How stigma impedes mental health treatment

Dodoma. It’s 6:30am. A gentle morning breeze is blowing in Dodoma, the capital city of Tanzania.

After several cancellations of Bolt taxi services, the only option left for me to meet the director of Mirembe National Mental Health Hospital (MNMH) on time for an early morning interview was to use a motorcycle.

Established 96 years ago, MNMH is the only specialised mental health hospital in Tanzania.

In the curative aspect, it has sections for substance use disorders, forensic psychiatric services, child and adolescent mental health services, maternal mental health services, neuropsychiatric services, and general adult psychiatric services.

On my way to the hospital, my thoughts were full of precautions I should take when walking around different wards of the hospital with the fear of being attacked by mental health patients. I pictured a number of patients walking randomly within the hospital compound.

Upon my arrival, the ambiance was so cool and quiet. Very few people walked around the hospital. In the course of my interview with the MNMH director, Dr Paul Lawala, it became clear that the fear I harboured about the hospital represents the amount of stigma and discrimination society has around mental health challenges.

Dr Lawala, a mental health specialist who has been in the field for the past 16 years, says stigma is among the challenges affecting the treatment of mental health patients in the country.

Others are lack of awareness, shortage of staff, and a limited budget to run the MNMH.

The hospital has four dependent centres, namely, Mirembe Hospital, Isanga Institute, Hombolo, and Itega rehabilitation centres.

Dr Lawala says it is important for people to distinguish mental health from mental health challenges. There is confusion on how people term mental health as they refer to mental illness, he says.

According to him, mental health is the state of an individual being well in behaviour, emotions, and thoughts that helps the individual to be independent, able to be productive, and contribute to his or her community with the ability to cope with stress.

On the other hand, Dr Lawala says mental health challenges are complications that can result in mental health illnesses. Complications such as changes in behaviours, emotions, or thoughts can lead to mental illnesses.

“It is very simple to identify signs at an early stage, as one completely changes how they do things. From being able to manage his or her finances to not being able, from developing new habits of not being productive, being late at work, not dressing as appropriate as he or she was, from isolating themselves, avoiding family and friends, and locking themselves all day long for more than a week,” says Lawala.

Lack of sufficient funds to pay workers who work beyond official working hours has also affected caregiving at the hospital.

The state of affairs makes it difficult for patients to get needed care, and as a result, the hospital has to pay its workers extra money for extra hours at work.

The costs are for food, water, electricity bills, and admission, among others.

He said more than 80 percent of the patients at the hospital need extra care, and the cost goes to the government. “The hospital has about 506 patients, and society has stayed away from the responsibility of supporting the patients,” he says.

Previously, he said, the hospital was not offering outpatient services, which is, according to him, the reason why society believed that any mental health patient was to be taken to the hospital. “The hospital came up with reforms that helped reduce the burden,” he says.

He says some wards take between 30 and 35 patients. He says the costs of treating between 250 and 300 patients per month go up to between Sh100 and 120 million. The amount covers only the normal services, excluding payments for workers who work extra hours.

“We have limited resources, and the subsidy is not enough. Currently, the number of patients admitted at this facility is 500, so the hospital requires between Sh500 million and Sh600 million annually to afford serving these patients. But during this financial year, the hospital received half Sh250 million per year,” says Lawala.

He says one patient spends an average of Sh6,000 a day, meaning that all 500 patients spend around Sh3 million per month. According to him, the cost of medicine per person ranges between Sh40,000 and Sh50,000, while payments for extra working hours cost Sh60,000 per worker.

“Three years ago, the hospital had a bad working environment. We were attending more than 700 patients, and up until last year, we had not had more than 350 patients. In 2021/2022, we built 45 new modern buildings.

“Before this, the hospital had a very poor working environment for both the workers and the patients. Some wards were in bad shape, especially at Isanga Hospital. Now the wards are good and friendly,” he says.

Supported by Bill & Melinda Gates Foundation