‘Mental health care has improved’
On October 10, Malawi will join the rest of the world in commemorating World Mental Day. Clinical psychologist Chiwoza Bandawe talks about the importance of the day to Malawi and other issues.
Q: Why is it necessary for Malawi to join the world in commemorating World Mental Health on October 10?
A:
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 or infirmity”. Mental health is, therefore, an intrinsic part of health and wellbeing.
WHO estimates that around 14 percent of the global burden of disease is attributable to mental, neurological or substance-use related disorders. By far, the largest incidence of mental illness occurs in Lower and Middle Income Countries (LMIC’s) such as Malawi. Furthermore, an observed ‘treatment gap’ due to lack of resources has led to a situation in which over 75% of people with mental illness do not receive mental health care. It is also recognised that more than half of the 10 leading risk factors that cause about one third of premature deaths worldwide have behavioural determinants (e.g. unsafe sex, tobacco use and alcohol consumption). Despite this evidence, mental health is a neglected area within public health. World Mental Health Day therefore helps highlight these factors and reminds the world to focus on mental health.
Q: Has research been conducted in issues of mental health to determine how widespread mental problems are in Malawi?
A:
The Ministry of Health in conjunction with the National Research Council of Malawi (NRCM) and the Health Research Capacity Strengthening Initiative (HRCSI) is in the process of developing a National Health Research Agenda for Malawi. The mental health research gap indicates there has not been much research on mental health in Malawi to ascertain how widespread the problem is, leading to a wide knowledge gap. There has however been independent research on a wide range of topics and issues [related to mental health].
Q: What are the major causes of mental illnesses in Malawi?
A:
This is the biggest challenge about the field of mental health in Malawi. We need epidemiological studies that can clearly ascertain and document the most common mental health challenges in Malawi. Most of the information we get is from the mental hospital and other psychiatry outlets. Among the most common are: Psychosis due to drug and substance abuse, followed by depression due to poverty and HIV and Aids.
Q: Which age group is most affected and why?
A:
It is noticed that the youth (15-29) are the most vulnerable and affected although data for this is limited to hospitals and not nationwide. Reasons include economic factors which bring about stress leading to depression and substance use as well as unemployment.
Q: What are some of the best ways people can avoid mental illness?
A:
Prevention is always better than cure, the saying goes and awareness of mental health through increased mental health education is an important first step to help avoid mental disorders. People need to be aware of their weak or vulnerable points that can lead them, say, to substance use such as excessive alcohol or recognise their stress signals so that they can manage it before it becomes worse. Those who are on medication and their mental illness is controlled need to consistently take their medications as prescribed to them.
Q: Does the country have proper care for mental patients?
A:
The quality of care the country provides for mental health has improved drastically over the past few years. In particular there has been government investment into personnel by upgrading psychiatric nurses and clinical officers. Training of staff is regular. St. John of God community services in Mzuzu has also provided a strong contribution to improving the quality of mental health care provision in the community.
Q: Does the Malawi Government dedicate enough resources towards mental care?
A:
It is generally recognised that most African governments devote little to mental health because of the pressing needs of infectious diseases. The Malawi Government however, is trying to improve its dedication by strengthening personnel, such as upgrading psychiatric clinical officers and psychiatric nurses in order to improve on mental health care delivery. Mental health has now been included in the government essential health care package.
Q: We always see mental patients loitering the streets. How safe is this?
A:
Generally, they are safe. It is a stereotype to believe all those who suffer from schizophrenia or any other psychotic disorders are violent. Whilst some may be, when provoked, not all are violent. This belief adds to their stigma.
Q: What issues should Malawians think about on 10 October?
A:
Malawians should focus on mental health and in particular the ways in which the elderly are affected psychologically by the challenges they go through. Many are accused of being witches. These factors have such an impact on their psychological well being. We need to think about the elderly particularly this October 2013.
