally relevant). The ACT model may be particularly advantageous for a number of reasons: 
ACT training may have a positive impact on participants’ well-being in a
Sierra Leonean context. Promoting self-care and preventing burnout will be
an important component of sustaining mental health services in Sierra Leone.
Connecting and collaborating with established services is crucial, particularly for NGOs from other cultural backgrounds who aim to provide psychotherapeutic support in these contexts. commit and act’s experience has highlighted the value of conducting extensive research about an area, its needs, potential cultural issues, existing services and other considerations, before one can determine the most appropriate way of providing support. Given that Sierra Leone has limited mental health care services and that staff are overburdened and lack sufficient training and resources, a number of vital components are needed for scaling up services in this context, including: (1) community-based approaches to training and delivering psychosocial support; (2) working with a range of different professionals, non-specialized workforces, and local people; (3) utilizing validated psychotherapeutic approaches (e.g., ACT); and (4) providing ongoing supervision and support so that individuals can develop their skills across time. By working with individuals from a range of sectors (e.g., schools, prison services, NGOs etc.), the number of access points to psychosocial support have increased, improving access to mental health care within the community. It is also hoped that over time and with increased use of these services, this will help to reduce stigma surrounding mental health issues in Sierra Leone.
Finally, by empowering local people to pursue their goals and vision, as individuals like Hannah have done, the possibilities for how this approach can be applied to various issues increase exponentially. However, government support is needed to further facilitate this. The Sierra Leonean government has made important strides in addressing mental health issues and identifying areas that must be targeted to better support people affected by mental health difficulties and their families and communities. It is imperative that the government collaborates with existing health care providers and NGOs and supports them to continue in their efforts to provide the best level of care for its population. One essential aspect of this will be to conduct ongoing research that examines the impact and effectiveness of current efforts, explores other issues and at-risk groups, and continues to inform best practice. While commit and act has made an important contribution in this context, greater efforts must be made to train up local researchers within Sierra Leone and to support their efforts so that there is a continuous process of improvement in relation to mental health care in the country.
-  There is a drive for more evidence-based services. ACT has a growingevidence-base across a range of issues (Ruiz 2010), and preliminary evidence suggests that it may be effective with diverse groups (Woidneck et al.2012); 2. From the practical perspective of trying to scale up and improve access tomental health care services, the ACT model is clinically effective, it can bereadily introduced through field-based training, and therapists can achievegood outcomes with clients with relatively little training using thisapproach; 3. ACT training can lead to positive outcomes both personally and professionally for therapists. Findings from Stewart et al. (2016) have indicated that