Making mental health work

Just last month, Maida Godfrey completed a six-week mental health treatment at St John of God Hospital in Lilongwe.

Not long ago, the 37-year-old lost her mind and no longer cared much about herself and anyone around her.

When she moved in, she was “hearing some voices” and vehemently objected to take medication.

A mental health outreach conducted by St John of God Hospitaller Services

Interestingly, she is now back to sanity after the session.

In her words, she is a living proof that seeking medical assistance for mental illnesses has saved many people with mental conditions.

However, the relief eludes many people in the country who are usually seen wandering aimlessly or sleeping about in trading centres.

The World Health Organisation (WHO) estimates that up to 20 in every 100 people in Malawi have mental disorders, including psychosis, depression or anxiety.

However, mental health remains under-funded despite these staggering figures.

In fact, the sector receives less than four percent of the healthcare budget allocated K112 billion.

In October 2017, the effects of neglect and low funding reared an ugly head when the Ministry of Health was forced to close the mental health section at Bwaila Hospital in Lilongwe, where our sister newspaper Weekend Nation, spotted patients wallowing in their own excreta from burst sewer pipes that soiled the unsanitary confinements.

In her incisive inquiry, Ombudsman Martha Chizuma described the conditions as dehumanising and posing danger to both patients and staff. 

The Ministry of Health has since moved the section to Kamuzu Central Hospital (KCH).

We visited the new site at KCH, where a small room serves as a staff office, a consultation room and a ward at the same time. This poses a risk to both patients and health workers as they are not protected from violent mental patients.

As the capital city’s largest hospital has no purpose-built mental ward, the Ministry of Health has signed a service-level agreement with the 49-bed St John of God Hospital in Lilongwe’s Area 43 where referrals from KCH and Zomba Mental Hospital get subsidised services.

The ministry has a similar arrangement with St John of God in Mzuzu, which handles all cases from the Northern Region.

St John of God programmes manager Mwawi Ng’oma calls for greater investment in mental health services as many people are seeking treatment for conditions that once went untreated and neglected due to lack of awareness, stigma and discrimination.

To meet the rising demand and raise awareness, the Catholic hospital also conducts outreach clinics in 17 areas across the Central Region.

“Mental health is an illness like any other. Unfortunately, many people consider people with mental problems as no longer useful. But we have seen many getting better after treatment,” she explains.

The service-level agreement with St John of God Hospitalers has eased the problems people face to access drugs Ng’oma described as “quite expensive.”

“There are cheaper ones, but they tend to have many side-effects,” she says.

The deal has also cut costs of transporting patients to Zomba Mental Hospital, the largest referral hospital which handles mental complications.

The country’s sole State-funded mental hospital has 400 beds, but often houses about 200 patients.

Parliament allocated the facility K472.3 million for other recurrent transactions in the 2018/19 financial year.

However, hospital director Immaculate Chamangwana says it receives just about K30 million a month.

Besides, it gets K1 billion every three months for procurement of drugs—but the funds for medicines are “never exhausted every financial year”, says Chamangwana.

However, the facility is struggling with rising prices of food, fuel, water, electricity and maintenance.

The hospital needs frequent maintenance and replacement of materials due to the violent nature of some clients, she stated.

“Materials that could have lasted longer only last for a short time,” says Chamangwana.

The hospital receives patients referred by all district hospitals in the country, with the majority emanating from the Southern Region. Increasing numbers of mental health cases exert pressure on overwhelmed healthcare workers.

Besides the shortage of skilled staff, Chamangwana is concerned that people with mental disorders still face stigma and discrimination, coupled with little or no support.

In most districts, she says, mental health services are provided in poor environment. n

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