Mental healthcare under resourced in Botswana

• Beds for patients not enough, no staff, referrals cost P7million

Inadequate staffing, old dilapidated facilities and funding remain the biggest obstacles to mental health care in the country, Dr Paul Sidandi has said. The Senior Consultant Psychiatrist at Jubilee Psychiatric Unit, Nyangabgwe Hospital in Francistown was sharing his experience on the state of Mental Health Services during the Fourth Mental Health and Psychosocial Support Services (MHPHSS) Forum at Andansonia Hotel.

The meet aimed to share experiences and best practices in addressing mental health and psychosocial challenges across Botswana, promote meaningful participation of marginalised groups, influence policies supporting mental health and psychosocial well-being, and encourage the sharing of experiences and practices in the broader humanitarian, development, and peace context. The World Health Organisation (WHO) has continuously stressed that mental health is everyone’s business for the past three years through the World Mental Health Day themes and charged governments from all around the globe with expanding high-quality mental health services at all levels. According to Dr Sidandi, within the field of mental health, Botswana faces a pressing issue of inadequate medical staffing. Currently, Nyangabgwe Hospital relies on four doctors, alongside one Medical Officer based in Mahalapye District Hospital with expertise in psychiatry. However, this falls short of the increasing demand for mental health services. Despite the high turnover rate of patients, the hospital struggles with bed occupancy, often exceeding 100 percent in the Male Psychiatric Ward and reaching 70 percent in the Female Psychiatric Ward. “To make matters even more challenging, the hospital’s referrals to Sbrana Psychiatric Hospital had to shift from a weekly to a fortnightly schedule due to space constraints. With an average of seven patients per trip, the constraints on patient care are evident,” he said. Inadequate staffing levels, according to Dr Sidandi, mean that an extra staff member must be present during patient interviews and treatment sessions. The facilities in Nyangabgwe Hospital, old and dilapidated, require frequent maintenance, resulting in service interruptions. Frequent traveling from the base station adds to the difficulties, with no InPatient Forensic Beds available, and a conspicuous absence of services for children and adolescents. Moreover, he noted that the costs involved in transferring patients to Lobatse, a 500km journey, are exorbitant, with weekly trips costing P10 000 each, totalling P520 000 per year. “This has been ongoing for 13 years, with an estimated expenditure of approximately P7 million to date. Not only is this model not cost-effective, but it also takes a toll on the relatives of the patients,” he said. In the face of these challenges, Dr. Sidandi suggested solutions that could turn the tide and address a significant portion of the complaints. His recommendations include the renovation of dilapidated structures to enhance functionality, the reintroduction of regular Multidisciplinary Team Meetings for comprehensive patient care, the provision of Occupational Therapy to support patient rehabilitation, and the allocation of additional security and staff to facilitate improved patient care and counselling. These, he said, could enhance the efficiency, accessibility, and effectiveness of mental health services in Botswana. Dr Sidandi emphasised the urgency of implementing these changes, with the hope of providing better care for patients, reducing relapses, and improving the overall state of mental health service provision in the country.