Zimbabwe in mental health crisis

Source: Zimbabwe in mental health crisis | The Financial Gazette April 6, 2017

…10 percent of Zim population mentally ill
…Economic woes trigger mental health crisis
THE effects of almost two decades of an economic free-fall has had a devastating mental, emotional and physical toll on the generality of Zimbabweans who can no longer absorb the rigours of the meltdown.
According to the World Health Organisation (WHO), some 1,3 million of the country’s 14 million people, representing 10 percent of the population, are now mental patients.
There were just above 600 000 mentally ill people in 1999, which means that the figure has more than doubled in less than 20 years.
Zimbabwe has only 14 psychiatrists to cater for the 1,3 million mental patients, translating to a doctor to patient ratio of 0,08 percent per 100 000 people, according to WHO.
WHO representative in Zimbabwe, David Okello, has described the situation as a “crisis”, which calls for urgent measures to reverse it.
He said: “We have a crisis in Zimbabwe, but perhaps not only in Zimbabwe. We need to appeal to decision-makers, that prisons are not meant for mental patients,” he said.
“The truth is, no one is invincible, noone can say they are immune to mental illnesses. You should not throw away your relatives, mental health is not a contagious diseases,” he added.
These scary statistics come when Zimbabwe is clearly at its weakest point.
Mental health facilities, including staff and drugs, are in serious short supply across the country. The whole country has only 20 registered clinical psychologists and nine public mental health institutions.
And as the country’s economy keeps shrinking, the situation can only get worse.
Zimbabwe is currently grappling with record unemployment, now believed to be over 90 percent, owing to the cathartic closure of companies and widespread retrenchments.
Even for those who are gainfully employed, very few are earning salaries that are consistent with the breadline, estimated at about US$550 per month.
The Financial Gazette revealed last week that the majority of employees outside the public sector are toiling for months on-end without pay.
In a 36-page report titled “Working Without Pay, Wage Theft in Zimbabwe”, the research division of the main labour body — the Zimbabwe Congress of Trade Unions — exposed a wage crisis that has reached catastrophic levels outside the Public Service Commission, which employs government workers.
The research unit, the Labour and Economic Development Research Institute of Zimbabwe, said at least 120 000 workers across the country worked without pay between 2015 and last year.
An estimated 350 000 formally employed workers have sunk into abject poverty, while top executives live in opulence — earning up to about 800 times more than shop floor workers.
At the time of the research, a staggering 40 000 workers had gone for three years without pay, while a further 80 000 had not received wages on time.
Because of the poorly performing economy, more than 80 percent of Zimbabwe’s population has been driven into the deepest depths of poverty.
According to the 2015 Zimbabwe Poverty Atlas, 96 percent of the country’s population in the countryside is now living on less than a dollar a day, while poverty in the major two cities of Harare and Bulawayo stands at 36,4 percent and 37,2 percent respectively.
It therefore should come as no surprise that more than 10 percent of the nation’s population is nursing one form of mental illness or another.
Overwhelmed by the situation, some families are neglecting mentally ill relatives by condemning them into psychiatric hospitals.
Principal director (curative services) in the Ministry of Health and Child Care, Sydney Makarawo, said the country’s prevailing harsh economic climate was among the major drivers of mental illnesses.
“About 450 million people are suffering from mental illness related cases worldwide, while over 1,3 million Zimbabweans are living with the condition. This is because of the harsh economic climate, xenophobia and natural disasters,” he said.
The country has also witnessed an increase in violent crimes and one cannot rule out the existence of a causal link between some of the vices and mental health illnesses.
Studies done elsewhere suggest that the risk of an individual with psychosis committing a violent offence is two to six times higher for men and two to eight times higher for women of similar age, compared to the general population.
Five percent to 28 percent of those charged with murder in prisons in Western countries have been diagnosed with a schizophrenia spectrum disorder.
Sociologist, Pardon Taodzera, opined that when the economy is not performing well, it leads to unemployment, forcing people into substance abuse, anxiety and depression.
“It is a vicious cycle….The ultimate destination is mental illness,” said Taodzera.
A psychiatrist, Nemache Mawere, observed that the challenges facing by mental health patients can cause serious risks to their health, dignity and lives.
“Due to a shortage of psychotic drugs, patients suffer from severe mental distress, causing multiple relapses of the disorder after they are discharged from central health facilities or tertiary care,” noted Mawere.
The Financial Gazette caught up with a mental health patient who lapsed into mental illness after being retrenched.
The patient whom we cannot name to protect him from stigmatisation is one of the few lucky ones whose condition has been stabilised through access to medication.
“I used to work as a distributor, but I was retrenched and because of the depression, I was diagnosed with a mental illness related condition. However, I soon realised that there were no enough psychotic drugs from the public health facilities and they cannot buy on their own. I used to hear strange voices but I can no longer hear them because I am on medication and I am stable,” he said.
For a lot of patients, they continue to suffer in silence, unable to access treatment.
Mental health stakeholders are appealing to government and the donor community to increase funding towards mental health to help ease the challenges patients are facing in accessing mental health care.
The main challenges that mental patients face include the shortage of psychotic drugs, lack of human and financial resources, lack of appropriate mental healthcare facilities, lack of de-centralised treatment, care and support, stigma and discrimination and lack of mental health education, among other things.
“There are few mental health trained personnel such as psychiatrists, mental health nurses, clinical psychologists, occupational therapists and speech therapists, compared to the needs of the population,” said Patrick Mhaka, a psychiatrist with the Zimbabwe Prison and Correctional Services.
Similarly, there are very few donor organisations that support mental health activities despite the magnitude of the crisis.
Doctors Without Borders (MSF) has appealed to the donor community to support community psychiatry or the availability of care at the community level to ease the problems that people with mental illnesses are facing.
“MSF has started to pilot the community psychiatry model in 13 polyclinics in Harare city to allow mental patients to get access to treatment, care and support closer to their homes,” said MSF head of mission for Zimbabwe, Abi Kebra Belaye, adding that solutions to improve mental healthcare provision in Zimbabwe include employing increased numbers of mental health personnel and investing in staff training of existing staff so that they are able to treat mental health disorders and assist patients and their families at all levels.
“There is also need for national authorities and donors to avail funds to purchase psychotropic drugs to ensure that there is a constant supply and also ensure that patients in rural areas also have access to medicine like any other disorders,” said Belaye.
A long-term solution to the crisis lies in correcting the country’s economic ills.
Despite the country’s latent abundant potential in terms of natural and human resources, the nation has remained stuck in the doldrums, pushing its citizens beyond their limits.
Already, there are tell-tale signs that the crisis is yet to bottom out, amid indications that Zimbabwe might slide towards the 2007/08 crisis levels.
A 2016 World Bank (WB) report indicates that the political and economic crises that characterised the Zimbabwean economy between 2000 and 2008 nearly halved its gross domestic product, “the sharpest contraction of its kind in a peacetime economy, raising poverty rates to more than 72 percent, with a fifth of the population in extreme poverty.”
The WB added that: “Health, education and other basic services, once regional models, largely collapsed and the Human Development Index in 2011 stood at 173 out of 187 countries. A lengthy isolation from the international community had restricted aid flows, resulting in the build-up of arrears to multilateral and bilateral partners.”
While Zimbabweans have always been known to be resilient people, it still remains to be seen if they would be able to withstand further economic challenges as inflation has started to rise again amid mounting cash shortages and downsizing of companies.
The rising inflation is a crude reminder of the record 500 million percent hyperinflation of 2008 that brought the country to its knees and drove the Zimbabwe dollar out of circulation.