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Mental Health in The Gambia

Sep 25, 2012, 10:04 AM

Hello and a warm welcome to yet another edition of Health Matters, you weekly health column, which is proudly sponsored by Ecobank, The Pan African Bank.
In our today’s issue, we take a look at a summary of the Mental Health Report, which presents a picture of mental health issues in the Gambia in 2012 prepared by Dawda Samba, Country Facilitator – Mental Health Leadership and Advocacy Program at the WHO Gambia Office.

Mental Health Report (Summary)
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%).
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).
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 The Gambia still retains the outdated ‘Lunatic detention Act’, enacted in 1917 and last reviewed in 1964, and it is no longer fit for purpose.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 a total of 432 respondents from all walks of life 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.
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.
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.
Children and Mental Health- Children with mental health problems are a very vulnerable group. This section reveals that children who are presumed to have mental health problems are denied the right to education, are physically assaulted at home and when taken for ‘care’ and are made more vulnerable to physical and sexual abuse. There is a great need for teachers to have training on mental health issues in children, and particularly on the fact that epilepsy is not contagious, and there is no need to exclude children from education on that basis.
The study revealed that hundreds of students nationwide are being forced to stop schooling because they have mental and neurological problems (epilepsy and learning or intellectual disability) and parents and some teachers believe that it is infectious so these children have to be taken out of the public school. This issue was particularly serious in the west coast region.

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 dow.
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.
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.
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”.
Medication - Until 2012 February, the hospital was using medications that have expired since November 2007, namely Lagarctil, Haldol, Melleril and Stellazine. Medications were not available during those years. By February 2012 all the stock of the expired drugs has been used. Currently it has less than 5 out of the dozens of WHO recommended antipsychotics.
The media - are crucial partners in awareness creation and the catalysts for change. But unfortunately though in a much lower scale now, the media still uses derogatory terms. Some of these terms are abusive, discriminatory and stigmatizing. Despite several advocacy efforts, few media houses still use terms like mad man, lunatic, imbecile etc.