Mental Health in Latvia
Latvia is located in the Baltic region. This northern European country’s active involvement in many international organizations allows for it to have diverse approaches to its policies. However, Latvia still has a long way to go when it comes to societal issues such as mental health. In fact, poor mental health in Latvia was one of the leading contributors to disease burden in 2017.

The World Health Organization (WHO) defines mental health as a balance between an individual’s potential, community interactions and everyday stressors of life. A high number of mental health disorders in a country results in social and economic burdens. Therefore, mental health treatment plays a crucial role in the overall health of a country’s citizens.

The population at risk of experiencing poor mental health are citizens who report a low level of social connection and household income. As the WHO’s definition of mental health describes, community and everyday stressors, such as economic issues, correlate to overall life satisfaction.

Societies typically measure mental health to increase diagnosis and treatment. Compared with other European countries, Latvia has lower indicators of mental health. Here are four key facts to know about mental health in Latvia.

4 Key Facts About Mental Health in Latvia

  1. The Progression of Mental Health Care: When Latvia was a part of the Soviet Union, patients took on a more passive role in their mental health medical treatment. Since then, Latvia restored its independence in 1991 and joined the European Union and NATO (North Atlantic Treaty Organization) in 2004. With its global involvement, Latvia not only gained allies but was also able to learn more diverse ways of treating mental health. Before joining the Organisation for Economic Co-operation and Development (OECD) in 2016, Latvia had to follow criteria related to quality health care such as giving patients a more active role in their treatment. As a result of these guidelines, Latvia is now moving toward better psychiatric care
  2. Rate of Diagnosis: A 2012 study assessed depression in a general population of Latvia for one year. It then measured how many people with this mental illness sought out health care. Results indicated that depression is under-diagnosed in Latvia. Latvia has improved its efficiency despite the health care system remaining underfunded. Changes like these are a part of a larger plan to increase mental health care.
  3. Progress Toward the Sustainable Development Goal 3: The United Nations has a 2030 Agenda for Sustainable Development, which includes encouraging mental health and well-being. Overall, the U.N. developed 17 goals to achieve prosperity. Despite the COVID-19 pandemic, Latvia is still making progress toward these goals through its parliament’s push for civic engagement. With an increase in political participation, more policies will develop that reflect the needs of its citizens, including in the mental health sector.
  4. Latvia’s National Development Plan: Latvia currently has a National Development Plan for 2021-2027. The country developed this primarily economic policy in accordance with the U.N. Agenda for Sustainable Development. Among these goals, Latvia included a section on quality of life, which stresses the importance of mental health along with physical health. In order to accomplish this, the country plans on having targeted cooperation between rural and urban areas and municipal cooperation between the economies in different regions. This cooperation will allow for participation that will recognize the various needs of its citizens.

Ritineitis

A nonprofit organization called Ritineitis has a foundation called the Adult Non-formal Education Center Azote that focuses on mentoring for educational and professional needs. One project, “ASNI,” allowed young people to come up with proposals that would help the daily life of Latvia’s citizens. The goal of this project was to promote youth civic participation. Numerous projects came out of this competition, including the promotion of youth sports, exercising and even weaving. Participating in civic participation at a young age will most likely lead to continuing this practice later in life. This participation will increase policies aimed at the societal needs of Latvian citizens, in turn, increasing mental health awareness.

Latvia may have lower mental health indicators than other European countries, but its current policies are working to improve ways to record this type of data. Its National Development Plan recognizes the need to promote “health literacy [as] a national priority.” Overall, Latvia is moving forward in its plans to increase the social and physical well-being of its population.

–  Mia Banuelos
Photo: Pixabay

 Mental Health in Rwanda Rwanda is a small country in sub-Saharan Africa. Rwanda has struggled to become a stable country economically and politically since it became independent in 1962. As a developing country, Rwanda is still trying to develop its healthcare system. With years of conflict and instability, people especially struggle with mental health in Rwanda.

