Why mental health matters
Mental health issues, while generally widespread, tend to be underrated by individuals and communities.
ACCORDING to the World Health Organisation, one in four people in the world will be affected by mental or neurological disorders at some point in their lives.
Around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.
Unfortunately, mental health issues are not given the requisite attention and are often stigmatised.
Depending on the beliefs, some people might be considered to be suffering from demonic possession or affliction or to be bewitched.
Dr Sacrifice Chirisa, a mental healthcare practitioner for over 13 years, believes that there is need for greater awareness regarding issues of mental health, especially in public spaces.
“The majority of people are surrounded by a lot of misinformation regarding mental health issues. Mental illness is seen as mysterious and yet it has caused a lot of suffering to both the patients and the families,” he said.
“Our challenge is that when people talk of mental illness they think of the extremes, but there are also some subtle illnesses that are there and affect people every day. People also tend to go to psychiatric units as a last resort, but we have a window in terms of treatment where if people came early they could be helped.
“Usually, when people seek psychiatric treatment they would have deteriorated to a point where it becomes harder and more expensive to help them.”
According to Dr Chirisa, there are a host of mental health illnesses that affect people such as not sleeping, stress, anxiety, and post-traumatic stress disorder (PTSD).
Cases range from extremely serious to some which are often ignored and go untreated.
Dr Chirisa said there are a wide range of conditions with various symptoms that would be difficult to describe with one stroke.
“Mental illness is broad. If you look at the diagnostic manual of mental health condition, it is a thick book with so many diagnoses that one can make,” he said. “Each diagnosis has specific symptoms.
“There are, however, major groups that we can talk about. We have psychotic disorders where someone then loses touch with reality and may experience hallucinations. This is a situation whereby your senses are activated in the absence of physical stimulation.
“So, you can have delusions where someone has thoughts that their mind is being tampered with or that they are an important person, that they have extreme power.
“You can also have what are called negative symptoms where a person is not talking, emotionless, sitting, not participating, and just wants to be by themselves. There are also anxiety disorders where people are feeling dread, having palpitations and their mind is continuously raving.
“There are also sleep disorders. A lot of people are not sleeping and a lot of conditions in psychiatry cause sleeplessness, but sleeping itself can be a diagnosis. Then there are affective disorders, such as depression, there’s bipolar where someone is very high and happy, extremely ecstatic then the next moment they are extremely depressed.”
A public discussion on mental health is important because it de-stigmatises mental health issues and allows people to seek help without fear or prejudice.
“People with mental health problems tend to be marginalised. We have seen people tied to trees, we have seen people who are beaten, and families end up devastated and won’t come out and bring their relatives for treatment because they can be accused of witchcraft,” said Dr Chirisa.
“There is a fear of what the society will think and say.
“But mental problems exist in all societies and races all over the world. As mental health practitioners, we feel and know that if we put the correct information in public domains, we will decrease the level of stigma concerning mental health illness and the level of suffering and increase awareness so that more people can access services and help.”
One of the biggest issues with mental health illness is that unlike physical illness which people can see, when one suffers from a mental illness they may seem fine on the outside but they would be suffering inside.
“Mental health is just as important as physical health,” said Dr Chirisa.
“In fact, you cannot say you are healthy without mental health. Unfortunately, we do not see the psych or psychology side of it and tend to focus on physical illness.
“A lot of emphasis is on physical and we appreciate that. We are not trying to demean the importance of physical health, but what we are saying is that it’s also important to give equivalent level of emphasis to psychiatric or mental health.
“I will tell you now, mental health illness can be devastating. I have seen fathers cry when their son who they expected to be the pride of the family, a graduate, suddenly develops mental illness and they do not know what to do.”
According to Dr Chirisa, everyone is susceptible to mental illness given the correct set of conditions, circumstances and pressure.
“Everyone has a breaking point and this can lead them to developing a mental illness,” he said.
