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Addressing Mental Health in Burundi

Mental Health in Burundi
The aftermath of the long-lasting Burundian Civil War manifests as poverty, trauma and inequality in Burundi. These factors devastate the mental health of people in Burundi; depression, anxiety and PTSD are common in adults and children alike.

An Overview of Burundi

From 1993 to 2005, the Republic of Burundi, a country located in East Africa, endured a violent civil war stemming from ethnic conflicts between the Hutu majority and the Tutsi minority. Although the civil war officially came to an end 17 years ago, ethnic violence and injustice persist, causing many to live in fear or flee as refugees. Furthermore, the long-term impacts of the civil war linger in the form of poverty and mental illness.

According to the World Food Program U.S.A, Burundi ranks as one of the most impoverished nations globally, with a staggering poverty rate of 65%. Furthermore, on the 2019 Human Development Index (HDI), Burundi ranks 185th out of 189 nations. “The HDI is a summary measure for assessing long-term progress in three basic dimensions of human development: a long and healthy life, access to knowledge and a decent standard of living.” Burundi’s ranking places the nation “in the low human development category.”

With 12.2 million citizens crammed into 9,920 square miles, overpopulation and food insecurity are major problems. Malaria, measles, HIV/AIDS and tuberculosis are common causes of death in Burundi. COVID-19 and a lack of adequate medical care exacerbate poor living conditions within the country. These factors push mental health treatment to the back burner.

Case Study

The aftermath of the war created a ripple of trauma for many citizens. A 2018 study by Nkengurutse and Bitangumutwenzi illuminates the severity of mental health in Burundi. The study included 120 subjects from ages 15 to 55. The results were frighteningly dire: 100% of patients had some form of moderate to severe mental illness. About 57% suffered depression, 20% had “psychotic features,” 13% had bipolar disorder, 8% received a schizophrenia diagnosis and 65% were victims of trauma.

Subjects remained as inpatients for about 20 days. Mental health stigma (60%) and “poor economic insertion” (90%) stood as barriers to full recovery. After a year, 30% of treated patients reported a full recovery while 42% went into relapse. This study illustrates the sheer volume of Burundians that struggle with mental illness and the factors presenting barriers in mental health recovery.

The Good News

Sports unite warring factions of Burundi, reducing the ethnic tensions prevalent across the nation. Burundi recognizes sports as an outlet, never missing a Summer Olympic Game since its first debut in the Olympics in 1996. Athletes from Burundi also compete in the African Wrestling Championship, winning gold and silver medals. Among women, soccer offers many females a source of income, providing a way to use their talents to make a living, the Guardian explains. Soccer also grants these girls and women independence and freedom, a rare commodity for many Burundian females who often face parental pressures to marry as teenagers. Athletes provide role models for young Burundians and boost morale throughout the country, directly improving mental health and confidence.

Why Mental Health Matters

Poor mental health directly correlates with poverty. The Psychiatric Times observed that childhood poverty may lead to depression and anxiety, a decline in school performance and an increased rate of “psychiatric disorders in adulthood.” This impact on education is evident in Burundi as the nation’s literacy rate stood at about 68% in 2017, well below the world average of 86%.

In addition, poverty has direct links to depression, anxiety, psychological distress and suicidality. This causal relationship between poverty and mental illness creates a constant loop that is especially dangerous in Burundi where it is extremely difficult to escape the cycle of poverty. Poverty leads to poor mental health, which impedes the ability of individuals to pull themselves out of the depths of poverty, thus worsening their mental states. In 2019, the Mental Health Innovation Network stated that “90% of people with mental illnesses have no access to treatment, especially in [impoverished] and rural areas.”

Organizations Assist

While UNICEF’s mental health services in 2020 gave 160,000 Burundian children access to mental health resources, partially alleviating the issue, there are still millions of Burundians in need of mental health treatment.

Human Health Aid–Burundi (HHA Burundi) is a nonprofit that “medical students, psychologists and social workers” established in 2005. The organization works with Burundian communities, “especially children and women who suffer from anxiety, depression, trauma and other psychosocial consequences of their war experiences,” to improve “access to mental health care and psychosocial support.” HHA Burundi also provides direct aid to refugees by sending clothing, food and other necessities. Through programs such as Health School and Sanitation Training in Burundi, HHA Burundi transforms lives.

In addition, UNICEF secured $9.8 million worth of funds for Burundi in 2020 for the provision of education, food, medicine and other humanitarian needs. Aid lessens the economic and emotional strain in Burundi, therefore, contributing to positive mental health.