5 Facts About Mental Health in Rwanda

  1. The Rwandan Genocide plays a significant role. Roughly 25% of Rwandan citizens struggle with PTSD and one in six people suffer from depression. The reason why so many Rwandans have mental health conditions can be explained by one key event in Rwandan history. During the Rwandan genocide of 1994, members of the Hutu ethnic majority murdered as many as 800,000 people, mostly of the Tutsi minority. The mass genocide caused severe trauma to survivors who still suffer from mental health issues 26 years after the event.
  2. Rwanda has very few resources. According to the World Health Organization, Rwanda has only two mental health hospitals, zero child psychiatrists, and only 0.06 psychiatrists per 100,000 people. With a large amount of the population plagued by mental health issues, Rwanda needs more resources to help the mentally ill.
  3. Suicide rates have greatly decreased in Rwanda. In 2016, the suicide rate in Rwanda was 11 deaths per 100,000 people. This is a great improvement compared to the 24.6 suicides per 100,000 people in 2000. An increase in mental health resources contributes to the lowering of the suicide rate in Rwanda.
  4. Increased mental health funding is essential. The average mental health expenditure per person in Rwanda is 84.08 Rwandan francs. Most citizens of Rwanda do not have the financial resources to afford mental healthcare. The government currently uses 10% of its healthcare budget on mental health services. Considering how large the mental health crisis is, the government should increase its expenditure to address the crisis. Since citizens cannot afford to pay for mental health resources, the government will need to help provide more free or affordable resources.
  5. The Rwandan Government is updating policies to address mental health. In 2018, Rwanda’s updated strategic plan for its health sector set new targets for expanding mental health care services. Its purpose is to help increase access to mental health resources by decentralizing mental health and integrating it into primary care. Also, this plan calls for a decrease in the cost of mental healthcare and an increase in the quality of care. The plan hopes to accomplish strategic goals by 2024. If successful, this plan may be used as a method to help other countries establish a quality mental health plan.

The Road Ahead for Rwanda

Considering Rwanda’s violent history, it is no surprise that the population struggles with mental health. Over the years, progress has been made with regard to mental health in Rwanda. However, many more resources are needed to help address the mental health crisis in Rwanda. With Rwanda’s updated strategic plan to address the issue and an increase in expenditure, the well-being of Rwandan’s will be positively impacted.

Hannah Drzewiecki
Photo: Flickr

Bipolar Awareness in IndiaIndia is the second-most densely populated nation in the world, with more than 1.3 billion people. Of that number, more than 82 million citizens suffer from bipolar disorder, according to data from 2019. Bipolar disorder in India often goes undiagnosed and untreated for reasons ranging from ancient superstitions to the cost of treatment, but, bipolar awareness in India is steadily progressing.

Bipolar Disorder in India

Improved bipolar awareness in India exemplifies how a concerted effort can reduce stigma and create an affordable and readily available avenue for treatments such as therapy and medication. Indians, mostly women, have been disowned and abandoned by family or a spouse after receiving a bipolar diagnosis. In a country where the consequences of a mental condition are isolation and disconnection, the need for awareness and education is paramount.

A nation that once attributed bipolar disorder to demonic spirits, planetary alignments or a sinful past life, has come extremely far in its understanding of the illness. But, the stigma surrounding the disorder is still prevalent in India, and many, especially those from rural locations, believe bipolar disorder is a choice or an illness reserved for the rich and privileged.

BipolarIndia Organization

One resource improving bipolar awareness in India is the organization BipolarIndia. The community was created in 2013 by Vijay Nallawala, an Indian man that suffers from bipolar disorder, and his mentor and friend, Puneet Bhatnagar. BipolarIndia’s mission is to create an empathetic, judgment-free environment for bipolar people to find information, treatment, and most of all, support from those that can relate to their struggle.

