"I'm dead inside": Voices of mental health struggles

With the help of therapy and medication, Sarah is on a path to healing, urging others, It's okay to not be okay sometimes, and it's okay to ask for help.

John Lekeni, a middle-aged farmer, felt a constant physical tension caused by anxiety stemming from the stress of providing for his family.  After years of feeling unwell, his doctor finally identified the root cause. Medication and lifestyle changes have helped him manage his condition.

Mary Haule* (Not her real name), a social worker, sees first-hand how untreated mental illnesses fracture families.  "Depression or substance abuse in one member can throw everything into chaos, especially harming children." She stresses the importance of early intervention and strong community support.

This ripple effect is compounded by a tragically underfunded mental health system. While dedicated, the Ministry of Health can only allocate a small percentage of its budget, leaving many feeling abandoned.

Berthas Joseph's story is a heart-breaking example. After losing her premature baby, she recalls, "Every morning, I force a smile, but deep down, I'm dead inside."  Bertha's struggle began with an unthinkable loss – her baby, born too soon, passed away after only two days. 

While mourning this devastating loss, the child's father, the one person she expected to share her grief, walked away. This act of abandonment compounded the unimaginable pain, leaving Bertha feeling utterly alone in her despair.

What it's like in Arusha

At Mount Meru Hospital, the range of mental illnesses encountered is extensive. Reflecting the countrywide challenges faced in Arusha, Dr Blandina Itambu, who works in the mental health and methadone unit of the hospital, has first-hand experience with the crisis.

She defines mental health in a holistic manner, encompassing emotional, social, spiritual, and physical well-being.

"Being mentally well means that you should be emotionally, socially, spiritually, and physically well," she explains.

According to Dr Blandina, mental health issues are identified when individuals exhibit abnormal behaviours, such as excessive aggression, public disrobing, or extreme, unprompted laughter or crying. 

Dr Blandina details common cases including psychosis caused by substance abuse, stress-related issues, and postpartum psychosis. Schizophrenia is less frequent but remains a concern. Additionally, there are instances of acute confusion, which require careful evaluation to differentiate between mental health issues and physical causes. In contrast, cases of dementia are relatively uncommon, as Dr Blandina clarifies.

Stark numbers, insufficient resources, and stigma

Mount Meru Hospital in Arusha, Tanzania, highlights the dire need for mental health services in the region and the country as a whole.

In 2022, the hospital's mental health facilities served 3544 patients. However, the numbers surged in 2023, with a staggering 60 percent increase to 5727 people seeking help.

As Dr Blandina explains, women disproportionately bear the burden of mental health issues, making up the majority of those receiving care. According to observations, many women face significant challenges as they often serve as the pillars of their families.

Factors such as relationship problems, being abandoned with children, unemployment, deception by partners, and economic hardship contribute to their mental well-being. With mothers bearing the major responsibility of the family, the current economic situation further exacerbates the situation.

Mental health care access in Tanzania faces significant hurdles due to widespread stigma and limited awareness.

Cultural interpretations often link mental health disorders to supernatural causes, leading individuals to shy away from seeking professional help.

This necessitates innovative strategies to bridge the gap between traditional beliefs and evidence-based practices.

Dr Blandina's experience at Mount Meru Hospital reinforces this challenge.  She highlights how families often describe patients exhibiting unusual behaviours as being "possessed by demons" or having begun their "madness".

This perception significantly impacts individuals seeking help and creates a social environment that discourages open discussions about mental health.

Dr Blandina further explains there's an increase in the number of patients due to the initiative put together by the clinic to combat stigma and help individuals seek more help when they face mental health issues. 

"On average, we welcome 295.3 patients each month. Thanks to awareness campaigns in schools, radio outreach programs, and other initiatives, we're seeing more people seeking help for their mental health," she shares.

Dr Paul Lawala, Director of Mirembe National Mental Health Hospital (MNMHH), also emphasises the critical need for public education on mental health to mitigate stigma and misconceptions that deter individuals from seeking the necessary care.

“We receive several patients from time to time yet it is not enough compared to the severity of mental health challenges that most Tanzanians face. The thought of a person being treated at Mirembe is presumed with psychiatric issues which is not necessarily the case. It is important to educate the public on the importance of mental health to improve their productivity at individual and national level,” Dr Lawala says.

Dr Blandina further confirms the strain on resources in the facility: "We don't have a proper facility, this is a clinic, especially for those who have already regained consciousness. We don’t have a place to admit patients with acute mental health disorders in Arusha."

Teddy John, a psychologist with the Malezi Box Program, emphasises the importance of understanding the root causes of mental health issues, highlighting how both biological and environmental factors play a role.

“Biological factors are attributed to mental health at the time of gestation till birth. A pregnant woman with anxiety and depression is more likely to have a child afflicted with similar mental challenges. A person who has gone through a traumatic life experience is more likely to be associated with environmental factors from the life experiences. What causes one joy might be a trigger warning for the other,” Teddy says.

The seasonal variations of patients

Patient numbers at Mount Meru Hospital aren't constant throughout the year. Dr Blandina reveals how seasons and the region's agricultural activities play a significant role in the demand for mental health services.

This decrease is partly due to infrastructural limitations such as poor road conditions which make travel to the hospital difficult, especially for those relying on public transportation or walking.

Additionally, the agricultural cycle demands the attention of many patients and their families during this time, leading them to prioritise farm work over attending consultations, especially for less pressing mental health concerns.

Despite seasonal drops, Dr Blandina acknowledges an encouraging long-term trend: "Overall, patient numbers are increasing. Awareness campaigns are making a difference. People are starting to understand that mental health issues are not about curses or demons – they're treatable health conditions, like any other."