While addressing mental health in Burundi is a matter of urgency, several organizations are stepping in to assist. Furthermore, sport provides citizens an outlet for trauma, giving Burundians a source of hope in a war-torn country. As organizations strive to push mental health to the forefront of foreign aid, the hope is for Burundians to receive the mental health assistance they require to thrive.

– Mariam Abaza
Photo: Flickr

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Mental Health in the United Kingdom

Mental Health in the United KingdomIn April 2021, psychiatrists warned that the United Kingdom may be in the depths of a mental health crisis. The number of people seeking help for issues such as anxiety and depression climbed to record numbers in 2020. In fact, these numbers were so high that the National Health Service (NHS) struggled to meet the service demand for mental health in the United Kingdom. Affirming this in October 2021, Somerset, a mental health organization, said that the U.K. is facing a “mental health pandemic.”

4 Facts About Mental Health in the United Kingdom

  1. COVID-19 significantly impacts mental health in the United Kingdom. The Office for National Statistics (ONS) reported in October 2021, that at the height of the pandemic, 21% of adults in Great Britain suffered depression. This is an uptick from the pre-pandemic level of 10%. Furthermore, nearly 75% of these adults reporting symptoms of depression attribute those symptoms to the impacts of the COVID-19 pandemic.
  2. Mental illness is on the rise among the youth. The U.K. Children’s Society indicates that “in the last three years, the likelihood of young people having a mental health problem” has risen by 50%. Exacerbating these issues further, about 75% of youth suffering from mental health issues do not receive the mental health assistance they require. Dr. Santiago Nieto, a general practitioner who works at Northampton’s County Surgery, told the BBC in November 2021 that “there is far more anxiety, more depression, more cases of suicide or attempted suicide and more serious self-harm.”
  3. Geography matters in the case of mental health in the U.K. Research shows that mental health issues are more common in certain areas within the U.K. For example, the Health and Social Care Board finds that mental diseases such as anxiety and depression are more prevalent “in children and young people in Northern Ireland” in comparison to other areas of the U.K. This survey is the first of its kind, and though it is unclear why this disparity exists, researchers find that an array of factors contribute to the rising levels of depression, including “family trauma, adversity, poor health and disability.” Furthermore, according to the ONS, “adults living in the most deprived areas of England” are twice as likely to experience depression as those living “in the least deprived areas of England.”
  4. Unemployment strongly affects mental health. According to the ONS, adults facing unemployment are 50% more susceptible to depression than employed adults. Noting a situation prompting further inquiry, The Health Foundation released a report in April 2021 examining the relationship between mental health and unemployment, especially amid COVID-19. The report finds that “the relationship between mental health and unemployment in the U.K. is bi-directional,” meaning that strong mental health can help an individual secure a job and losing a job can damage mental health. The report estimates that the rising unemployment rate in the U.K. will worsen the mental health of “an additional 200,000 people” by the end of 2021.

NHS to the Rescue

Despite the challenges of mental health in the United Kingdom, there is a strong apparatus in place to address the challenge. In 2008, the NHS introduced the Improving Access to Psychological Therapies (IAPT) program, which has since become one of the most recognized mental health programs in the world. The IAPT utilizes talk therapies to treat people with anxiety and depression in England. Due to its success, the NHS is expanding the program. New goals aim to reach nearly 2 million adults with IAPT services by 2024. Program expansion will also focus on “supporting people to find or stay in work” amid rising unemployment.

COVID-19, rising unemployment, growing depression and anxiety rates among the youth as well as unequal access to care presents a complicated problem for the United Kingdom, which will require creative solutions. However, the nation remains steadfast in its commitment to improving mental health in the United Kingdom with the support of the NHS and countless organizations.

– Richard J. Vieira
Photo: Flickr

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The Impact of Poverty on Mental Health in Norway

Mental Health in Norway
Mental health is a disease that affects an estimated 792 million people worldwide. Yet when people live in poverty and lack the money to attain basic needs, mental health often falls on the back burner. This is especially true in Norway. Though the country has a low poverty rate coupled with substantial efforts to improve access to and quality of mental health care, about half of all people in Norway experience a mental health disorder at some point in their life, and these numbers are rising in the wake of COVID-19.

