Mental Health

WOMEN AND MENTAL HEALTH SITUATION

By Sarjo Camara Singateh

Mental health has become a dilemma in the country as many developing countries are faced with the problem of mental health as mentally deranged people are seen in the streets, doing either picking stones/sticks, carrying rags, dancing or standing in roadsides and the health workers are making their efforts raise the profile of mental health care in the country. But the budget line has catered a little interest in the field of curing or treating mentally ill people as only 0.05% is allocated to mental health from the health budget. The domain seems to be a grey area for many health workers as little attention was giving to the sector in the past.

Recently a lot has been dedicated to the unit which includes the thrive Gambia project that have trained almost 60 health personnel to take care of the mental health issues in the country.

In the society many parents and guidance had disown or left their relatives in the streets with no care given to them. The most dishearten issue is that women with mental health problems are sleeping in the streets and some continue to give birth without knowing who perpetuate those crimes against them.

With this figures represented the women’s mental health is not an exception. Women with mental illness continued to walk in the streets without proper clothing and clean drinking water or adequate shelter. Some of these women were sexually harass by mental fit /ill men in the society and even where they are kept as patients.
No security is given to women with mental health problems as male partners can have access to them without any much effort to do. It is against the right of a woman and girl child especially when they cannot consent to any proposal or offer.
According to a research done by mental health leadership programme in the Gambia has revealed that Sexual Abuse - Between 2010 and 2011, 46 cases of sexual abuse of people with mental health problems were documented during the study. This led to eleven pregnancies, but only seven babies were accounted for by their families. The majority of these cases are recorded in the greater Banjul area with Bundung, Tallinding, Lamin, Banjul, Serekunda and Brikama topping the list.

The study also receive reports of nine cases of sexual abuse at the Tanka Tanka psychiatric hospital from April to July 2012. This was mainly pepetrated by fellow patients in the hospital. There is no barrier betwen the male and female patients and they can visit each other without any hinderance both at day and night. Amongst other things, this shows that human rights violations are taking place in psychiatric hospitals.

“This report presents a picture of mental health in the Gambia in 2012. It covers the services available, the challenges in service delivery, human rights violations, the reasons for admissions and treatment, policy and legislation. It is estimated that the prevalence of mental health issues is almost 20% within the population, but there is a large gap between the numbers of people affected by a mental disorder and those receiving treatment. While the prevalence rate is estimated to be between 27,300 (severe disorders) and 91,000 (all mental disorders), within a population of 1.8 million, the estimated number of people receiving treatment is 3,200 (8.5%)” said the mental health leader programme facilitator, Dawda Samba.

Mr. Samba noted that 432 respondents completed a survey on mental health and 75% of them believed that mental health could be associated with evil spirits. The understanding of mental health care and illness prevention at the grassroots level was observed to be very low, and demonstrates a need for widespread public health education on mental health issues.

However, mental health services are very limited in the Gambia; there are significant gaps in capacity, human resources, materials, medication and outreach services, most of which stem from very limited budget allocation (about 0.5% of the national health budget is spent on mental health services).

Mr. Modou Njie the director of health promotion and education.-----

This report offers a statistical report of the current situation, as well as recommendations for the Ministry of Health and Social Welfare, the World Health Organisation, community based organisations and individuals to improve the current situation.

One key recommendation is for the immediate National Mental Health Policy (prepared in 2007) endorsement as well as for legislative change. The Gambia retains the outdated ‘Lunatic detention Act’, enacted in 1917 and last reviewed in 1964, and it is no longer fit for purpose.

The study covered 432 respondents from all lifestyles including service users, traditional healers, families and government authorities. It covered the whole country.