“Some people become mental health patients as they grow, when dementia kicks in. Some will develop problems early.
“There are various causes for mental illness - biological, psychological as well as environmental causes. All these interact and cause mental illness.
“People losing their jobs or people going through divorce are all susceptible. The High Court said there’s been an increase in divorce and this has a mental health impact on the two adults involved, their children and their extended families.
“Rape victims and victims of sexual abuse are also affected. Although they go to the clinic and are given medication to prevent pregnancy and HIV, which is good and must be done, there is another aspect which is not addressed — the mental health issues for these patients. This is where you then find people become depressed, suicidal and have PTSD.
“There are also people involved in accidents, who have head injuries that change their personality. Some people suffer massive trauma and it shakes them. They start to suffer from different kinds of illnesses.”
Dr Chirisa believes that those with the knowledge on mental health issues should occupy media spaces to make the public aware of the various conditions, symptoms and treatments for these illnesses.
He has committed himself to writing a weekly column to address these issues.
“What we hope is that by increasing awareness we can help more people,” said Dr Chirisa.
“We need to focus on giving people information that is clear and accurate. So, for example, under depression, we want to talk about how depression presents. How does it present in women, in men, in children and in the elderly? It’s all different.
“We are hoping that as people follow the conversation, we would have covered so many topics that people would now be able to identify problems that they may have to seek help.
“There’s also need to discuss how to keep mentally healthy. Just like exercise keeps you physically well, there are certain things that people need to do to keep their psych framework intact and to keep fit physically.”
Zimbabwe has a host of organisations that deal with and support the care of mental health patients.
Psychiatric Association of Zimbabwe, the Psychiatric Nurse Association, peer groups of psychiatric mental health patients who have formed associations, are all part of a network that deals with issues related to mental health.
According to Dr Chirisa, psychiatry cannot be managed by one person and needs cooperation from individuals to State level.
“Psychiatric illnesses are treated and managed by teamwork where you are pulling in psychiatrists, you’re pulling in psychologists, occupational therapists, nurses, the police who help to bring in people who are refusing to come in,” he said.
“It’s a community effort that is needed which involves State actors, including different ministries. Unfortunately it has been left on its own, but now we need to involve the whole community so that our mental health as a community increases.
“We all have a role to play, even the individual. You may have a friend who has become depressed and suicidal. It’s your role to say I think you need help and I think I can go with you to get help, instead of leaving that person and stigmatising them. It is our role to make sure we look out for each other.”
There are a number of facilities where one can seek treatment for mental health illness in Zimbabwe in both the public and private sector.
Public sector mental health institutions are available at centres like Harare Central Hospital, Parirenyatwa Hospital, Ingutsheni Hospital in Bulawayo and Ngomahuru Hospital in Masvingo.
Other districts such Chinhoyi and Gweru also have mental health institutions.
“All doctors, especially those trained in this country, pass through mental health training and are trained to recognise mental illness,” said Dr Chirisa.
“We expect that every doctor should somehow be able to recognise mental illness as it is a part of their curriculum.
“Nurses also pass through the psychiatric ward and they should, therefore, be able to recognise mental illness and then direct these to the appropriate centres where people can receive help.”
In the private sector, there are specialist psychiatric doctors.
Zimbabwe has 10 psychiatrists, as well as psychologists with private rooms.
“We generally work through a referral system, so when you think or see that you have a mental health problem, go and see a medical practitioner and they will refer you according to the problem to the appropriate doctor or centre,” said Dr Chirisa.
He bemoaned the fact that mental health services are not well developed in Zimbabwe as was the typical picture across most African nations.
“There is underfunding in the mental health services sector, but what we hope is that mental health should be universal in every city and every town,” said Dr Chirisa.
“In the public sector, the cost of mental health care is free. Government has a very good proactive mental health policy where mental health services are free.
“In the private sector, one pays for the convenience and these fees have been agreed with the Association of Healthcare Funders of Zimbabwe and with the doctors.”