BipolarIndia hosts a National Conference every year on World Bipolar Day to create awareness for the illness and educate residents from all over the country. In 2015, the organization began hosting monthly support meetings for individuals to speak with peers that can understand their struggle. It has also recently developed a way for patients to receive real-time support through the Telegram App when they feel they may need immediate help. Resources such as the Telegram App are invaluable due to the lack of mental health professionals in India.

The Mental Health Care Bill

Data from a 2005 report shows that there are only three psychiatrists per million citizens and only 0.06% of India’s healthcare budget goes toward improving mental healthcare. The Indian Government passed a Mental Health Care Bill in June of 2013 laying out a mission to improve bipolar awareness in India as well as reduce stigma surrounding all mental health issues. The bill has been undergoing revisions and policy modifications based on the guidance given by the Indian Association of Psychiatry.

Efforts to Raise Awareness

The government’s efforts to raise awareness about the complexity of bipolar disorder and the number of Indians that suffer in silence is vital to the disorder being understood. The Indian government aims to provide communities with adequate care and reliable information, leading the nation to a better understanding of a complicated mental disorder.

Bipolar awareness in India has improved with private organizations such as the International Bipolar Foundation (IBPF) funding research on effective treatments and raising awareness across the globe.

Also fighting for bipolar awareness, Indian celebrities, including Deepika Padukone, Rukh Kahn, Yo Yo Honey Singh and Anushka Sharma, have stepped forward and opened up about their personal battles with bipolar disorder, combatting the stigma surrounding the illness.

The Road Ahead

Bipolar awareness in India has slowly improved but still has a long way to go. If the government aims to change the attitude toward bipolar disorder and improve treatment, a significant investment in research is vital as well as a comprehensive understanding of the disorder.

–  Veronica Booth
Photo: Flickr

Mental Health in Malaysia
Populations of people who suffer from mental illness exist in every country in the world. Some countries, like Malaysia, have a more prominent number of mental illness cases than others, having an equal ratio of one in five cases in comparison to the United States. Malaysian Medics International (MMI) pointed out that Malaysia has a national average of 1.27 psychiatrists per 100,000 people, a stark contrast to the World Health Organization’s (WHO) recommendation for a ratio of one psychiatrist per 10,000 people. Here is some information about mental health in Malaysia and efforts to treat it.

About Mental Illness in Malaysia

Mental illness can have a large variety of causes. Moreover, pre-existing circumstances such as poverty can make cases of mental illness worse. Such cases tend to make it difficult for patients to maintain a steady lifestyle due to mental health symptoms that make full functionality difficult. The poverty that is already prominent often means that a support system is not present to give the patients the time they need to recover. In 2020, the police reported that 25% of recent suicides related to pressures of debt.

Stigma exists in Malaysia regarding mental health. Some Malaysians perceive mental illness as a natural phenomenon or a kind of divine punishment; this viewpoint often exists within families who have more religious inclinations. Many cases see these families attempting to ‘purge’ such conditions through spiritual means that have not always received medical approval and may not have positive effects.

Mental Health Among Youth

Prior to 2014-2015, few investigations into the statistics of mental health of the youth of Malaysia occurred. With the inclusion of mental health in the National Health Morbidity survey, the country is now taking the numbers more seriously and believes it should observe mental health numbers in order to preserve future generations.

In 2015, the National Health Morbidity Survey stated that mental health illnesses and conditions were likely to become the second most prominent illness after heart disease in Malaysia by 2020. In 2017, the National Health Morbidity Survey showed that one in five adolescents has depression while two in five have anxiety. At that time, 11.2% reported suicidal tendencies or intentions, and 10.1% reported that they have attempted suicide. Now in 2021, that statistic has increased since the start of the COVID-19 pandemic, which has caused an increasing report of cases of mental health problems. Worldwide, the increase of those who suffer from mental illness has risen by an estimated 10 million.

Treatment for Mental Health Issues

Not everyone has access to treatment. Some are unable to afford it and certain areas lack proper clinics. Even in cases where there are professionals who can help, it can be difficult to make a consistent appointment. The WHO revealed statistics that showed that the ratio of psychiatrists to patients is 1:200,000 in Malaysia. On the chance that a person would be able to get a consultation, the aid they need may not always be available or open to them.