“There is a large gap between the numbers of people affected by a mental disorder and those receiving treatment. While the prevalence rate is estimated to be between 27,300 (severe disorders) and 91,000 (all mental disorders) the maximum number of people receiving treatment is estimated to be 3,278. In 2009, 2010 and 2011 there were 738, 1041 and 878 annual admissions for treatment at Tanka Tanka psychiatric hospital respectively. Additionally, a total number of 1,092 and 909 patients received outpatient treatment from the Community Mental Health Team (CMHT) in 2010 and 2011 respectively”. mental health report on the Gambia

“2/3 of the respondents associated the cause of mental health problems to evil spirits, jinn’s, substance abuse and marabou work. The understanding of mental health care and illness prevention at the grassroots level was observed to be very low. All the traditional healers visited associated mental illnesses with spiritual and natural happenings, which, they believed, could be appropriately treated traditionally.” Dawda Samba

Services - 91.5% of the respondents stated that mental health services are not available in their communities. Staff of the psychiatric hospital will on daily basis walk a distance of about 1.5km in an isolated bushy environment to report to work every day. On two occasions, staff reported being attacked on the highway to the psychiatric hospital. It was also on the national news that a dead body was dumped on the same highway to the psychiatric hospital. The community mental health team (CMHT) goes to about 18 health facilities in provincial Gambia every 3 months and the rest of the hundreds of clinics and health centres are left unattended to. For the past 2 years the CMHT had only 4 visits instead of the 8.

Mental Health financing - Over three years (2007 – 2009) the budget for mental health services was about 0.54% of the health budget. Given that people with mental health needs are at least 20% of the population, there is a clear need for a greater and immediate budgetary allocation

Human resource - The human resource base of the mental health services of the Gambia is very poor in all aspects of psychiatric care. There is only one community mental health nurse working in the psychiatric services in the country. The hospital has two general trained nurses and because of this reason shifts are mostly manned by nurse attendants or auxiliary nurse. There is no psychologist so patients do not have access to professional counselling sessions or other forms of psychological assistance. There are no social workers so that some patients stay for years in the hospital without relatives coming to pick them up. There is one patient who has stayed for more than a decade without discharge, whilst a good number have been there for years.

Physical Restraints - From the respondents a total of 86% (370) stated that patients with mental health problems were chained. This was confirmed by the two sets of traditional healers in Busura and Jappineh who said that patients are chained because they are violent and uncooperative, or to calm them down.

There have been several cases (20 to 30) people diagnosed of having some form of mental illness and are kept in the prisons. We came across a case in Jeshwang, the mother of the patient stated that she has already made the arrangement for her son to be remanded in the prisons because he comfortably absconds from the psychiatric hospital anytime he is admitted there.
Mental Health Legislation and Policy – The only national mental health document, “Lunatic detention Act” was enacted in 1917 and last revised in 1964. It is old, derogatory and discriminating. It labels everybody with mental health problems as a “lunatic” and should be “detained”.
Experience of Sexual Abuse between 2010 and 2011, 46 cases of sexual abuse of people with mental health problems were documented during the study. This led to eleven pregnancies, but only seven babies were accounted for by their families. The majority of these cases are recorded in the greater Banjul area with Bundung, Tallinding, Lamin, Banjul, Serekunda and Brikama topping the list.

Awa`s Case:
From a study done in 2012

Marion Aslan, the executive director, Elemental wellbeing- England who initiated thrive Gambia Project in her co- publisher of a book with Dr. Mike Smith, alongside Mr. Salif Manneh, community psychiatric nurse based in United Kingdom. She said neurotic illness, nervous breakdown, psychoses, and the meaning of ‘severe mental health” is schizophrenia is a profoundly disabling condition where the mental functions are fragmented and the sufferer may experience unusual beliefs and also in a group of mental illnesses if ‘psychotic depression’ which is much more severe than ‘neurotic depression”. That some causes of women’s mental health could be attached to maternal depression which 80% of new mothers experience in the ‘baby blues,” but this is not maternal depression. These conditions have some of the same symptoms, but “baby blues’ normally goes away after a couple weeks. Maternal depression last much longer. She said 10-20% of pregnant women have prenatal depression which includes crying or weeping, irritability etc, postpartum depression 10-20% of new mothers, this includes difficulty concentrating or making decisions; postpartum depression includes lack of interest in the baby, family or activities.
Postpartum psychosis a small percentage of mothers who experience depression can have what is called postpartum or puerperal psychosis. And it is 1-2 per 1,000 new mothers, this conditions produces hallucination, delusion, anger, paranoia, restlessness, suicidal and homicidal thoughts, voices and delusions.