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Mental health in Southeast Africa is providing medical and therapeutic care to people diagnosed with psychiatric, neurological, or psychological disorders. Mental health care uses information about symptoms, beliefs about what causes mental illness, treatment options, and social stigma against mental disorders, to provide appropriate care for individuals suffering from mental illness. Countries in Southeast Africa are often incredibly poor and have long experienced conflict, poverty, violence, and disease. [1] [2] Generally, mental illness occurs about as often in low- and middle-income countries (LAMIC) as in high-income countries, but mental health services (such as psychiatric hospitals and appropriate antipsychotic medications) in LAMIC are inadequate, inaccessible, unavailable, or culturally inappropriate. [3] [4] Professor Anyang’ Nyong'o wrote a letter on June 23, 2011 to the Kenyan National Commission of Human Rights, stating, "Currently there is a very big gap existing between the mental health needs of Kenyans and the existing mental health services at all levels of the health care services delivery system."[5] Up to 75% of people suffering from mental illness in Southeast Africa do not receive treatment. [6]

Many people in Southeast Africa are malnourished or have infectious diseases, which are life threatening conditions. [4] [7] [8] Mental disorders are not considered life threatening, so they are typically deemed less important. [9] [4] [7] [8] Mental health services in Southeast Africa are very limited due to cultural differences in mental health and limited human, technological, and financial resources.

Addressing mental health

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Efforts have been made in some countries to allocate government funding to mental health initiatives. Uganda's policies are prime examples of efforts to improve mental health care. In 2006-2007, a new mental health policy was created after systematically analyzing the current health care system.[10] The vision for this project was to adequately address mental health issues, neurological disorders, and substance use in Uganda. Guiding principles were implemented, key priority areas were identified, policy objectives were selected, and the Uganda Ministry of Health began to make mental health a priority.[10]

The University of Toronto collaborated with Addis Ababa University in Ethiopia, and created a psychiatry residency program in the early 2000s. Before that program was established, Ethiopia had three working psychiatrists, but there are currently around 45 practicing in the country. [1]The capital city has one psychiatric hospital and a School of Public Health, and a few outpatient clinics are appearing elsewhere.

The World Health Organization (WHO) and other international organizations continually work with developing African nations to implement strategies to improve mental health care in these countries. Even still, the mental health policies currently in place are in dire need of updating.[11]

Symptoms and casual explanations of mental illness

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Symptoms of mental illness in Southeast Africa are often very observable, because people typically think others are mentally ill when they attract negative public attention. Common symptoms include headache, insomnia, violent or strange behavior, walking around naked, throwing stones, eating garbage, talkativeness, or a mother failing to effectively interact with her child. [4] [12] [13] [14]

Many socioeconomic factors, such as disease, sexual abuse, political unrest, violence, and substance abuse or addiction, are risk factors of mental illness; in Southeast Africa (particularly Rwanda, Ethiopia, and Uganda), many people have developed post-traumatic stress disorder following exposure to genocide, civil war, tribal clashes, or internal displacement. [9] Throughout the world, there are many ideas of what causes mental illness, but ideas of causation in Southeast Africa sometimes deviate from those in developed countries. Different cultural groups perceive mental disorders differently. [2] [15][16] [17] Common explanations of mental illness in Southeast Africa include bewitchment, spiritual or religious causes, evil spirits, thinking too much, a mother’s inability to breastfeed her newborn, or exposure to too much wind immediately after childbirth. [18][12] [16] In a CNN series, African Voices, leading psychiatrist Frank Njenga stated that when a patient has some form of illness such as depression or schizophrenia, community members and traditional healers often look at it as being possessed by demons or witchcraft.[19]

Mental health stigma

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Stigma is negative inward and/or outward attitudes toward specific populations. Mental health stigma is common, but the degree of stigma depends on the specific disorder; for example, stigma toward very severe mental disorders is similar to stigma toward leprosy. [20][21] Stigmatizing attitudes can be directed toward individual people, groups of people, families, or the self. [21] [22] [20] Stigma has many serious consequences, including lowered self-esteem, feelings of dejection, depression, and shame, fewer opportunities for work and marriage, poor quality of life, higher suicide rates, and refusing to take prescribed medication. [21][4][22][7][16]

