By Gamuchirai Chinamasa
There is very slow change and evolution when it comes to how mental health is perceived, understood and addressed in Africa, which is a large continent. You can go online on the Google search engines all day and night and yet fail to come up with many resources that are helpful.
African countries are still facing many problems caused by ignoring the importance of mental health and its existence in the African society. Most African families believe that mental health (specifically depression, bipolar, and anxiety amongst many others) is a “white man’s” disease. Resultantly the general society subscribes to the belief that anyone who struggles with this condition is either lazy or bewitched.
The African continent is also struggling with many years and decades of poverty, low income, malnutrition, various diseases and poor services in general. Mental health issues are by far at the bottom of the list of priorities when it comes to African governments.
Mental health programs in African countries are found to be unsatisfactory yet it has been researched that most of the global health burden is due to mental disorders. Mental health facilities are poorly funded and psychiatric hospitals are dilapidated. There are very few specialized doctors in this field, medication is very expensive, thus leaving most patients on the streets having been thrown out by family members and going undiagnosed and without any help.
I have seen first-hand how a family can disown you based on something you have no control over. I have clients and friends suffering in silence because of the fear of what their family or community may say or do.
This was an apt description of me in 2017. My family is amazing but I still feared opening up to them about my diagnosis. I found that they would joke around or tell me that I was being too lazy to leave my room or help clean the house, without them realizing that I was fighting a very secret and deep battle that didn’t make these chores or activities easy.
To this day I don’t think they really get to know how hard it is to do simple things. To them I still come across as lazy but I am also tired of explaining. At the time of writing this book, the deep need to move out and live on my own with my son is so, very deep for me because I want to be able to do things my way without having to explain or disappoint anyone. I am sure that I am not the only one that feels this way.
In Africa there is a big need to change the negative perception around mental disorders that has captured our families and society. This turnaround will in turn reduce the occurrence of mental disorders, including those associated with abuse of addictive substances which is popular in Zimbabwe given that cocaine, marijuana, bronco amongst many substances are being made easily available.
Whilst we currently fear the COVID-19 pandemic coming back again, we may fail to see that the drug wave and pandemic is looming very close and is scary too. There is need to provide adequate care for the mentally ill, maximize scarce public resources and support families in the provision of the best possible care for the mentally ill. As a continent we need to recognize the need for clear strategies to reduce the disablement associated with mental illness and to promote research on mental illnesses as well as how to prevent or treat them.
In most parts of the African continent, people’s attitudes towards mental illness are still strongly influenced by traditional beliefs in supernatural causes and remedies. This belief system often leads to useless or health-damaging responses to mental illness. It also leads to the stigmatization of mentally ill persons and a reluctance in seeking care for those contending with suicidal tendencies. The general African belief is that mental illness is largely incurable and seen as a disease of “the spirits or unhappy ancestors,” which must be appeased by brewing beer or killing a chicken/goat/cow.
Education of the public on these matters is key in the development of mental health awareness in Africa, for the simple reason that many aspects of mental healthcare require the inclusion of the community. Community understanding is important in reducing stigma and discrimination.
In most parts of the continent, the family remains an integral resource for the support and care of patients with mental disorders. Families with mentally ill persons can only be strengthened in this role if they are not made to suffer rejection because of a lack of understanding or help by the community.
It is key for there to be transparency within families as well as enough resources to educate those that may genuinely not “get it.” It takes patience and willingness to do this. Some days it’s frustrating and annoying and you as a guardian need to take a break and that is okay too. I know that my past broke my Baba’s heart and probably still does but it is not things I planned or wish on anyone and can hardly be controlled so it is key to know that too as African families.
Issues relating to unemployment, homelessness and poverty need to be addressed appropriately in the prevention of mental illness. It is very difficult for one not to feel depressed, anxious or even lose their mind if they have the stress or pressure of school fees and bills yet they lack a stable income or any source of income.
It is very easy to feel suicidal and helpless as a single mother or father left to fend for your children when the father or mother is able to help, but unwilling to take on his rightful responsibility. It is difficult to stay afloat and sane while going through a divorce but have no emotional support from family or community members. If the above issues and triggers of mental health are not dealt with, then the rise in cases will continue because of the symbiotic relationship that exists between these factors.
Education and awareness of mental health needs to be mandatory for all health workers. In Africa, because mental health disorders are seen as taboo, it is not surprising to find that when you seek help by going to the local clinic or doctor, you are inadequately diagnosed as suffering from high blood pressure, or encouraged to take paracetamol and rest, or even worse still, that it is all in your mind.
This has led to many deaths that could have been avoided had health care workers been trained and educated on how to pin point mental health disorders and what to do about it. I remember being at a certain casualty facility after a suicidal attempt. Once they had pumped my stomach, one of the nurses in the ICU came to me and said “why would you try take your own life, you are so ungrateful yet you have such an amazing family, your poor father!”
In all honesty I just said to myself, “this is only moments after my life has just been saved that you want me to feel bad again?” It is such responses which then lead one to start feeling like it is better to exit this earth and not stress anyone anymore.
Had this nurse been trained with the appropriate skills, then the conversation we had should not have been judgmental, but rather empathetic and uplifting. Mental health is not an off and on button, we don’t choose to feel this way or react in those ways. So if our own health workers don’t know bedside etiquette what more our family and friends?
Effective treatment exists for many mental disorders. There is medication now for depression, anxiety, schizophrenia, bipolar, amongst many other disorders. Drugs are not always needed, but when they are they aren’t easily accessible or affordable, most medical aid insurance companies will not even cover them fully if at all, thereby making health delivery inaccessible in fighting mental health.
Access to this medication in Africa is very limited, as governments cannot afford to purchase the treatment, thus resulting in patients not being medicated or patients turning to supernatural ways to deal with their issues directly or through their family members.
Rehabilitation and medication for mental health disorders is very expensive therefore leaving only the middle class and upward being able to afford. This is how it lands its description as “a white man’s disease.” Most medical aid insurance providers do not cover therapy let alone medication when needed or scans when required. The patient has to foot the bills for the shortfalls. This alone defeats the whole purpose of having a medical aid cover because up-front payments are required.
Sometimes the shortage of the medication is an issue considering that most of the medication is imported. Unfortunately during COVID-19 pandemic it is dreadful to imagine what pharmacists and patients have had to endure because of the restrictive lockdown measures which saw most borders closing. In light of this, it is vital that each country begins to manufacture their own medication to avoid full reliance on imported solutions.
There is also need for support from family members and friends of those that have to deal with severe cases of mental disorders. Family members need to be educated on how to deal with the disorder as well as have an outlet to vent about their own frustrations with this new responsibility as their health can be compromised by stress. Lack of inadequate support will just lead to the entire family needing help for one mental disorder or another.
There are not enough studies being carried out in Africa about mental health in order to reveal is lacking and how to deal with the problem.
Mental health is usually ignored or side-lined, thereby leading to a lack of resources and studies around it. Researchers, writers and mental health advocates often do not get the encouragement they need and deserve in order to do their work. The gap in awareness with regard to mental health issues shows the need for massive research funding in this area.
The kind of research that will bring solutions and highlight the key issues in each community is what is required. The training of medical students should include information and skills in mental health in order to show the importance of mental disorders in the work of physicians and not leave it to just those specializing in psychiatry.
Mental health in Africa is widely misunderstood, underrated and very stereotypical. Certain religions do not even allow for their congregation to seek medical help for medical issues, needless to mention those with mental health issues.
About Author: Gamuchirai Chinamasa is a registered systemic family counsellor and mental health champion.