GlobalHealthAfrica

Archive for the ‘Mental Health’ Category

Responding to the Needs of the Vulnerable: The State of Mental Health Care in Africa

In Community Health, Health Policies, Mental Health on May 18, 2014 at 12:28 am

In Africa, the problem of mental health and substance use disorders is particularly pronounced. GHA contributor, Diana Kingsbury, calls for governments and donors to increase their focus on mental health issues.

Among the many public health challenges that impact countries worldwide, mental health and substance use disorders continue to rank among the most persistent. These disorders are the leading cause of death and disability worldwide and account for about 23% of all years of life lost globally, according to the World Health Organization (WHO). For low- and middle-income countries, adequately addressing mental health needs is particularly challenging. Statistics show that 75-85% of individuals living with severe mental disorders in low-and middle-income countries are not receiving necessary treatment, compared to 35-50% in high-income countries.

Picketing in Cape Town, South Africa. Image by Halden Krog

Picketing in Cape Town, South Africa. Image by Halden Krog

In Africa, this problem is particularly pronounced. While the overall prevalence of mental health and substance use disorders across the continent is largely unreported, the lack of adequate services has been identified and is growing in relevance in the global health arena. The mental health care crisis within Africa is the result of several inter-related factors including a significantly understaffed mental health care workforce. For example, in the Niger Delta region of Nigeria, there is only one neuro-psychiatric hospital for the region’s four million inhabitants.

In Uganda, a nation of 33 million, there are only 33 psychiatrists. In Kenya, there are only 83 psychiatrists for a population of 40 million. In Ghana, there is only one psychiatrist available for 1.5 million people.

Across Africa, the burden of inadequate access to mental health care has resulted in lack of treatment, follow-up, and often inhumane treatment of the mentally ill. The additional burden of stigmatization often leaves individuals with mental disorders without any source of social support. Coupled with the significant social stresses that challenge the continent, such as poverty, food insecurity, conflict, and infectious disease, the risk of developing a mental disorder also increases. Very few prevention programs are currently in place to assist those at-risk in confronting these stresses. The limited availability of an appropriate mental health care system is a significant public health problem that needs to be addressed.

From a governmental perspective, there is limited infrastructure available to provide appropriate mental health care for those in need. It has been reported that 70% of African nations spend less than 1% of their health budgets on mental health and the majority of available funds are put toward psychiatric institutions and not community-based programs. Additionally, only 50% of African nations have a mental health policy, and if they do have a law, it is usually archaic and obsolete. In light of recent events in South Sudan and the disappearance of over 260 school girls in Nigeria, it is clear that in order to heal psychological wounds caused by violent conflict and social unrest, a commitment to building a mental health care system that can readily respond to the needs of the people should be of paramount importance.

Efforts that have been made to reverse current trends have proven successful. For example, former U.S. President Jimmy Carter’s “Carter Center” has established a mental health program in Liberia that seeks to train mental health care professionals within the country so that access to necessary mental health care services may be improved. As a result of the center’s efforts, mental health care access can be expanded to nearly 70% of the country. Organizations such as “BasicNeeds” also seek to break through stigmas associated with mental health disorders in the developing world, and create community supports that are vital to the integration and care of the mentally ill within the community. Through the work of non-governmental and philanthropic organizations, an organized effort to integrate mental health care into the primary care system, as well as an emerging focus on the mental health needs of the developing world, more attention has been brought to this issue. The relevance of adequate mental health care across the globe should not be underestimated.

Introducing Post Abortion Stress Syndrome (PASS)

In Health Policies, Mental Health on February 16, 2013 at 3:36 am

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The topic of Post Abortion Stress Syndrome (PASS) brings up great controversy among pro-life and pro-choice groups everywhere. In fact, there is much debate about the existence of this problem because some fear that pro-life groups invented PASS in an attempt to hinder further abortions. However, other groups of people recognize PASS as a problem. This article is not about the controversy, but a highlight on PASS especially since it is present in Southern Africa (Boulind & Edward, 2008).

The term Post Abortion Stress Syndrome is not known by a lot of people and there is little research from the African continent. Post-Abortion Stress Syndrome, abbreviated as PAS or PASS is a form of trauma that can occur in women after an abortion (Speckhard & Rue, 1992). It has also been called post traumatic abortion syndrome. According to a South African study published in the journal BMC Psychiatry, women who have experienced abortion have high levels of post-traumatic stress disorder (PTSD), which follow findings from earlier studies linking abortion and PTSD (Suliman et al. 2007). Moreover, the study states that high rates of PTSD characterize women who have undergone voluntary pregnancy termination. Believing that PASS exists means that health professionals should provide supportive and constructive counseling around the trauma symptoms African women experience. What are your thoughts on PASS?

