Challenges doctors, carers face in mental health hospitals

Upon arriving at Isanga Mental Health Institute, I spotted an old, sad, worn-out nurse statue placed at the facility, which is part of Mirembe National Mental Health Hospital (MNMH) in the capital, Dodoma.

The joints of the statue at the upper and lower arms are broken. Its left arm and part of the wrist are completely broken.

The nurse statue was placed at the institute many years ago in the memory of Fatuma, a nurse who lost her life while attending patients at the hospital. Fatuma was severely beaten by a mentally disordered patient who broke her leg. She died while undergoing treatment.

Fatuma’s case presents the daily reality facing mental health providers at the Isanga Institute and other such centres in Tanzania.

Have you ever thought about what the working environment for mental health workers looks like?

The fact is that physical and verbal abuse have become everyday realities for mental health workers at Isanga Institute.

Criminal lunatics sometimes spit out food or spat on the workers as they struggle to treat them. A shortage of mental health workers and a lack of risk allowances are just some of the problems these critical workers face in the country.

The call is for the government to turn its eye on professionals and improve their working environment and remuneration.

As the world commemorates World Health Day, here are the stories of mental health workers.

An assistant nursing officer at a male ward at Mirembe hospital, Samweli Mwalutambi, remembers how he was physically attacked by the patient five years ago.

“On that day, my role was to administer medication to patients. One of the patients refused; it is very common for most patients here. As I was convincing him, he jumped on me and hit me with his head. I still have a scar on my face to date,’’ says Mwalutambi.

To overcome some challenges, he suggests more staff be brought in to make the job easier and allow them to work normal hours. In each shift, there are only two staff, but in reality, five are always needed.

Responding to the issue of staff shortages, MNMH director Dr Paul Lawala, a mental health specialist, says he currently needs about 700 staff for general services, let alone qualified mental health staff. He only has 300 workers.

“Getting specialised experts for mental health challenges is still a challenge. To address this, we created a mentorship programme to prepare interns to be mental health experts. So far, we have managed to get four doctors who have applied to be enrolled for their second degrees, specifically in the mental health area. We believe that in the next five years we will be able to address the shortage of specialised health workers,” says Lawala.

The situation is the same at Morogoro Regional Referral Hospital. The chief medical officer in charge, Dr Daniel Nkungu, says the mental health unit, which is supposed to have two mental health psychiatrists, has only one clinical psychiatrist.

Risk allowances

On the other hand, Mr Mwalutambi calls for responsible authorities to start issuing risk allowances for mental health workers without delay. He says money cannot compensate for the pain they undergo, but it can at least be a sign that authorities understand the difficulties they go through.

He says he signed many risk allowance forms, but it took  too long to be paid that he decided to give up.

Dr Nkugu says it is about finding ways to attract more people to study mental health courses.

“Each expert in the health sector is at risk. Defining risk is a challenge. However, all the statutory benefits are always paid. We also encourage fast-track services at our hospital, and the mental health doctors are given 85 percent of each visit. This is another way to motivate mental health experts,” says Dr Nkungu.

A nurse at the mental health unit at the Morogoro Regional Referral Hospital, Asumpta Temba, says she has been in that unit for 10 years now. She says she has experienced all forms of verbal abuse from mental health patients.

According to the director of nursing services at MNMH, Clavery Lyera, the facility faces an acute shortage of wards and rooms for different types of patients.

He says at the Isanga health facility, the patients are always brought handcuffed under the escort of armed police officers. All of the patients at Isanga Institute, he says, are those facing criminal cases, and most of them have mental health challenges.

“Once these patients are brought to the hospital, the handcuffs are taken off, and the police officers leave them there without anything to guarantee their security. Can you imagine the situation we are working in?” asks Mr Lyera.

To deal with such situations, he says, the hospital usually conducts an induction course for new employees to help them understand the challenges they are likely to face at work and how to go about them.

The workers compensation fund at the hospital is there to support staff once they go through such incidents, but it takes a long time for the compensation to be effective,” says Lyera.

Ms Jane Nzowa, a nurse at the mental health unit at Sekou Toure Hospital, says she has gone through different challenges for many years, including being physically abused.

The Mental Health Situational Analysis report from the Ministry of Health, Community Development, Gender Elderly, and Children shows that the mental health profession faces the biggest challenges in terms of resource allocation and has the biggest shortage in terms of human resources.

In 2021, the psychiatrist-to-population ratio was 0.0625 for 100,000 people, compared to 0.0375 for a population of 100,000 individuals. A huge burden of mental health care has been carried out by mental health nurses for many years.

Supported by Bill & Melinda Gates Foundation