Mental health still big challenge in Malawi

Born 56 years ago, James Bunyenga, had spent about five years at Zomba Mental Hospital (ZMH) when he was discharged last November. He does not remember when he was admitted to the country’s psychiatric referral hospital, but recalls this was not  his first time there.

Currently, Bunyenga, who comes from Fasi Village, Traditional Authority (T/A) Ganya in Ntcheu is on the streets of Zomba, looking unkempt as he begs for alms.

He was discharged from the mental hospital after being put on chlorpromazine (CPZ) drug. He still takes it, but says it has not been easy to stick to the dosage as it requires one to eat a lot of food.

Bunyenga did not return to his home village because he had no money for transport.

Furthermore, the way mentally challenged people are treated by society once discharged from the mental hospital makes Bunyenga hopeless.

“After I was discharged from the hospital the first time, people still treated me like I was ill. My relatives were caring, but other people in the community treated me differently,” Bunyenga says.

Head of mental health department at the College of Medicine in Blantyre, Jennifer Ahrens, agrees that there is stigma surrounding mentally challenged people.

“Most people do not know how to treat mentally challenged patients that have recovered. Research shows that most of these people are sidelined in development activities,” Ahrens says.

She explains that all people need to do is accept that one has been treated and ought to be part of society..

Bunyenga is not the only one facing stigma.

A walk in the country’s cities and trading centres reveals the seriousness of mental health issues in the country. Mentally ill persons are seen walking on the streets day and night. Some turn violent as they beg for money from passersby.

But what really goes on in the mind of the mentally challenged?

Zomba Mental Hospital acting director McEvance Phiri says mentally-challenged people become absent-minded when they are critically ill.

“If you ask them how they are feeling, they can tell you they are good yet they are not. Sometimes they can pretend to be in a happy mood yet they have many problems in mind,” explains Phiri.

Sometimes, according to Phiri, mentally challenged people do not know what they are doing until they get medication.

“The best way to deal with mentally challenged people is to give them proper medication. This is done considering how one fell ill,” he says.

Ahrens says mental illness can be genetic.

“If a person has a mentally ill relative, he or she might also have it as it can be passed on through genes,” she says.

Ahrens adds that a strong attack of cerebral malaria or HIV and Aids can also lead to mental illness.

“HIV infected people can also get mental illness if the virus attacks the brain’s cerebrum,” she explains.

WHO estimates that around 14 percent of the global burden of disease is attributable to mental, neurological or substance-use related disorders.

Clinical psychologist Chiwoza Bandawe was quoted in the Weekend Nation of October 10 2013 as saying that the largest incidence of mental illness occurs in Lower and Middle Income Countries (LMIC’s) such as Malawi.

“The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. Mental health is, therefore, an intrinsic part of health and well-being,” explained Bandawe.

He further said an observed treatment gap due to lack of resources has led to a situation in which over 75 percent of people with mental illness do not receive mental health care.

But one may ask why does the country not have many mental health facilities?

ZMH’s Phiri says there are branches of mental departments at Queen Elizabeth Central Hospital (QECH) in Blantyre and Bwaila Hospital in Lilongwe. There is also an advanced St John of God Mission Hospital in Mzuzu.

However, ZMH is the main referral hospital for mental illnesses.

ZMH spokesperson Owen Mwale says the facility can admit almost 400 people.

Ahrens says for a mentally ill person to return to normal, it depends on what treatment has been given to that particular person.

“You can provide wrong treatment to the right person and also you can provide right treatment to the wrong person, so it depends. That is why appropriate people are recruited in various mental departments to check those attitudes,” says Ahrens.

However, experts agree that although mental illness in itself does not kill, the condition makes the patients vulnerable and exposes them to other diseases.

This is why government needs to consider the welfare of mentally ill patients, especially those roaming the country’s streets.