SITTING with her old rugged clothes fluttering in the early morning wind, Ms Nomthandazo Moyo (43) from Sidojiwe Flats in Bulawayo’s Belmont Industrial area looks to the horizon pondering, as she narrates the challenges of caring for her mentally-ill son, Njabulo (24).
Njabulo is her only child with her ex-husband Allan Mahlangu.
With sadness on her face, she contemplates the man that now has her facing stigma as being the mother of a “deranged” son who is going around the crowded hostels beating up people.
“Can you imagine being shunned by the whole community because of my son’s condition,” she asked.
“I am a social outcast as people tell me to get away, saying I’m a witch. What annoys me the most is when people accuse me of casting a spell on my son. It’s so hard to deal with.”
But her story is far from being unique. Being a parent of a child with mental illness can be challenging and stressful especially in developing countries like Zimbabwe, where mental illness continues to be associated with avenging spirits, witchcraft and demons which has contributed to serious discrimination. There is stigma even among health professionals.
According to the Ministry of Health and Child Care (MOHCC), at least 1,3 million people are living with mental illness in Zimbabwe. The World Health Organisation (WHO) also estimates that one in four people will be affected by a mental health problem or neurological disorder at some point in their lives.
For many Zimbabweans, like Ms Moyo, where mental health care has been unaffordable and inaccessible well before the Covid-19 pandemic hit, its outbreak has posed new challenges to the mental health care as treatment now takes a backseat as the limited resources are now geared for pandemic containment.
Investigations by Chronicle established that the Covid-19 crisis has created new barriers for people already suffering from mental illness, at the same time exposing decades of neglect and underinvestment in the country’s mental health care.
According to the latest special initiative country report for mental health situation in Zimbabwe by WHO, of the total health budget, 0.42 percent is allocated to mental health. Public spending on mental health is estimated at 0.13 USD per capita each year.
The pandemic has also disrupted the already limited mental health services in the country, with some patients avoiding seeking services in hospitals for fear of contracting the virus while restricted movement has hindered people from going to health facilities.
Mrs Enia Madzura, who has a child with mental retardation and seizure disorder said living with a mentally ill child especially during the ongoing Covid-19 pandemic was distressful.
“Life with a child with mental illness is difficult,” said Mrs Madzura. “The emergence of Covid-19 has further complicated life as people with mental disorders are now exposed to more barriers in accessing timely health services, because of discrimination associated with mental illness.”
Investigations also found out that mentally-ill patients are also being sidelined in the country’s ongoing Covid-19 vaccination programme despite such patients being highly vulnerable to contracting and dying from the disease.
Clinical director of Ingutsheni Hospital, the country’s biggest mental health referral institution, Dr Wellington Ranga, believes during crises like the ongoing pandemic, mental health care can remain or be classified as a matter of secondary importance.
“When it comes to mental health, people put it below other things, and it is naturally like that when there is an emergency situation like the ongoing Covid-19 pandemic,” said Dr Ranga.
“Resources get channeled towards containment of the pandemic because that is where they are most needed. This is also because with Covid-19 people will die but with mental illness one can outlast the pandemic.”
Adding to the burden of mental health concerns, Dr Ranga said there was rampant stigma and discrimination of people suffering from mental illness.
“People don’t look at mental health the way it is supposed to be,” he said. “They don’t priotise mental health patients. For example we should have many visitors at Ingutsheni Hospital since we have 623 patients as compared to other local health institutions but we don’t see anyone despite the fact that our visiting hours are flexible as they are from 6am to 6pm every day.”
He added: “Even if you look, there is no public transport that comes to Ingutsheni Hospital as compared to other health institutions like Mpilo and United Bulawayo Hospitals (UBH) where they are designated areas where one can easily get transport to go there.”
In his article titled: Zimbabwe: Stigma and discrimination of patients with mental illness is rampant in the community, Mr Norman Magaya, a mental health nurse working with the discharge team at Harare Central Hospital Psychiatric unit said mental health was neglected as some people associate it with traditional harmful practices.
“In the communities where we work, stigma and discrimination against patients with mental illness is rampant,” said Mr Magaya. “Some attribute it to evil spirits. Others blame the patient for the illness. Often, you’ll hear people say that patients with mental illness have committed a crime against somebody and the illness is their punishment for that,” said Mr Magaya.
