05.11.2020 | Kommentarer

Mental Health Prejudice and Social Stigma in Zambia

Abstract

Mental illness and mental disorders are extensive in Zambia, and yet not many are aware of the situation. Highlighting mental issues and the impact of mental stigma, discrimination and prejudice have on the victims is vital to the development and progress of mental illness acceptance and treatment. How can this injustice be avoided? It is not ethically right to abuse individuals who are suffering from mental illness. Though mental illness affects people’s social lives and other aspects of life, people will still find it justifiable to discriminate, humiliate and stigmatize. This adds to the detrimental mental instability victims face. Depression and schizophrenia are the most diagnosed mental illnesses in Zambia and mortality rates arising from the stigma of mental illness, and other issues have increased. Traditional healers are for many the priority to approach for consultation and to seek treatment before they can see a medical doctor or visit their nearest health centre. There are laws in Zambia that affect the rights of people with mental illnesses and disorders, and this is attributed to the fact that the general population has misinterpreted the laws. The Zambian government has been doing everything in its power to repeal some of the laws that were endorsed and adopted from the colonial era. However, in 2019, the government of Zambia endorsed The Mental Health Bill that “seeks to provide for respect, non-discrimination, autonomy, right to self-determination and legal capacity of individuals who have mental health problems, illnesses and disorders. It also ensures the protection of patients and other people from harm, protects property and regulates patients’ affairs.” (Ministry of Health. The Republic of Zambia. 2019). The Bill positively represents the steps being taken towards the fight against mental discrimination and stigma.

Keywords: Mental illness, mental disorder, stigma, discrimination, Zambia.

Authors:

Ireen Alanen BSc nursing student in Novia UAS.

Anita Wikberg, Supervisor, RN, RM, PhD, Senior lecturer at Novia UAS

Introduction

Mental illness is a universal, frequent and severe rising issue in Zambia with a prevalence rate of 20% (Munakampe. 2020). Some countries have the means of fighting this deadly mind prison, while other countries are still in the process of finding out how to deal with the problem. Zambia is one of the few countries still struggling with how to handle mental illness and treatments. A person cannot take care of themselves from the neck downwards without including the mind. If the mind is “sick”, everything else will feel “sick”. There are different types of mental illnesses. Depression and schizophrenia are the most diagnosed mental illnesses in Zambia with Depression having the highest diagnostic rate of 34% (Ravi and Subodh. 2017.) and mortality rates regarding the stigma of mental illness, and other issues have increased (Mayeya et al. 2004). Depression is mostly not treated as the people afflicted by it are too shy to come forward and talk about their mental illness with family and friends. Instead, they suffer in silence. Schizophrenia patients, on the other hand, are treated as outcasts in their own families and communities. Families are too ashamed to come forward and open up about the difficulties they face taking care of family members having a mental illness. This has adhered to the notion that when one is suffering from mental illness, then it means that the person has been bewitched.
Additionally, everyone in one way or the other has experienced psychological problems at some point in their lives. Fortunately, for some, they were able to overcome it because perhaps it was a mild, momentary breakdown or they did just get the help that they needed. The people that suffer from mental illnesses are stigmatized, judged, and some are even taken advantage of sexually, as they are not in their right minds to make consensual decisions concerning what they want or rather what is right for them. These acts are triggered by ignorance and the fact that they do not understand the chemistry of what is happening in the human brain/mind as well as why and how it comes about (Kapungwe et al. 2010). It is regrettable because, instead of them being helped, they are taken advantage of. Similarly, because of all these discriminations and stigma that they go through, people with mental illness are now having a high risk of mortality rates due to the reasons mentioned earlier as suicide is taking place in the society among mentally ill people from time to time (Ravi and Subodh. 2017.)

Individuals with mental illnesses usually have to deal with problems like a coin toss. One side of the coin has everyone in the community stigmatizing the victims and abusing them whilst on the other side of the coin is the mental illness itself that they have to face and fight (Rüsch, Zlati, Black, and Thornicroft. 2014). It is not an easy road for the patients. Unfortunately, individuals in the community all have one thing in common, and that is the attitude they have towards discrimination and stigmatization of mental illnesses.

Traditional healers are for many the priority to be approached for consultation and seeking treatment. That is, 70–80% of people with mental illness would rather see a traditional healer or witch doctor before they can see a medical doctor or visit their nearest health centre (Mental Disability Advocacy Center - MDAC and Mental Health Users Network of Zambia - MHUNZA. 2014) also reported (Mayeya et al. 2004) It is a common practice to many in Zambia to turn to traditional healers or witch doctors for a cure. When patients/victims are exhibiting any kind of mental or unstable behaviour, families will turn to the witch doctors for help. This will hinder the treatment time of the patients' real underlying disease. For example, patients with cerebral malaria exhibit behaviour of that of a mentally ill person. Instead of taking the patient to the hospital, he/she will be transferred to the witch doctor who will do nothing for them. The delay in treatment can even cause death in the worst-case scenario. This is also the same case with victims (with mental disorders) of sexual abuse, instead of helping them seek help and punishment for the offender, they are taken to the witch doctors for a “cure” or merely cleansing. Some of the traditional witch doctors are legit whilst others are only looking to survive by exploiting and preying on the minds of illiterate.