People show stigmatizing attitudes in different ways. When a 35-year old woman in Ethiopia was considered mentally ill, her family gave her roasted coffee beans, a new dress, and slaughtered poultry. These were considered gifts and luxuries. [23] However, a community in Somalia collectively gathered funds to pay for someone to get psychiatric treatment, but it was not because community wanted the individual to improve. The underlying reason was stigma: they simply did not want a mentally ill person living in the same village. Internalized, externalized, and family stigmas are more common in rural areas , where residents often have low levels of education. [22] [21]

One of the most negative consequences of mental health stigma is treatment non-adherence, or patients refusing to take doctor-prescribed medication. Treatment non-adherence significantly decreases the likelihood of improvement and recovery. [7]. People with schizophrenia in Ethiopia reported non-adherence because they wanted to hide their illness from others (stigma), or they saw premature improvement in symptoms and did not want to take the medication long-term. [7] Mental health stigma is very common in Southeast Africa, and causes many problems for those suffering from mental illness.

According to Vikram Patel, a global mental health expert and Professor at the London School of Hygiene and Tropical Medicine, mental health stigmatization is due to traditional and cultural methods of dealing with mental illness, and can be addressed through increased public awareness of mental illness and educational anti-stigma campaigns.[24]

References

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  1. ^ a b Teshima, J. (2008). Teaching child psychiatry in Ethiopia: challenges and rewards. Journal of the Canadian Academy of Child and Adolescent Psychiatry,17(3), 145.
  2. ^ a b Teferra, S., & Shibre, T. (2012). Perceived causes of severe mental disturbance and preferred interventions by the Borana semi-nomadic population in southern Ethiopia: a qualitative study. BMC Psychiatry, 12(1), 79.
  3. ^ Morris, J., Belfer, M., Daniels, A., Flisher, A., Villé, L., Lora, A., & Saxena, S. (2011). Treated prevalence of and mental health services received by children and adolescents in 42 low‐and‐middle‐income countries. Journal of Child Psychology and Psychiatry, 52(12), 1239-1246.
  4. ^ a b c d e Alem, A., Jacobsson, L., Araya, M., Kebede, D., & Kullgren, G. (1999). How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia. Acta Psychiatrica Scandinavica, 100(S397), 40-47.
  5. ^ Kenya National Commission on Human Rights. (2011). Silenced minds: The systemic neglect of the mental health system in Kenya. Nairobi: Kenya National Commission on Human Rights. Retrieved from http://www.knchr.org/Portals/0/EcosocReports/THE_ MENTAL_HEALTH_REPORT.pdf
  6. ^ Raviola, G., Becker, A. E., & Farmer, P. (2011). A global scope for global health—including mental health. The Lancet, 378(9803), 1613-1615.
  7. ^ a b c d e Teferra, S., Hanlon, C., Beyero, T., Jacobsson, L., & Shibre, T. (2013). Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers. BMC Psychiatry, 13(1), 168.
  8. ^ a b Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007). No health without mental health. The Lancet, 370(9590), 859-877.
  9. ^ a b Gureje, O., & Alem, A. (2000). Mental health policy development in Africa. Bulletin of the World Health Organization, 78(4), 475-482. Retrieved from http://www.who.int/bulletin/archives/78(4)475.pdf
  10. ^ a b Ssebunnya , J., Kigozi , F., & Ndyanabangi , S. (2012). Developing a national mental health policy: A case study from Uganda. PLoS Med, 9(10), doi: 10.1371/journal.pmed.1001319
