Aren’t we all mad?

Most Malawians shun mental patients as victims of witchcraft, alcoholism and drug abuse, but this is a symptom of a graver problem government cannot treat alone. JAMES CHAVULA writes in commemoration of the World Mental Health Day today.

Between Blantyre Central Business District to Machinjiri Township, there are two ways—except both of them take you face to face with the stubborn question of mental patients in the country’s cities. If you take the road that passes through Limbe, the likelihood is high that you meet one who has been stoning cars for about 10 years. If you take the road that cuts through Chirimba and Magalasi, you only have to keep your eyes open to see another perching precariously on the banks of the Chirimba River in a shack made of cartons.

But the two are just examples of a problem which follows you to every corner of what is generally marketed as the country’s commercial capital. There are people with mental illness roaming the streets. Oftentimes, they shoulder loads of goods that look and stink as filthy as they can be.

What are the mental of patients doing in the middle of a city which prides itself as the country’s commercial capital?

“Cases of mental patients roaming the streets are worrisome. Some of the patients are females and are vulnerable to rape. The problem is that they cannot go to the hospital on their own,” said Blantyre District Health Office (DHO) mental health coordinator Rene Kawaga amid a Ministry of Health operation, code-named pick-a-patient campaign, which sought to take mentally ill persons off the streets of Blantyre in September 2009.

During the sweeping exercise, medical personnel persuaded the patients to relocate to Zomba Mental Hospital. The violent ones had to be captured by force, with the aid of police officers. Television and print journalists captured the one-off campaign on camera, forcing St John of God Community to come out gun blazing in defence of the patients’ right to privacy and confidentiality like any other citizens.

“Could we imagine patients diagnosed with HIV or tuberculosis being shown on television without consent,” argued the Mzuzu-based mental health organisation.

In 1991, the United Nations assembly adopted 25 principles to confidentiality and consenting to treatment are some of the 25 principles for protecting people diagnosed with mental illness.

The campaign, which was meant to be done once every three months, might have been under fire due to rights abuses and lack of funding as Kawaga hinted, but it signalled a long overdue acceptance that the patients need treatment, not being scoffed at on the streets.

Dr Beatrice Mwagomba, programme manager for non-communicable diseases in the Ministry of Health, explains: “There are several things that contribute to mental illness, but people tend to ignore the early signs as misalawithout offering any help.”

Last year, Principal Secretary of the Health Ministry Dr Charles Mwansambo decried that inhumane treatment of people with mental health challenges sometimes manifests itself as name-calling and denying survivors access to employment and other vital services.

Ill-treatment sometimes stems from the hasty generalisation that the condition is a result of alcoholism and drug abuse. While these are some of the causes, mental instability can also be the aftermaths of head injuries, STIs, meningitis, anxiety, stress and disappointment.

“People think mental health only concerns mental patients, but it also affects people that are depressed. That’s why people commit suicide,” explains clinical psychologist Dr Chiwoza Bandawe.

As the negligent discriminatory behaviour continues, the World Health Organisation (WHO) projects that by 2020, mental illnesses will be the second-leading cause of disabilities after heart diseases.

The good news is that early treatment could reduce disability rates, says WHO.

Unfortunately, mental health is given low priority, with Professor Crick Lund, a specialist at the University of Cape Town, saying it accounts for one percent of health budgets on the continent.

Malawi devoted 1.7 percent of the health allocation to this area. In 2011, then Health minister Jean Kalilani bemoaned poor investment, saying: “Not investing in mental health is very expensive; mental health is an integral part of good health.”

While some strides are being made, there is need to sensitise citizens and organisations to start taking part in ensuring all patients have access to diagnostic and treatment services in time.

The scenes on the streets can be shocking. For Peter MacBridge, who works for Northern Ireland Association of Mental Health, the influx many mistake for an eyesore is a call to action.

When McBride visited Malawi to see a relative and saw mental patients helplessly moving about the villages, he thought something had to be done to help.

In 1997, he formed Vwira Mental Organisation, a community-based organisation in Mzuzu that give patients food and drugs, sends them to St John of God and facilitates survivors’ integration into society.

By contrast, some Malawians seem to think it is only the responsibility of government to rid the streets of people in need of mental health services.