CAG: How Tanzania can improve mental heath services

Dar es Salaam. The Controller and Auditor (CAG) General has revealed 12 significant shortcomings in the provision of mental health services in the country.

According to the CAG’s 2022/23 report, deficiencies include inadequate community-level diagnosis and financial resources, staff shortages and poor drug distribution.

This has been highlighted in the Efficiency Audit Report on Access to Mental Health Services, which is part of the annual audit report.

“The number of patients increases every year, as do deaths. Many centres do not provide isolation services to help patients recover, and out of the 28 regions, only five have isolation centres for mental health services,” the report says.

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Reached for comment on Tuesday, Health permanent secretary John Jingu said, “Mental health is a sensitive area that we are currently working on to ensure that we strengthen systems so that people are able to readily access appropriate services.”

The CAG’s report, quoting the Health ministry’s annual performance review, notes that there is an increase in the number of patients and deaths due to mental health issues.

“In 2022, the National Mental Hospital of Mirembe reported an increase in the number of patients treated for mental illnesses from 3,472 patients in 2019 to 5,060 patients in 2022, which is a 31 percent increase.”

In 2020, it was estimated that the burden of mental illnesses contributed to a suicide rate of 8.15 per 100,000 people.

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Similarly, the ministry’s report estimated that the burden of mental illnesses increased from 386,358 patients to 2,102,726 patients from 2012 to 2021, respectively, representing an 82 percent increase.

Also highlighted is the lack of a mental health policy despite the amendment of the relevant law, “which does not adequately meet current needs and challenges regarding access to mental health services. Outdated policies and laws hinder progress and the provision of better mental health services”.

The report says mental health services are either inaccessible or unavailable in many parts of the country, with stigmatisation and cultural beliefs making the situation worse.

“Knowledge about mental health, mental illness, and acceptance of mental health treatment is very limited in Tanzania, mainly due to social stigma.”

Community-level diagnosis has also come under the spotlight as there is a lack of attention in identifying people with challenges and efforts have instead focused on other vulnerable groups.

This has been attributed to a general lack of sufficient funding for social welfare services and a shortage of community welfare officers at lower levels of administration.

While the introduction of psychological and social services is a positive development, these have not been fully integrated into plans, budgets, policies and programmes at various levels of administration.

“There is a severe shortage of professionals, infrastructure, medical supplies, and psychiatric drugs to facilitate the provision of mental health services. This shortage involves all health facilities, from national to regional and district levels.”

The report adds that health facilities lack adequate infrastructure to meet the needs of mental health patients, including wards for adults, children and adolescents. There is also a shortage of funds and plans for the construction of wards for mental health patients.

There is a significant gap in access to psychiatric drugs and rehabilitation services, with some facilities being in a poor condition.

The report urges the Health ministry develop national clinic guidelines and operational procedures, including the establishment of infrastructure for mental health services and ensure the availability of capable staff and essential equipment.

The President’s Office, Regional Administration and Local Government (PO-RALG), should also effectively implement psychological support guidelines and ensure the identification of patients at the community level and follow up on their treatments.

“The Ministry of Community Development, Gender, Women and Children should ensure the training and empowerment of community welfare officers and other workers at the community level to identify and register new clients.”

The report highlights the prevalence of mental health disorders such as depression, anxiety and substance abuse in Tanzania, affecting more than 1.5 million people, with a significant number affected by depression being women.

Psychology expert Charles Kalungu told The Citizen that the provision of mental health services has been overlooked.

“When the mind is not well, many things may not succeed, hence the need for a policy to address and promote mental health in terms of treatment,” he said.

Some individuals may not necessarily need medication, but can benefit from counselling, Mr Kalungu added and said the government should consider establishing counselling centres in workplaces, where individuals who appear to be physically well, but who may be struggling with underlying mental issues, can receive assistance and prevent their conditions from deteriorating to a point where medication becomes necessary.

“Psychology professionals are crucial. They should be given an opportunity to utilise their expertise. They are eager to apply their knowledge and should be empowered,” he said.