  11. ^ Institute of Medicine (US) Forum on Neuroscience and Nervous System Disorders & Uganda National Academy of Sciences Forum on Health and Nutrition (2010). Mental, neurological, and substance use disorders in Sub-Saharan Africa: Reducing the treatment gap, improving quality of care. Washington D.C.: National Academies Press. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK53436/
  12. ^ a b Almedom, A. M., Tesfamichael, B., Yacob, A., Debretsion, Z., Teklehaimanot, K., Beyene, T.,…Alemu, Z. (2003). Maternal psychosocial well-being in Eritrea: application of participatory methods and tools of investigation and analysis in complex emergency settings. Bulletin of the World Health Organization, 81(5), 360-366.
  13. ^ Boynton, L., Bentley, J., Jackson, J. C., & Gibbs, T. A. (2010). The role of stigma and state in the mental health of Somalis. Journal of Psychiatric Practice, 16(4), 265-268.
  14. ^ Guerin, B., Guerin, P., Diiriye, R. O., & Yates, S. (2004). Somali conceptions and expectations concerning mental health: Some guidelines for mental health professionals. New Zealand Journal of Psychology.
  15. ^ Alem, A., Jacobsson, L., & Hanlon, C. (2008). Community‐based mental health care in Africa: mental health workers’ views. World Psychiatry, 7(1), 54-57.
  16. ^ a b c Shibre, T., Negash, A., Kullgren, G., Kebede, D., Alem, A., Fekadu, A., … Jacobsson, L. (2001). Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia.Social Psychiatry and Psychiatric Epidemiology, 36(6), 299-303
  17. ^ Bhui, K., Craig, T., Mohamud, S., Warfa, N., Stansfeld, S. A., Thornicroft, G., … McCrone, P. (2006). Mental disorders among Somali refugees. Social Psychiatry and Psychiatric Epidemiology, 41(5), 400-408.
  18. ^ Almedom, A. M. (2004). Factors that mitigate war-induced anxiety and mental distress. Journal of Biosocial Science, 36(04), 445-461.
  19. ^ Lillian, L., McKenzie, D., & Ellis, J. (2012, January 31). Kenya doctor fights mental health stigma in 'traumatized continent'. CNN. Retrieved from http://www.cnn.com/2012/01/31/health/frank-njenga-mental-health
  20. ^ a b Hinshaw, S. P., & Stier, A. (2008). Stigma as related to mental disorders. Annual Review of Clinical Psychology, 4, 367-393.
  21. ^ a b c d Assefa, D., Shibre, T., Asher, L., & Fekadu, A. (2012). Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry, 12(1), 239.
  22. ^ a b c Girma, E., Möller-Leimkühler, A. M., Müller, N., Dehning, S., Froeschl, G., & Tesfaye, M. (2014). Public stigma against family members of people with mental illness: findings from the Gilgel Gibe Field Research Center (GGFRC), Southwest Ethiopia. BMC International Health and Human Rights, 14(1), 2.
  23. ^ Hodes, R. (1997). Cross-cultural medicine and diverse health beliefs. Ethiopians abroad. Western Journal of Medicine, 166(1), 29.
  24. ^ Anthea Gordon (2011-09-08). "Mental Health Remains An Invisible Problem in Africa". Think Africa Press. Retrieved 2013-10-04.

Category:Mental health Category:Social issues Category:Southeast Africa



This is currently under construction; I am writing the article as part of a university project, and will complete it by the end of April. I ask that you please do not make any edits to my article before then. Thank you.


This is a test. [1]

Edits I have made:

1) Added a 'further reading' reference to Wikipedia page on Culture-Bound Syndromes (https://en.wikipedia.org/wiki/Culture-bound_syndrome#Further_reading) Reference added: Kirmayer, L. J. (2001), "Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment.", Journal of Clinical Psychiatry 62: 22–30

2) Added a reference to Wikipedia page on Cultural Competence (https://en.wikipedia.org/wiki/Cultural_competence#References) Reference added: Stuart, R. B. (2004). Twelve Practical Suggestions for Achieving Multicultural Competence. Professional psychology: Research and practice, 35(1), 3.

  1. ^ Dovenberg, Liz. (2015). This is My Book. NU Press: Boston.

P.S. Current formatting issue with Wikipedia. Please ignore.

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