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Lack of Financing, Skilled Personnel Challenge Health Care in Zambia

The World Health Organization is encouraging governments to come up with plans to include mental health care in their health services. Many African states are struggling to meet the goal, in part because of the cost of improving health care in a developing nation. From Lusaka, reporter Sanday Chongo Kabange takes a look at how one nation, Zambia, is coping with mental health care issues.

On the streets of the Zambian capital, Lusaka, it’s not unusual to come across a person shouting for no apparent reason, talking nonsense, carrying huge, filthy bags or even committing acts of violence.

John Mayeya is a mental health specialist at the Ministry of Health.

He says Zambians suffer from some of the same disorders as others around the world, including schizophrenia, affective disorders, acute psychotic episodes, alcohol-related problems and organic brain syndromes.

As for the causes, he says, "It could be challenges of life, for instance unemployment, divorce, alcohol and drug problems. It could be due to infections to the brain like severe malaria. Road traffic accidents can also lead mental illness. Socio-economic and extreme religious beliefs can also precipitate mental illness in somebody who is vulnerable."

In Zambia, people who are mentally ill are often stigmatized, feared, scorned and condemned.

Among the exceptions, however, are the aged. It’s traditionally the duty of the extended family to look after older citizens – who sometimes suffer from mental illnesses such as dementia and depression. They and other common mental illnesses are often treated at home, while more serious ones are recommended to mental health centres.

Chainama Hills is Zambia’s only mental hospital. It offers long-term treatment with medication for severely ill patients. Talk therapy is not available at the center.

There are close to 560 beds for psychiatric patients across the country. A small force of trained personnel attends to them.

Over time the number of frontline mental health workers and professional staff has been declining. In fact, there is only one practicing psychiatrist for the whole country. Other key mental health workers such as psychologists, social workers and occupational therapists, are also in short supply. Mayeya says this is due to the retirement of skilled professionals – or the “brain drain,” in which they leave the country for better paying jobs abroad. It’s also attributed to the low output of training institutions.

But two years ago, the Zambian government took action to ease the growing problem of mental illness – and developed an official stand on the issue. The Mental Health Policy serves as a legal and legislative guideline for mental health institutions and workers.

The government is also in the process of revising the 1951 Mental Disorders Act, which refers to mentally ill people as idiots, imbeciles and invalids. The revised act will incorporate and define the legal rights and treatment of mental patients.

Mayeya says it will then be in line with health and human rights related United Nations Millennium Development Goals.

“We are proposing that we call them mentally ill persons and not imbeciles," he said. "We are also dealing with admission procedures. At present you have to get a detention order from the magistrate before some one is admitted to Chainama [Zambia’s only mental health institution]. Detention orders pertain to the withdrawal of human rights of someone for 14 days. But we are doing away with that. We want people to be admitted straight away where if there will be any detention orders to be administered they should be administered by medical personnel who understands the patients well.”

The World Health Organisation Health Promotions officer, Norah Mweemba, says her agency is working with the Zambian government to bring mental health care policy up to date.