Health Care in Norway

Norway offers universal health care coverage to all of its citizens and extends this service to all citizens from the European Union. It receives funding through general taxes and payroll contributions by employees, and provides a variety of services, with mental health being one of them. In 1956, this system, called the National Insurance Scheme, became a right for all Norway citizens. Though it ensures access to local municipalities and general practitioners, patients that require long-term or outpatient care must pay a fraction of it, making services unattainable for some poorer citizens.

How Does Economic Status Influence Mental Health?

 Mental health problems can arise in anyone, regardless of age, socioeconomic status or demographic group. The ways these disorders affect the individual vary. However, people in poverty are more susceptible, as a large factor fueling these disorders is one’s life situation. In fact, life factors like disability, unemployment, sicknesses and others drive common mental illnesses like depression and anxiety.

A study that the International Journal for Equity in Health published found “the prevalence of psychological distress increasing by decreasing social status,” and noted economic problems as a major factor of it. Life factors, like living in poverty, have proven to increase levels of mental health disorders, but so do perceived living situations. Another study, published in Science Direct, investigated Norwegian adolescents’ view of living status. It found that if people felt they were impoverished or living in a low-income household, they had higher instances of mental health disorders. This perception, it found, might even be more influential than actual living conditions.

Impact of Mental Health Disorders on Norwegians

Estimates have determined that nearly 15% of children worldwide suffer from a mental health disorder. In 2018, 16.5% of  Norwegians 15 to 24 years old reported experiencing “severe psychological distress.” Typically, mental disorders manifest as early as 14 years of age, with personality and anxiety disorders developing as early as 11 years old. The Organisation for Economic Co-operation and Development said that “without early and effective treatment and inclusion in society, young people with mental disorders risk becoming lifetime users of adult mental health services.” On top of this, instances of mental illness in children and young adults are particularly concerning since they lead to poorer education and difficulty transitioning into the workplace. Consequently, affected individuals earn lower incomes as adults if not treated properly at a young age.

Concerningly, in the last decade, Norway experienced an increase in permanent poverty among children, a factor that directly relates to mental health. Oslo, the country’s capital, has notable disparities in income throughout the city’s districts. This impacts mental health in Norway since living in city districts with high-income inequality, like in much of Oslo, lowers the probability of accessing mental health services, according to a study by Jon Finnvold of Oslo Metropolitan University. The study also highlighted that kids living in lower-income households experienced a higher risk of behavioral, or mental, problems.

What is Norway Doing to Improve Mental Health Services?

Notably, in the past few decades, there has been substantial investment in mental health services in Norway. Between 1999 and 2008, it invested NOK 6.3 billion ($735, 739, 200) into the Escalation Plan for Mental Health. This investment lowered suicide rates and helped improve services already provided by municipalities and increased access to children.

However, there are still discrepancies in access to care for mental health in Norway, largely based on socioeconomic status. Any problems Norway faced with its mental health care system only became more pronounced during the pandemic: like all countries, it saw an increase in patients requesting mental health assistance, especially in early 2020, the onset of the pandemic. A lot of these increases, as scientists speculate in a study that VOX EU published, come from the effects of lockdown and movement restrictions. Scientists are looking to policymakers, as they enforced said lockdowns, and draw on this evidence to show the harm isolation has on people’s overall mental health.

In no way do mental health problems only affect Norway; they also affect the entire world without discrimination, planting its seeds in the minds of the richest and the poorest of citizens belonging to any race, ethnicity or income level. Yet, people with lower incomes and of a minority ethnicity are particularly vulnerable to feeling the weight of these illnesses, as they have less access to services.

In Norway, the government’s universal health care system calls for equal access to all health services, including mental health, but it is just not the case. Those needing more comprehensive care still must pay a portion out of pocket, a bill that not everyone can afford to pay. Oslo specifically is home to unequal access, a direct result of the stark income discrepancies throughout the city. Norway has made substantial progress through mental health investment, but there is always a need to reach more people, to focus on the vulnerable populations to ensure they have the same opportunity for care as everyone else. There are still people not receiving care, as costs remain a barrier for those needing extensive treatment.

– Cameryn Cass
Photo: Unsplash

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10 facts about mental health and poverty

Mental Health and PovertyAwareness around mental health is increasing globally, not least as depression ranks third in the global burden of disease, with predictions that it will take the lead in 2030. However, in some parts of the world, poverty rates can be two times higher among those with mental health disorders than among those without disabilities. It is crucial to realize the strong relationship between mental health and poverty in order to better tackle both problems. Here are 10 facts about the link between mental health and poverty that everyone should know.

