27 Mar 2017

Stigma is still a major issue in mental health. In an interview with senior consultant psychiatrist and hospital superintendent at Sbrana Psychiatric Hospital in Lobatse, Dr Mpho Thula said stigma remains a significant barrier to care and to social inclusion of those with mental illness.
Dr Thula said those with mental illness were still viewed with suspicion and fear which has a profound impact on them.
He further pointed out that stigma was a huge barrier to the recovery of those with mental illness as it hinders participation in treatment.
“Some families have even been known to hide their loved ones with mental illness from the public hence denying them access to treatment,” said Dr Thula, adding that it was a significant barrier to social inclusion.
He noted that stigma could result in the patient feeling like they were not worthy, resulting in loss of self-esteem and possible exacerbation of the illness.
Dr Thula further stated that besides stigma, there still exists a scarcity of awareness about mental illness.
He said in some cases patients were presented late for care because symptoms were attributed to other causes such as spirituality, possession by spirits or just acceptance by the community of somebody with mental illness as “the village idiot.”
Dr Thula also said probably because Botswana has a huge burden of infectious diseases notably HIV/AIDS, which gets most of the priority in resourcing and funding, it has resulted in huge deficits in service availability, particularly with community mental health services, saying almost everything was dependent on hospitalisation in a few centres such as Sbrana Psychiatric Hospital in Lobatse.
He noted that it removes patients from their communities and that following their discharge follow ups and reintegration into their communities for a proper recovery was often lacking.
He also decried community mental health teams, saying they were either absent or deficient, adding that community mental health structures or facilities for recovery of patients were also not there.
Dr Thula pointed out that according to the World Health Organisation, mental and substance use disorders were the leading cause of disability worldwide.  
He lobbied for more resources for mental health, adding that otherwise the country would suffer significant economic costs in the future because of its lack of investment in mental health.
Dr Thula noted that over 10 800 people were treated for mental illnesses at Sbrana Psychiatric Hospital in 2016, saying they had 1 462 as in-patients and 9 338 out-patients from January to December .
He said the causes of mental illness were varied, adding that mental illnesses could run in a family, which means that people who have a close family member with mental illness were more likely to develop a mental illness.
He pointed out that susceptibility was passed on through genes, but however pointed out that having a family member with a mental illness alone does not automatically mean that one would also develop a mental illness.
He highlighted that the development of mental illness results from a complex interaction between multiple genes and other environmental factors.
Dr Thula said such factors may include an important loss such as the loss of a parent, experiencing severe childhood psychological and emotional trauma, including neglect, psychological or sexual abuse, poor nutrition and exposure to toxins such as lead may play a role in the development of mental illnesses.
He added that the abuse of illicit drugs or substances by the person or the person’s parents or family in the person’s presence, social isolation, a relationship break-up, relationship difficulties, social adversity including financial problems, death or divorce, a dysfunctional family life, feelings of inadequacy, low self-esteem, anxiety, anger or loneliness, social or cultural expectations could be a factor in the development of mental disorders.
Dr Thula also said some infections that affect the brain could cause symptoms of mental illness such as AIDS, adding that similarly, brain injury or inherent defects in the brain could also result in mental illness.
He also pointed out that disruption of the development of the brain of an unborn baby or trauma that occurs at the time of birth such as lack of oxygen to the brain could be a factor in the development of certain conditions such as autism.
“Neurological illnesses such as epilepsy also predispose people to mental illness,” pointed Dr Thula, adding that people with chronic medical illnesses, especially those associated with pain and those with terminal illnesses have a high prevalence of mental illness.
“Some patients never recover completely and other patients need ongoing support and care,” he said.
“The reality is that most of the major mental illnesses are chronic, hence the goal should be a valued pattern of life and living with or without ongoing symptoms and difficulties,” he stated.
Dr Thula however stated that  most of the major mental illnesses like schizophrenia, bipolar affective disorder and addiction tend to become chronic in the majority of patients, saying that means they require long term treatment and follow up to manage.
He said mental illness recovery was concerned with gaining hope, meaning, purpose and control over patterns of living, as valued and chosen by the person himself and herself.
He said that could be achieved even when one has a chronic mental illness which has not been cured but was properly managed. ENDS