References

1. A. C. Speckjhard and V. M. Rue, “Postabortion Syndrome: An Emerging Public Health Concern,” Journal of Social Issues 48 (1992):95-119.

2. M. Boulind and D. Edward, “The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa,” Journal of Psychology in Africa 18 (2008): 539-548.

3. S. Suliman, T. Ericksen, P. Labuschgne, R. de Wit, D.J. Stein and S. Seedat, “Comparison of Pain, Cortisol Levels, and Psychological Distress in Women Undergoing Surgical Termination of Pregnancy under Local Anaesthesia versus Intravenous Sedation,” BMC Psychiatry 7 (2007):1-9.

Autism in Africa

In Mental Health on November 10, 2012 at 4:02 am

Autism is a popular topic in developed countries. My perception was that it was a phenomena confined to the West with little or no occurrence in Africa. Therefore, I was surprised to watch a TED video of someone, who I suspect to be originally from Nigeria, share her experience with Autism. I was intrigued  to learn more about this disorder and its impact on Africans.

Autism is a developmental disorder which usually manifests in early childhood. Children with autism exhibit repetitive behaviour  patterns and interests, and obvious deficits in communication and social interaction. The earliest research on autism in Africa was carried out by Victor Lotter as far back as 1978. His research was carried out in 6 African countries. The result of his research was a low prevalence of autism. However, his research methods appeared to be flawed. Since then, not a lot of a studies has been carried out on this disorder. The prevalence rate in the various countries on the continent is unknown. Outside the African continent, it has been observed that children born to Africans immigrants in Europe exhibit a higher prevalence of autism compared to the indigenous population.

There is a need for research to be carried out to determine the burden of Autism in Africa. Also, it is important that health care providers are trained to identify and address cases. Policymakers also need to focus on providing the necessary infrastructure to manage this condition. In the video below, Faith Jegede shares her experience of living with 2 brothers with Autism.

Adapting to Meet the Health Needs of Elderly with Dementia

In Dementia, Elderly, Mental Health on October 5, 2012 at 6:31 am

One of the main health challenges for the elderly in Africa are non-communicable diseases such as dementia, but current health systems are not designed to meet such chronic care needs. Dementia is set to become a major problem for African countries. The World Alzheimer report 2011, from Alzheimer’s Disease International, estimated that by 2050 the number of people living with dementia would rise from 36 million to 115 million. The proportion living in low- and middle-income countries would rise from 58% to 71%, and African countries are part of the list.

According to World Health Organization (WHO), health systems in Africa, need to adapt to meet the chronic care needs of the elderly as the shift to aging populations gathers pace in low- and middle-income countries in the world. As populations age rapidly, infrastructure must be put in place to address the needs of elderly with dementia.

 

Dare to Care: Becoming Part of the Solution for Mental Illness

In Mental Health on September 17, 2012 at 12:13 pm

“I decided to seek help because I was hearing voices and seeing people who were not there. Finding it difficult to distinguish what was real and what was not. I told my parents and they decided I go to church and see our Pastor, you know seek divine help, hoping I was still in shock over a nightmare”- I am not Crazy!”: Diary of a Bipolar Menace.

The issue of mental health is yet to be fully addressed in the various nations of Africa. Individuals with mental illness are often viewed as having demonic possession or they are stigmatized and ostracized from their families. For those that seek medical care, there are usually little or no available services. However, various events and current research show that there is an increased need for mental health services in Africa especially in conflict and post-conflict areas. A recent report by Voice of America (VOA) illustrates the great need for mental health services and the lack of adequate capacity to address mental health concerns in the region. VOA reports that former combatants in South Sudan exhibit symptoms of Post Traumatic Stress Disorder (PTSD) which could  lead to suicide and various forms of violence including maiming and killing others. South Sudan has psychologists but not a single psychiatrist nor adequate mental health facilities and psychiatric medication. As a result, these psychologists have no option but to sedate mental health suffers and if that does not work, they are sent to prison in the capital city, Juba. The same story holds for Liberia and the Democratic Republic of Congo.

But can we do something about it? Vikram Patel, the Co-director of the Centre for Global Mental Health says yes. In his talk seen below, Dr. Patel describes a model of care which trains ordinary people in resource-poor areas with the aim of empowering them to protect the health of their communities. He has also published a book titled “Where There is No Psychiatrist”, which provides readers with a guide to problem-solve various clinical disorders.

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