He said the care given to mental health patients was not the same as that given to patients suffering from other conditions like HIV and Aids, cancer and diabetes.
Stigma remains a serious problem, with many cases of human rights violations like chaining or beating experienced by people with mental illness.
“To combat stigma, we need to mobilise the community on mental health. Awareness campaigns should be done at all levels, from the ward, district, provincial and national level,” said Mr Magaya.
Mental health activist and founder of the African Institute for ending Violence, Bullying and Suicide (AFRIBS) Miss Zenani Masuku said the Covid-19 pandemic has shown, more than ever, how mental health issue is integral to health and well-being as demand for these services have risen amid the pandemic.
“Before Covid-19 pandemic, mental health care in Zimbabwe was a topic that was rarely spoken about or advocated for,” said Miss Masuku.
“Many people are still not aware of services that are available to them in the event that they experience a mental health crisis. But the pandemic has simply made people aware that there is such a thing called mental health illness and this is because of new studies which are emerging suggesting that people who were sick with Covid-19 had a significant chance of developing a psychiatric disorder after recovering.”
It is also clear from her observation that the long-term mental health impact of Covid-19 must not be ignored as it is likely to last much longer than the physical health impact.
A Covid-19 survivor, Lovemore, who did not want his last name used for privacy reasons said: “In addition to physical problems, Covid-19 patients suffer from considerable stress throughout the time they will be in isolation or hospital. It is thus important not to ignore the psychological disturbances and post-traumatic stress symptoms among those surviving the disease.”
While there is scant data on how Covid-19 is increasing mental health conditions, one study in South Africa found that 10–20 percent of the 220 people surveyed reported potent experiences of anxiety and fear as a result of the pandemic.
WHO has also warned the coronavirus pandemic could have a years-long effect on mental health amid an increase in reports of anxiety, depression and distress.
Commenting on the psychological impact of Covid-19 on the mental health care, Dr Printah Nkala of the Psychology and Counselling Department at the Zimbabwe Open University (ZOU), said while the pandemic psychologically threatens all members of society, people with mental health disorders were disproportionately impacted due to attitudinal, environmental and institutional barriers that are reproduced in the Covid-19 response.
“This being a new phenomenon which has negatively affected many people’s mental health, it is adding to a long-simmering mental health care crisis in the country,” said Dr Nkala. “It has indeed heightened the burden and created new barriers for people already suffering from mental illness and substance use disorders.”
He added: “There is however, need to promote public psychological counselling services whereby the media, and relevant professional groups need to disseminate authenticated information on Covid-19 and its effects on mental health with special attention being given to people with mental health disorders as they are not secluded to contracting the virus.”
Despite the growing numbers over the years of people affected by mental illness, mental health services, including drugs, remain in dire shortage across the country. Mental health drugs such as Fluphenezine deconoate (FD) and Chlorpromazine (CPZ) are constantly in short supply.
In April 2019, the MOHCC launched a Mental Health strategy to cover the period 2019- 2023. This came at a time when the MOHCC was moving with the global thrust to promote early identification, treatment, rehabilitative and palliative services in non-communicable diseases (NCDs).
However, despite the country now having a clear blueprint, mental health care still remains as one of the biggest unmet needs of our time.
While mental health care has been neglected for far too long, investigations also revealed that there is scarce research on the effect of Covid-19 on caregivers. There are concerns that the current public health messaging might be leaving out this important at-risk population who are underutilised in the treatment of people with mental illness.
Miss Masuku highlighted that the current Covid-19 pandemic was affecting not only people with mental health disorders, but also their families and caregivers.
“Urgent attention is needed to ensure that the appropriate support is provided,” said Miss Masuku. “The pandemic could lead to substantial deterioration of family functioning caused by the unimaginable pressure inflicted by Covid-19 restrictions and precautions; in particular, the increased pressure on caregivers might result in an imbalance in the demand for resources and disputes between family members.”
As such, funding and urgent action is needed to protect mental health, prevent mental disorders, and scale up mental health detection, treatment, and support services as well as pandemic-related psychological and emotional distress. This is because good mental health is a basic human asset which people should recognise, protect and cherish.
*This story was made possible by a grant by the Voluntary Media Council of Zimbabwe (VMCZ).