Need to challenge the deep-rooted mental health stigma in society

Beginning from a wider panoramic view, mental health has a deep-rooted stigma across the African continent. Tanzania is not spared in this. While there is a rise in public awareness of mental health now, there is still a lot to be done.

There are two aspects here: one is to end the segregation of those with noticeable mental illnesses or disabilities, and the other is to make people comfortable accepting the reality when they need mental health assistance. While not all mental health issues are clinical, all require immediate professional handling to prevent escalation.

Mental health disorders is an umbrella term covering a variety of issues like depression, anxiety disorders, disruptive behaviour, dissocial disorders, neurodevelopmental disorders (behavioural and cognitive), eating disorders, schizophrenia, post-traumatic stress disorder (PTSD), and others.

These disorders are much more common than we think. According to the World Health Organisation (WHO), 1 in every 8 people globally lives with a mental disorder. WHO acknowledges the fact that most people do not have access to effective mental health care (WHO: Mental Disorders Fact Sheets, 2022).

Though many people are embarrassed to accept having a mental disorder, denial exacerbates the condition, causing more disturbance in their thinking, behaviour and control/regulation of emotions.

However, while there is intentional denial, which some use as a defensive mechanism, when unwilling to face the fact, there is also what experts call ‘anosognosia’ – a situation where one is unaware of their mental health condition or they can’t perceive their condition accurately due to inaccurate insights.

Notwithstanding, due to partial negligence of the problem in most African countries over many years, it is hard to rely on available statistics, which often differ across national and international research bodies. In Tanzania, for example, the first-ever national mental health dialogue was held just recently in 2022.

We cannot compare our effectiveness in tackling this problem with countries like the United Kingdom, where mental health legislation dates back to 1774 with the Madhouse Act and the first community mental health charity, Together, launched in 1879.

They are certainly far ahead in diagnosis, community-oriented handling, as well as societal awareness of the care of mental health patients. We are still at the low levels of breaking the stigma and overcoming biases. Globally too, it has only been 32 years since mental health was recognised as a global problem needing a global solution.

In the 2011 Cross-Government mental health outcomes strategy for all people of all ages titled ‘No Health without Mental Health’, for example, the UK government identified mental health as the single largest cause of disability in the UK, contributing up to 22.8%, even more than cancer and cardiovascular diseases.

The economic costs put together include direct costs of services, lost productivity at work, and reduced quality of life. The cost of all that amounted to over 100 billion pounds each year, which was still deemed not sufficient.

In Tanzania, just like other low- and middle-income countries, the budget allocation for mental health issues is significantly low. A 2023 peer-reviewed research publication by Tanzanians Joel Ambikile and Masunga Iseselo says: “Total mental health expenditure per person in the country is estimated to be Sh 43.1. The government spends only 4% of the total government health expenditure on mental health.

The country has two mental hospitals, five psychiatric units in general hospitals, one forensic inpatient unit, and four residential care facilities. The total number of the mental health workforce is 278 with the rate per 100,000 populations being 0.06 for psychiatrists, 0.36 for mental health nurses, 0.01 for psychologists, 0.06 for social workers, and 0.02 for occupational therapists.” (Ref. Ambikile J.S. & Masunga I.K. in PLOS Global Public Health Journal, article no. 0001518, 2023).

Moreover, one problem we have not spoken about enough in Africa is associating mental health issues with witchcraft and superstition. Purely health and social problems are approached as spiritual problems, which further deviates from the line of proper treatment.

It is even worse when some kind of superstition and clairvoyance is involved, which oftentimes instigates hatred and conflicts within families, resulting in more complications.

Experts establish that mental health problems are not solely inherited. Their onset is a product of genetic, environmental and social interaction.

The WHO particularly mentions those at risk of developing mental disorders, such as those living in poverty, people with disabilities, and those who experience violence, disasters, and inequalities. These realities affect most people in our country today and are far from being fully resolved.

While the government invests more in research, community-based management structure and social health care services, it also has to be involved, with the help of interested organisations, in raising awareness and exposing the existing stigma and the harm it causes to help safeguard lives.

The citizens also need to be encouraged to seek professional mental health care when the need is noticed, rather than denying, or even worse, entertaining superstition.

Shimbo Pastory is an advocate for positive social transformation. He writes from Manila, the Philippines. Email [email protected], WhatsApp: +639951661979.