Containing mental health issues among the youth

Blantyre, December 03, Mana: Every day has been a struggle for 25-year-old Jane (not her real name) since the relationship with her boyfriend hit the rocks six months ago. She now feels a sense of worthlessness. This usually sends her into emotional tantrums.

“I started having this feeling after breaking up with my boyfriend in April this year. My expectations were very high and when we fell out, I became hopeless. Self-harming and suicide became a daily preoccupation, as I thought of ending it all,” Jane narrates.

Elsewhere, Cynthia developed a mental health disorder after being emotionally abused by her partner. She also lost her child while going through the ordeal.

“I was abused by the person I trusted and believed would take care of me. I had always expected that he would stand with me for better or for worse. Losing my child was the worst thing that happened in my life,” Cynthia states.

“This thing was weighing on me heavily and I almost gave up on life,” she says, adding that she was always in isolation.

Similarly, Daniel (not his real name), 31, from Blantyre went into a mental breakdown after divorcing his wife whose effects have been enormous.

“I broke up with my wife two months after our holy matrimony. I dated the lady for almost eight years and we had a child between us before the wedding. At the time of breaking up, she was three weeks pregnant.

“The pressure was immense; the family matters subjected me to a rock and a hard place,” Daniel explains, noting that the break up led him into solitude, resentment, mood swings, less productive at work as well as stress.

Unfortunately, the two characters exemplified in the story have not had access to mental health care because they did not know where to seek such support. In fact, stigma towards people with mental health issues further compounded the matter.

“I was just battling the effects because I didn’t know where to seek redress. I have never heard of any clinic which provides services related to mental health,” confesses Jane.

Daniel concurs with Jane: “I didn’t get any support because I’ve never heard of any mental health services since the condition is not considered as a major problem. Besides, I haven’t heard of any advocacy on the subject as a result people suffer in silence.”

Similarly, Cynthia did not imagine that she needed any medical help, and the fact that people do not look at mental health seriously contributed to her failure to seek support.

Zomba Mental Hospital Psychiatric Officer, Henry Kawiya singles out common mental issues among the youth in Malawi as depression, anxiety, and substance abuse.

“Although we have not done a national representative study on the extent of depression, a survey that was done in Lilongwe found that 18.9 percent of youths that were HIV positive had depression,” Kawiya discloses.

St. John of God Hospitaller Services Clinical Psychologist, Ndumanene Silungwe says most mental health problems emerge during puberty either due to genetics or dysfunctional lifestyle.

“Across the globe, post-adolescence make up the main population for mental health problems. Anxiety and depression often begin during adolescence, from 15 years above and so is the onset of substance and drug abuse,” Silungwe observes.

He says most youths do not seek help for mental health problems because they do not have information on how the condition presents itself.

Dr. Michael Udedi agrees with Silungwe in a 2016 study authored with four others titled: “An Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania,” which shows that lack of awareness and little knowledge about common mental disorders contribute to the stigma that prevents young people from seeking support.

“This situation combined with the shortage of trained health personnel to effectively treat young people with mental disorders has created an environment where many young people suffer in silence,” reads part of the study presented at the 6th annual Malawi Mental Health conference in Blantyre.

The World Health Organisations (WHO) Mental Health Action Plan 2013-2020 also notes that most health systems have not yet adequately responded to the burden of mental disorders and consequently; the gap between the need for treatment and its provision is huge all over the world.

“Between 76 and 85 percent of people with mental illnesses don’t receive treatment for their condition in low and middle-income countries,” reads WHOs action plan.

Moreover, WHO Mental Health Atlas 2014 says more than 45 percent of the world’s population live in a country where there is less than one psychiatrist for every 100,000 people and there are even fewer neurologists.

In Malawi, there are only three designated mental health facilities; namely, Zomba Mental Hospital, St. John of God in Mzuzu, and St. John of God in Lilongwe against a growing population of close to 20 million.

Malawi Health Equity Network (MHEN) Executive Director, George Jobe feels that Malawi is “greatly” missing on offering services to prevent mental health breakdowns, noting that the system is more curative than preventative.

“The system is more reactive than proactive. We believe that most of the people who commit suicide and those experiencing mental impairments, including the youth, would have been saved had it been that we have robust systems,” Jobe says.

Jobe suggests that Zomba Mental Hospital should expand and establish clinics in all district hospitals with well-trained staff and proper medication where youth-friendly counseling services should be provided.

“There should be youth-friendly counseling services to motivate the youth to patronize the facilities, particularly now that they are vulnerable to a myriad of situations such as unemployment, relationship break-ups, and drug abuse.

“We also need to place emphasis on prevention instead of the curative aspect. Additionally, Malawi needs to introduce psychosocial support services at mental health care facilities and encourage the private hospitals to provide such services,” Jobe suggests.

Silungwe, however, cites strengthened families, positive parenting as well as education about mental and soul health to ensure the promotion of mental health among the youth.

On the other hand, Kawiya adds that people need to be transparent about mental health because it affects everyone in society, noting that certain patterns in young people should also be observed.

Minister of Health, Khumbize Chiponda says the government is going to review the service-level agreement with St. John of God to include outpatient services to allow people to have access to counseling and medication for free at the facility.

“St. John is a CHAM (Christian Hospitals Association of Malawi) facility but we have an agreement where they can provide certain services but out-patient services.

“We have since discovered that we have a lot of people who are not hospitalized but they still need to be counseled or get medicine,” Chiponda says.

Speaking on the sidelines of the 2021 World Mental Health Day commemoration, Chiponda urges partners to join the Ministry of Health in efforts of promoting mental health and psychosocial support.

“Partners must work towards the integration and prioritization of mental health in Covid-19 response and recovery plans and future pandemic preparedness as well as Mental Health and Psychosocial Support (MHPSS) implementation and advocacy across sectors such as social welfare, education, gender, and health,” Chiponda adds.