10 Facts About the Link Between Mental Health and Poverty

  1. Poverty can cause poor mental health. Poverty can increase the likelihood of mental health diseases and therefore is a causal factor. An example of this in action is that higher stress levels due to poverty-related issues can trigger depression.
  2. Poverty can be a consequence of poor mental health. One of the main factors includes an inhibited ability to work leading to unemployment through reduced productivity. Meanwhile, another factor is poor mental health because those afflicted may experience increased health expenditure leading to a lower socioeconomic standing.
  3. Mental health disorders are more prevalent in low- and middle-income countries (LMICs). More than 13% of the world’s burden of disease comes from mental disorders such as depression, anxiety and schizophrenia. From this, nearly three-quarters of this burden exists in LMICs. Yet, in places such as Ghana and Ethiopia, fewer than 10% of those suffering from a mental health condition receive treatment. Overall, in Africa, government expenditure on mental health is only $0.10 per capita.
  4. Growing up in poverty at home seriously impacts cognitive development. Scientific studies have inextricably linked mental health and poverty, showing that experiencing childhood in circumstances of poverty has damaging effects on mental development. Growing up in a stressful environment like poverty can lead to the body producing short-term coping strategies which can lead to long-term health issues such as increased susceptibility to certain cancers. Researchers have also scientifically proven that childhood poverty leads to diminished cognitive performance, as children raised in these environments consistently show lower cognitive performances, especially in language functions and abilities such as memory, planning and decision-making. This continues a vicious cycle of generational poverty.
  5. Stressful life events have a close association with poor mental health and worsening poverty. These events might include violence and crime. Discrimination also acts as a barrier to opportunities and causes poorer mental health as well as a decreased ability to perform. In South Africa, a history of violence, exclusion and racial discrimination have strong links to their high statistics of mental disorders, with 16.5% of the population reporting suffering at least one in 2007.
  6. The preoccupation with scarcity in poverty leads to lower cognitive capacity. When someone is occupied mentally with issues of scarcity, such as money or where their next meal is coming from, this uses up a lot of mental capacity. A study occurred in India proving the effects of scarcity on mental power and performance. Researchers tested more than 460 sugarcane farmers’ cognitive function before their annual harvest, when the farmers were poorer, and after. The results showed a decreased mental capacity of 10 IQ points pre-harvest, the equivalent to a whole night’s sleep. This proves that scarcity due to poverty heavily affects mental capacity and can leave little energy to dedicate to work which can lead to poor performance and unemployment. Equally, if someone is already unemployed, it means little mental capacity remains for seeking ways out of poverty, such as pursuing job training or further education.
  7. The stigma around those living in poverty provokes poorer mental health in this population and continued poverty. Many in the world have the perception that people in poverty are lazy. This stigma decreases the general population’s willingness to help those in poverty. It also affects the latter’s view of themselves as it significantly impacts people’s mental well-being through exclusion, isolation, feelings of helplessness and lower confidence. This can further decrease educational and professional attainment where it may already be lower due to impacted childhood development and decreased mental capacity.
  8. The economic burden of poor mental health is vast. Although mental health is categorically not an economic problem, it does heavily impact the global economy to a shocking extent. Globally, the cost of lost productivity due to depression and anxiety disorders is $1.5 trillion a year. This equates to 4.7 billion days of lost productivity. As well as this decreasing amount of money for the economy, a higher rate of mental health problems requires increasingly more health expenditure, further lessening the economic power of a country.
  9. Poor mental health poses serious problems for LMICs’ development. As well as inhibiting economic productivity, poor mental health also weakens immunity. Therefore, sufferers are more likely to become infected with HIV and malaria treatments are less effective, posing significant problems for national and global health goals. Yet, a decent investment in mental health programs and treatment brings back significant gains. A study in Ghana showed that for every dollar invested in depression and anxiety treatment over a 10-year period, society would respectively receive $7.40 and $4.90. Meanwhile, a lack of investment makes development goals much harder, if not impossible, to achieve.

Concluding Thoughts

The link between mental health and poverty is clear, and therefore the creation of dual poverty-alleviation and mental health programs will lead to increased health and economic prosperity for all.

– Hope Browne
Photo: Unsplash

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How Mental Health in Developing Countries is Improving

Mental Health in Developing Countries
Due to conflict, poverty and disease, mental health is a serious issue that might not be addressed in some areas around the globe. However, six different projects in Kenya, Zimbabwe, Uganda, Vietnam, Pakistan and Haiti are examples of how mental health is improving in developing countries.

