Tanzania, being one among the developing countries in the world, has an astonishing shortage in men-tal healthcare. Access to mental health services is restricted. And this restriction, comes from a variety of factors, from lim-ited healthcare facilities, lack of mental health caretakers, as well as lack of funding and budget.
Compared to 10 years ago there is improvement and a direction to go; you could say ‘from nothing to something’. But still mental health seems to have no priority in all levels of policies. Stigma and marginalising people with a mental health disorder is still rampant. Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intel-lectual disabilities and developmental disorders including autism.
Globally, an estimated 300 million people are affected by depression. More women are affected than men.
According to a mental health report from World Health Organisation (WHO), titled, Mental Health Gap Action Pro-gramme (mhGAP): Scaling up Care for Mental, Neurological and Substance Use Disorders, estimates that 14 per cent of the global burden of disease, measured in disability-adjusted life years (DALYs), can be attributed to mental, neurological and substance use (MNS) disorders.
According to WHO’s Mental health Atlas, Tanzania’s neuropsychiatric disor-ders are estimated to contribute to 5.3 per cent of the global burden of disease. The Atlas also shows that Tanzania has 124 mental health outpatient facilities, with 662 psychiatric beds in general hospitals.
Looking at the high number of people suffering from these disorders, it should be expected that there was a strong system in place to treat these illnesses. But in fact, this is far from the reality. Getting a help for a patient with a mental illness is often an exercise in futility.
As a general practi-tioner, I often see patients with all kinds of diseases. When a patient has a disease where more specialised medical care is needed, I refer the patient to an appropri-ate specialist. But with mental diseases, this is often an impossible feat.It’s understood that people with mental health illness are always stigmatised.
This can be true especially when we tend to neglect or not pay attention to what they are going through. Patients already have a hard time admitting there is a mental problem. People even crack jokes about mental diseases, saying someone is acting schizo-phrenic or something similar.
And people laugh and think it is funny.Apart from it, the lack of mental health-care expertise at all levels still remains a challenge. There is still a general idea that ‘crazy people’ can’t be treated, so why choose psychiatry; better send the ‘crazy ones’ to traditional healers. There are also not many well paid jobs in the sector of psychiatry. There isn’t much involvement from the international sector [non-governmental organisations, for instance] or job opportunities either, like in the HIV/Aids and Malaria sector. There are even examples where even few mental health specialists we have, are now working in other health sectors or even in totally other professions.
A way forwardWe should strengthen the mental health capacity building by training more and more mental health specialists as well as increasing funding on mental health programmes. Tanzania, one of the devel-oping countries, has lowest physician to population ratios: 1.4 healthcare providers (HCPs) per 1000 individuals. And when it comes to mental health, this is even worse, with 0.04 psychiatrists and 0.005 psychologists per 100,000 pop-ulation, and an overall total of 0.3 mental health workers (including psychologists, psychiatrists, nurses, and other mental health providers) per 100,000 population.
Primary healthcare is generally provid-ed through district hospitals, community health centres or dispensaries. Failure to recognise mental disorders as a priority in health policy and funding, stigmatisation of patients, and specialty mental healthcare providers, poor mental health literacy, and a lack of mental health competencies among community based healthcare providers are all additional fac-tors associated with challenges in delivery of mental healthcare to young people.
It’s understood that, majority of the population consists of those aged between 0 and 25years. Due to gradually increas-ing life-expectancy, this group will mature into adulthood, bringing with them a high prevalence of depression resulting in increased pressures for mental healthcare systems that are unable to address current needs.
For this reason, there is a need to address the issue of adolescent depression in Tan-zania as soon as possible and, given the magnitude of the challenge, it should be addressed at the primary healthcare level.
The author is the Medical Doctor based in Dar es Salaam.