The Mental Illness and Support Association (MIASA)

There are organizations that are already working to offer as much support as possible for those who may not have access to resources like therapy or medication. Beginning in 2017, the Mental Illness And Support Association (MIASA) made it its mission to promote awareness on the importance of mental health in Malaysia. Its charities and services seek to provide aid for patients and caregivers alike. It offers a holistic solution by also encouraging spirituality alongside medical treatment, which is to give patients empowerment and autonomy.

The Malaysian Communications and Multimedia Commission (MCMC)

Certain companies are also working to make it easier for those with mental illnesses to reach out if there are no professionals available to them. In August 2019, the Malaysian Communications and Multimedia Commission (MCMC) worked with eight phone operation companies in order to waive call charges for people making calls to the Befrienders helpline, which is a mental health helpline that provides services such as counseling and emotional support over the phone. With the right aid, it is working to ensure that anyone can get the support they need for a healthy, functioning lifestyle.

It is the hope of the Malaysian government that with greater advocacy, the rise of mental illness in the growing youth will level out. The medical studies that have made this rise clear have helped to erase doubts about the prominence of mental illness and prove the need for treatment for mental health in Malaysia. In order to preserve future generations, the country will continue to take measures in order to give patients the support they need to live functioning and healthy lifestyles.

– Seren Dere
Photo: Flickr

Mental Health in Mexico
The progress of psychology, medical intervention and social work is making mental health and illness awareness a necessary part of daily life. In Mexico, estimates have determined that 17% of the population has at least one mental disorder, with the expectation that one in four people could suffer from an ailment once during their lifetime. According to Plan Seguro, a health insurance provider, the financial and economic costs of mental illnesses in developing countries is equal to 4% of a country’s GDP. Red Voz Pro Salud Mental (VPSM), a nonprofit organization in Mexico, is doing its part to better serve the community and bring understanding and resources to those struggling with mental health disorders. Gabriela Cámara, psychologist and honorary president of Red Voz Pro, addresses the issues surrounding mental health in Mexico through education and the establishment of vital rehabilitation programs and facilities.

Combating Stigmas Around Mental Health

Red Voz Pro Salud Mental is a nonprofit network of organizations providing services for those suffering from mental illnesses in Mexico, as well as their families and professionals in the field. These resources range from establishing support groups and publicizing vital information on social media to providing psychoeducation of clients and promoting laws to the federal government. It also teaches the National Alliance of Mental Health’s Family to Family course and VPSM’s Land Ahoy course for patients. In an interview with The Borgen Project, Cámara contended that the most urgent challenge facing VPSM is “combating the stigma” that comes with mental illness. According to Doctor Medina Mora’s study at the National Alliance on Mental Illness, Mexico ranked second in the world in the level of stigma associated with mental health services. As a result, outreach is a crucial tool in Red Voz’s belt.

The biggest misconception regarding mental health in Mexico is the belief “that one gets better with cleansing or esoteric methods, or that it is the fault of the mother or family or the patient themselves.” This mythmaking, blame-casting idea affects a patient’s ability to get treatment, find employment and social interaction opportunities or disclose their concerns with family and friends. Red Voz Pro’s solution is one of publicity and support.

The Key is Education

Cámara insists that “through support groups, messages on social media and psychoeducation,” Mexico can overcome the stigma of mental illness. By eradicating stigma, the country can turn its focus to fostering a communal understanding of mental health and thus develop a greater ability to help those afflicted. Mental disorders among young people are almost twice as high in Mexico than in the U.S. and Canada. This likely mirrors poverty’s relationship with mental illness. Cámara points out, “lower-income increases the chance of family violence, stress, post-traumatic stress disorder, depression and suicide,” all of which one can combat with education.

