When asked to offer his opinion about mental illness, a Zambian man precisely stated that “mental illnesses are caused by witchcraft.'' He further substantiated his statement by questioning the usefulness of seeking medical help for witchcraft-related mental illnesses. In his own words, he said, “ Zambian doctors aren’t trained in treating witchcraft, so it’s much helpful to access help from readily available traditional healers.”
The aforementioned statements reveal three things:1) there are diverse perceptions of what causes mental disorders, 2) mental disorders aren’t treated as a medical issue, and 3) people are seeking mental disorder treatment, but spiritual treatment. Seeking out spiritual or traditional interventions for mental disorders is the norm for many Zambians. In Zambia, approximately 70-80% of people who suffer from mental illnesses consult traditional health practitioners before seeking out medical help. Why is this the case? Among other reasons, inadequate access to mental health services compounded by stigma, discrimination, and lack of education about mental health, are primary drivers. To put this stigma into perspective, a Zambian woman alluded to how, for instance, once people know that you have a mental illness, they immediately stop treating you as a person. For the sake of emphasis, this is equivalent to attacking the personhood of people living with mental disorders. In Zambia, the stigmatization of mental illness is ubiquitous, with the majority coming from family members, community members, and at times, health care workers.
The stigmatization of mental illness is well noted in Zambia’s Mental Disorders Act 1951, where people with mental disorders are referred to as idiots, imbeciles, and invalids. Efforts to repeal the Mental Disorders Act 1951 are still ongoing, with the latest news indicating that in 2019, the Mental Health Bill passed its first reading review in the parliament. Although this effort is encouraging, further delays in the repeal continue to prove that mental health is not receiving enough attention.
It is pleasing that more Zambians are becoming comfortable with discussing mental health, but more serious discussions need to happen at the governmental level. Among those who are discussing mental health, they have noted difficulties with finding the right language to describe their mental health status. One man mentioned that “ I do experience depression, but I am hesitant to seek help because I don’t have the right language to articulate my mental health problem in a way health workers can understand.” At times when I visit the clinic to access mental health services, I am prescribed Panadol and simply advised to “stop thinking too much.” That is it,” says one woman living in rural Zambia.
While mental health affects both urban and rural populations, the rural Zambian population is disproportionately affected by severe mental health disorders. Similarly, another woman shared her struggle with defining mental illness. In her own words, she defined mental illness as a “brain problem” that occurs when a person is “not thinking straight.” Others noted that learning about mental health is like learning another foreign language, while some still believe that mental illness is a disease for rich people.
From these comments, two things are obvious:1) lack of mental health education has a direct effect on one’s ability to describe their mental illness symptoms, 2) health care workers lack the necessary training needed to diagnose and treat mental health illness, and 3) lack of mental health education contributes to harmful beliefs about mental illness. A key takeaway is that mental health education can help patients to describe their symptoms in a way that facilitates timely diagnosis and treatment.
In Zambia, mental health and psychiatry are only taught at two Zambian institutions- Zambia University and Chainama College of Health Sciences. Even worse, mental health has not been included in the health care service package; for instance, in the Zambian Ministry of Health budget, less than 1% of funds were allocated towards mental health services. Another concern is that mental health services are not integrated into the primary health care system. Research studies have suggested that the integration of mental health services into primary health care can significantly improve the provision of mental health services. The lack of attention toward mental health is also evident in the poor surveillance infrastructure. For instance, the exact burden of mental disorders in Zambia is unknown; however, hospital admissions associated with mental disorders suggest a prevalence rate of 3.61 and 1.8 per 10 000 population for acute psychotic states and schizophrenia, respectively. By contrast, other researchers have estimated the burden of mental disorders in Zambia to be 20%. The World Health Organization(WHO) reported that the Zambian psychiatric workforce accounts for only 0.06%. In 2017, the total number of governmental and non-governmental mental health professionals in Zambia was 474, and there were 2.94 total mental health workers per population of 100,000(ibid).
There is still work to be done to increase access to mental health services and empower people living with mental illness in Zambia. If we want to be intentional about improving mental health, we have to create an enabling environment, where people can openly share stories of struggle, resilience and healing. With an enabling environment, more people can begin to treat mental health as a public health priority. As one Zambian woman said, “ mental health is another good development for us.”
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