Kenya: Africa Mental Health Foundation (AMHF)

In 2004, Professor David Ndetei founded AMHF in hopes to improve the mental health of underprivileged individuals in Kenya. He heavily invested in training psychiatrists in the Department of Psychiatry at the University of Nairobi in order to ensure high-quality mental health care for patients. A previous project that AMHF completed was The Kenya Integrated Intervention Model For Dialogue and Screening (KIDS). This program focused on treating mental illnesses in children and adolescents and preventing further mental health problems in adulthood.

Zimbabwe: The Friendship Bench

According to facts and figures supported by The Friendship Bench, one in four Zimbabweans suffers from common mental disorders. Poverty, marital problems and HIV all play a role in rising mental illness in Zimbabwe. The Friendship Bench attempts to combat kufungisisa, kusuwisisa and moyo unorwadza, which are all Shona terms for anxiety and depression, by employing lay health workers. These workers, also known as community grandmothers, speak with patients in casual and comfortable environments, provide home visits and offer support via mobile phones and tablets.

The Friendship Bench also has a key focus in community activation. After patients complete their therapy treatments, they are referred to a post-therapy support group with others who suffer from similar disorders. The effectiveness of The Friendship Bench proves to be successful — an assessment after six months of treatment and therapy groups resulted in the prevalence of depression decreasing by 10 percent in Zimbabwe.

Uganda: Group Support Psychotherapy

Although Uganda has been acknowledged for HIV/AIDS treatment and awareness efforts in recent years, the mental health implications of being diagnosed and the stigmas surrounding these diseases need improvement. Funded by Grand Challenges Canada and conceptualized by Dr. Etheldreda Nakimuli-Mpungu, the Group Support Psychotherapy program helps treat depression in HIV/AIDS patients by implementing positive coping skills and helping patients obtain a liveable income.

The results of this program are impressive. After 6 months it was reported that an astounding 85 percent of patients claimed to have recovered from their depression. They also reported positive changes in terms of self-esteem and their ability to function in social situations.

Vietnam: Frugal Innovations – Promoting Mental Health Among Adults and Children

According to a 2011 study conducted by the World Health Organization, Vietnam ranked last among 144 low and middle-income countries on the basis of access to mental health treatment. The Frugal Innovations project, led by Simon Fraser University’s Faculty of Health Sciences, launched this two-year pilot program to assist low-income adults in Vietnam. Two methods were performed in this project: community health workers were trained to help those suffering from anxiety and depression and coaching via telephone to help families with children who suffer from behavioral difficulties.

The pilot program was deemed a success. With further funding, this program will expand across nine provinces in Vietnam and offer child and family-focused components of treatment. If this program continues to succeed, an estimated 4,250 Vietnamese citizens with depression will have access to treatment.

Pakistan: Family Networks for Kids (FaNS)

Family Networks for Kids, created by The Human Development Research Foundation (HDRF), helps children through mental health treatment and helps families of these children cope with the stigma and other challenges that come along with mental disorders. These treatments are technologically based, through tablets that provide interactive activities for children to complete. This technology is also beneficial for the entire family. Parents or other guardians can answer questions through an Interactive Voice Response (IVR), which helps identify developmental disorders in children. This saves time and money by families not having to visit a doctor.

An assessment of this program showed positive results from participating children. Children that finished treatments reportedly had an increase in engagement with school and societal functions and improved self-care. With further training and funding, HDRF hopes to continue the FaNS program and help an estimated 3,000 more children and adults with mental health treatment.

Haiti: Zanmi Lasante

The biggest health care provider in Haiti, Zanmi Lasante, was founded in 1983. However, mental health treatment was not a key focus of this organization until the catastrophic earthquake that occurred in 2010. Four core issues focused on the most were depression, epilepsy, psychotic disorders and mental illnesses in children and adolescents.

Mental health treatment through Zanmi Lasante is normally offered through primary care services. Traditional healers, community health workers, psychologists, social workers, nurses and physicians are all employed through the organization for mental health treatments towards patients.

Leaps and Bounds

These six projects display how much mental health has improved in developing countries. Thousands of adults and children have been diagnosed and treated with various mental disorders due to these initiatives, benefiting from the expertise of trained professionals and generous amounts of funding. Due to their successes, these projects will continue to expand and help more people in need of treatment.

– Maddison Hines
Photo: Pixabay