Depression will be the second leading cause of disability in the world in the decade ahead and the first in developing countries, such as Mexico. The number of people experiencing mental health illnesses only continues to increase, putting the onus on learning how to recognize, accept, investigate and nurture the thoughts and feelings that one may associate with malaise. While education might appear the trite and oversimplified solution to mental health in Mexico, Cámera asserts it is the way forward.

Institutional Organizations Help Support Mental Health

VPSM focuses on “uniting similar civil organizations with government programs, crisis hotlines, and rehabilitation facilities” as a means to serve its population. The need for comprehensive health coverage is a problem that Mexico, and other nations, face. “Approximately 40% of the population has no insurance,” says Cámara, leaving integral treatments underdeveloped and underfunded. Mexico is waiting to see if the current administration is willing to tackle these issues. Number six of Red Voz’s 13 “Objectives at the National Level” is to work with the federal health system to detect and prevent issues that arise from unidentified mental health problems. By giving an increased voice to nonprofit health services such as VPSM, the federal government can receive support from a caseload and transparency point of view.

Moreover, institutional restructuring and cooperation is a process that Cámara maintains is vital to help citizens get through these hardships. “Institutions must have programs of relapse prevention, support for families, people working to decrease suicide, etc.” Without these social nets, human beings lack adequate understanding of what they are going through and thus make struggle and despair an obvious pathway. VPSM aims to be there for Mexicans looking to steer back toward the road of recovery and community.

Red Voz Pro Salud Mental is consolidating an alliance between mental health networks in Mexico by promoting psychoeducation to improve the quality of life of those struggling with mental disorders. In a world where systems feel impervious to mental health, particularly in Mexico, this nonprofit stands out by valuing human-to-human management, supporting other civil organizations and understanding mental health disorders.

– Spencer Daniels
Photo: Flickr

Mental Health in Bosnia and Herzegovina
In the past half-century, mental health treatment has become a hallmark of national development and Europe has been no exception. Nations of the former Soviet Bloc have seen major developments in the last several years. Before violence broke out in the former Yugoslavia, Bosnia and Herzegovina had a fairly strong psychiatric care system with wards in larger hospitals. However, since the stabilization of the region, the system has undergone rebuilding with a focus on not only hospital wards, but also community mental health care clinics.

Despite its small population of only 3.5 million, Bosnia and Herzegovina have been a model of mental health care in the Balkan region. Mental health care in Bosnia and Herzegovina has been extremely important since the deadly conflicts within the former Yugoslavia, particularly the Bosnian Genocide from 1992-1995. Additionally, it continues to be important into the 20th century with high rates of mental illness among survivors of the conflict.

The Situation

While mental health in Bosnia and Herzegovina has not received a lot of study, it is clear that post-war Bosnia and Herzegovina has comparatively high levels of mental illness stemming from trauma. This includes but is not limited to mental illnesses such as post-traumatic stress disorder, depression and personality disorders. Many citizens have experienced internal displacement or repatriation or suffered violent trauma during the period of unrest in the Balkans in the 1990s and early 2000s leading to extensive need for mental health care both long term and in crisis situations. While this suffering is certainly not ideal, it has encouraged a number of organizations to assist in not only the implementation of systems of accessible mental health care but also campaigns to destigmatize mental illness in new and innovative ways.

These systems have been highly successful and have provided care for thousands of individuals through 74 community mental health centers, several teaching clinical centers in major cities and nine full psychiatric wards all of which can handle both acute and chronic mental health concerns. The involvement of the Swiss Federal Department of Foreign Affairs has helped make these achievements possible. It has made a major effort to structure and fund the creation of vast mental health programs and networks along with the help of several international NGOs including HealthNet International, the World Health Organization (WHO), Medica Zenica and the Red Cross. All of these organizations have contributed to funding, training and organizing clinics around the country. This has allowed for a complete restructuring of the mental health care system in the country including international advocacy groups collaboration on legislation to improve the lives of mentally ill citizens.

