Let’s talk about mental health

The World Health Organization acknowledges a diverse range of mental disorders which are characterized by abnormal thoughts, views or opinions, behaviors and relationships with others.

SUCH disorders include depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism (WHO, 2017).

A person may maintain good mental health or acquire a mental impairment depending in part on the extent to which the person is able to manage stress, their own way of thinking, their emotions and their relations with others (WHO, 2017).

In addition, social, cultural, economic, political and environmental issues may have an impact on the mental well-being of a person.

Boylan (1991) argues that poverty on its own does not cause mental impairment, but poverty may make it worse as needs and wants rise to a level where they are at odds with income. Additional causes of mental impairment include nutrition and heredity, and complications that are associated with pregnancy (WHO, 2017).

Whilst WHO reports that 278 000 women across the world died in 2010 due to complications during pregnancy or childbirth, there is evidence that some women who survive such complications may acquire mental disorders.

Pregnancy in some women may increase their vulnerability to mental disorders and such conditions may go undetected because they may be attributed to changes that occur during pregnancy in relation to physiology and maternal temperament (Carter and Kostaras, 2005).

Even in cases where mental disorders may be appropriately diagnosed, the challenge is that they may be under treated due to concerns regarding the harm that may be caused by some medical drugs to both the mother and the unborn child.

The WHO articulates various types of mental disorders which include the following:

Depression

Depression is one of the leading causes of mental disability worldwide. Characteristics of depression include sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration. Severe depression can result in a person committing suicide (WHO, 2017).

The WHO notes that compared to men, more women are affected by depression. A study carried out in Zimbabwe resonates with such an assertion and states that widowed, divorced and separated women have a greater place among those affected by severe depression (Abas and Broadhead, 1997).

The same authors note that bereavement, marital problems, infertility and the illness of a child contribute to the increased number of Zimbabwean women who suffer from severe depression.

A study carried out in Bangladesh revealed that women who totally depend on men are unhappy, particularly in times of economic crisis when they are in most cases divorced by their husbands, resulting in them acquiring mental impairments (Boylan, 1991).

In Zimbabwe, there is no direct Shona (vernacular) word for depression, but a study carried by Abas and Broadhead (1997), revealed that depression is commonly referred to as “kufungisisa” (thinking too much) or “kusuwa” (deep sadness). Other terms which refer to the discomfort of the heart are also used and such terms can be interpreted to mean fear, grief, and having a problem which is difficult or impossible to solve.

Bipolar affective disorder

People who have bipoloar affective disorder may in some instances be depressed, be hyper-active or be ‘normal’. They may at one time be extremely happy, and another time be highly irritable, over-active, exaggerate their self-esteem and they may experience a reduced need for sleep (WHO, 2017).

Schizophrenia and other psychoses

Schizophrenia is a severe mental disorder. Psychoses, including schizophrenia, are characterized by distortions in thinking and ways of seeing things, emotions, language, sense of self and behavior.

Common psychotic experiences include hallucinations (hearing, seeing or feeling things that are not there as if they are there) and delusions (fi xed false beliefs or suspicions that are firmly held even in cases where evidence is different - WHO, 2017).

Dementia

Dementia manifests in a decreased ability to process thought in relation to what is expected among people who are ageing normally. It therefore negatively affects the ability of a person to think, to remember things, to understand, to engage in sound judgment, to calculate and to learn; accompanied by decreased motivation as well a reduced ability to emotionally control oneself, and to interact socially with others. Dementia is caused by a variety of diseases and injuries that affect the brain, such as Alzheimer’s disease or stroke (WHO, 2017).

Developmental disorders, including autism

Developmental disorders represent a broad term which includes intellectual disability and autism. Intellectual disability is characterized in part by lower intelligence which reduces the ability of a person to adjust to the daily demands of life.

Symptoms of autism include impaired social behaviour, communication and language, and a narrow range of interests and activities that are both unique to the individual and are carried out repetitively (WHO, 2017).

Caring for children and adults with mental disabilities calls for synergy between health care staff, families and entire communities.

People should be aware of the things that trigger mental relapses among those with whom they live, and they should make an effort to avoid the occurrence of such things.

In the context of Bangladesh, the majority of medical doctors and in particular male medical doctors do not seem to cope with, to understand or to make an effort to understand the problems of poor people (Boylan, 1991).

The University of Zimbabwe trains psychiatrists, but the traditional belief among most local communities is that scientifically trained health care staff are unable to cure mental impairment but they can only suppress its manifestations by administering modern medical drugs.

The cultural labeling of some persons who have mental disability as vanhu vane mamhepo (people who are possessed by the spirit of the winds) results in traditional healers being perceived as the only practitioners who have the expertise to treat mental impairments. Research studies to that effect are scanty.

The above perspective may be attributed to the fact that compared to other impairments, mental disorders do not have a vaccine, or an identifiable germ that cause them, or standard treatments. Vaccinating children against measles can decrease the risk of them becoming blind, but there is no known vaccine that can prevent mental disability.

Way forward

Dr Abdus Sobha, a consultant psy- chiatrist at Bangladesh’s Pabna Mental Hospital said, “The brain is as important as the stomach and lungs. We should not segregate this aspect of health from all others (Boylan, 1991). However, the accurate measure of the success or failure of mental health programs is the extent to which such programs are able to enhance the care that is provided by families, as well as the ability of the programs to reach disadvantaged groups.”

Mental health programs should be able to accurately identify the nature of the mental impairment, provide appropriate medical drugs at a low cost to the family as well as offer counseling services and advice. The challenge of mental impairments can never be fully eliminated hence it is critical to acknowledge the severity of the problem and its impact on both humanity and development efforts.

It is encouraging to note that according to the World Health Organization (2017), world leaders have for the first time acknowledged the significance of promoting mental health as one of the health priorities within the global development agenda. As such, mental health has been included in the Sustainable Development Agenda, which was adopted at the United Nations General Assembly in September 2015.

Such a move by the UN is expected to make a significant contribution towards the achievement of positive change within communities and nations in which millions of people are expected to receive the much needed assistance (WHO, 2017).

However, there is need for families and entire communities to be actively involved in taking care of persons with mental disabilities to ensure that their needs are met and that their human rights are not violated. Using ropes and chains to tie up people with mental impairments or locking them up in homes whilst we go about our business is an inhuman ‘solution.’ ◆ Dr Christine Peta is a Public Health Care Practitioner who among other qualifications holds a PhD in Disability Studies. Be part of international debate on how best to nurture a society which is more accessible, supportive and inclusive of disabled people. Partner with Disability Centre for Africa (DCFA): WhatsApp; 0773-699-229, Website; www.dcfafrica.com; E-mail; dcfafrica@gmail.com