Additionally, according to a publication by (Khalifeh et al. 2015) that was released in Psychological Medicine, it stated that the probability for domestic violence, rape and other emotional trauma was considerably high when it came to men and women with mental disorders with statistics showing that 49% of the men and 69% of the women all with mental illnesses or conditions suffered abuse. Of the victims that had been raped from the survey conducted, more than half (53%) of the women had attempted to commit suicide, and of the general population women that had been victims of rape, 7% had attempted suicide. It is evident that with this type of statistics, only a few would get help. The abuse and rape of the mentally challenged individuals continue daily, and with an even more significant percentage of the crimes going unreported. (Khalifeh, et al. 2015)

There are laws in Zambia that affect the rights of people with mental illnesses and disorders, and this is mostly attributed to the fact that the general population has misinterpreted them. The Zambian government has been doing everything in its power to repeal some of the laws that were endorsed and adopted from the colonial era. The Mental Health Disorders Act of 1951 is one such act that was misinterpreted by the general population and indirectly affected patients with mental issues by people discriminating and stigmatizing patients. Anyone that had a mental disease or condition was given the victimized status of being mad, and that their wish should not be heard regarding “how they want to live their lives. This law uses the offensive (and legally meaningless) terms “mentally defective”, “idiots”, “feeble-minded”, “imbeciles” and “moral imbeciles”, all of whom can be lawfully detained against their will in their own and society’s best interests” (Mental Disability Advocacy Center - MDAC and Mental Health Users Network of Zambia - MHUNZA. 2014).

The Mental Health Disorders Act of 1951 which states that “An Act to provide for the care of persons suffering from a mental disorder or mental defect; to provide for the custody of their persons and the administration of their estates; and to provide for matters incidental to or connected with the Foregoing” (Laws of Zambia. Mental Disorders Act, Caption 305). The government has also set up strict laws regarding the mistreatment and torture of individuals with mental disorder and illness. However, the same government also has allowed for the said individuals to be detained should they be found to be of unsound mind. From the year’s past, individuals with mental disorders have been discriminated against without proper protection. However, on the bright side, in 2010, Zambia made a commitment when the government endorsed the Rights of Persons with Disabilities. It has been discovered, however, that even though the commitment was made, and ideas were suggested, discrimination, stigma and abuse still is a problem in the whole country including victim’s households and families being also culprits to this shameful act. In psychiatric wards, patients do not get the much-needed attention and care because there are too many patients admitted at the same time. Psychiatric professionals are not enough to support the number of patients admitted daily. (Mental Disability Advocacy Center - MDAC and Mental Health Users Network of Zambia – MHUNZA. 2014)

However, in 2019 The Mental Health Bill was passed, “The Bill seeks to provide for respect, non-discrimination, autonomy, right to self-determination and legal capacity of individuals who have mental health problems, illnesses and disorders. It also ensures the protection of patients and other people from harm, protects property and regulates patients’ affairs.” (Ministry of Health. The Republic of Zambia, 2019). The Bill is a positive step towards the much-needed sensitization of mental health welfare in Zambia.

Finally, Corrigan and Watson (2002), states that there are theories and myths in our communities that have been circulating through time with stigmatizing effects. The media does not help matters either. Any individual with mental illness has been labelled as a savage-violent individual that should not be entertained but feared; they are childish; or that having the mental illness is one’s fault. The misconception would be reduced if people from the general population could open their eyes and see that even people with mental issues can have a job and be good at it. They deserve to be embraced like any other individual. Educational campaigns, this would be a necessary strategy to inform the general public about different mental issues, research can be carried out by nurses or healthcare professionals, seminars are also an educative way of sensitizing people, nurses can be given more training, all these are some of the ways that the health sector can reach the general population with the sole purpose of awareness.

Conclusion

Zambia is a developing country that is still struggling economically. Therefore, there is a lot of struggles and budget cuts by the government that makes it difficult for the health sector to make a proper budget that benefits all. Because of these struggles, there is less education, awareness and ignorance about mental illness, which is on the rise. People are not interested in believing that mental illnesses are not intentional. They choose to ignore the fact that victims have no decision in this disorder, and despite the detrimental impact, the behaviour will ensue on the victims. Finally, the government needs to implement the commitment they made when they endorsed the Rights of Persons with Disabilities of 2010. Sitting down to come up with possible solutions to help and protect individuals with mental disorders was the first step. However, merely suggesting solutions is not solving the problem, but it is a step closer to getting to the desired goal. The government can set aside available resources to support the educational, economic, and research aspect to provide and bring awareness and attention to the subject of mental illnesses and disorders. Not having any understanding for this problem only supports society to maintain their beliefs. The only way to fight the stigma is to educate and sensitize.

References

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