Government-Provided Mental Health Care

While Bosnia and Herzegovina have an absolute poverty rate of over 16% which is above the global average, citizens can rely on government-provided mental health care through the Ministry of Health and Social Welfare. The Ministry of Health and Social Welfare operates through a decentralized system and receives funding through citizens’ mandatory national health insurance.

In addition to improvements in mental health care, new programs have seen extensive success in destigmatizing psychiatric illness. In the last several years, mental health in Bosnia and Herzegovina has improved through the implementation of mental health promotion programs in schools as well as in communities, which serve to normalize mental illness and discuss mental health. The success of these systems offers an example by which to construct mental health systems in smaller nations that desperately need access to these services.

Despite the struggles of the past half-century, Bosnia and Herzegovina has become an example of positive mental health care restructuring. Moreover, it seems likely that the system will continue to make improvements over time.

– Che Jackson
Photo: Flickr

Mental Health in New Zealand
Mental health in New Zealand became an important issue in the New Zealand 2017 general election. One survey from 2016/17 shows that 19% of New Zealand adults experienced anxiety and 20% experienced depression. In response to voter concern about low funding and a shortage of mental health professionals, Prime Minister Jacinda Ardern created the well-being budget in 2019.

The Well-Being Budget’s Objectives

The well-being budget has five main objectives:

  • Transition to a sustainable, low-emission economy.
  • Support a digital age in the nation.
  • Raise Māori and Pacific economic position.
  • Reduce child poverty.
  • Support mental health.

Within the well-being budget, New Zealand has allocated $1.9 billion toward mental well-being specifically over five years. The aim of this new well-being approach in mental health is to replace New Zealand’s outdated Mental Health Act with a more comprehensive mental health framework that focuses on wider quality of life measures and making long-term improvements to the system of mental health services.

The Mental Health Act

New Zealand originally enacted its Mental Health Act, also known as the Compulsory Assessment and Treatment Act, in 1992. The act mainly concerns individuals who could be a danger to themselves or others. This act states that doctors should try to obtain a patient’s consent, but that it is not absolutely necessary; in fact, they can use a degree of coercion in attempting to get a patient’s consent. Many no longer consider this kind of treatment acceptable, so one of the main objectives New Zealand’s government set to improve mental health services within the well-being budget is to replace the Mental Health Act with a law that is more in line with international standards.

The Well-Being Budget

New Zealand’s mental health provisions in the well-being budget come out of a longer trend moving the focus of mental health treatment to recovery and social well-being. This movement stresses individuals’ rights to make the most informed decisions for themselves. To support mental health in New Zealand, the government set goals to establish the Mental Health and Wellbeing Commission, strengthen suicide prevention response, replace the Mental Health Act and expand access to services.

New Zealand’s plan for suicide prevention has a $40 million budget that will go toward bolstering existing services as well as place more nurses in secondary schools to reach students. Expanding access to mental health services also comes as a two-part plan. The first part involves making mental health services a part of existing primary care services and the second part involves increasing the workforce of therapists and psychologists that provide therapy for people that have mild to moderate mental health diagnoses.

Progress

While the outbreak of the COVID-19 pandemic placed additional stress on New Zealand’s mental health services, the country has still made considerable progress:

  • Passed the necessary legislation to create a Mental Health and Wellbeing Commission (which should be operational by February 2021).
  • Used $40 million to create a Suicide Prevention Office and a suicide action plan.
  • Begun drafting to replace the 1992 Mental Health Act with the updated legislation.
  • Pledged $455 million toward new primary mental health and addiction services over the next five years.

The rollout of many of these new policies and services slowed down in 2020 to put more focus on the COVID-19 response, but expectations have determined that the rollout will pick up more in 2021. Mental health in New Zealand has come a long way, but the government still has not met all of the goals it laid out in the well-being budget.

– Starr Sumner
Photo: Flickr

Mental Health in Kenya
Kenya is a lower-middle-income country with a population of about 52.5 million and a physician-patient ratio of 0.2 to 1,000 people. The psychiatrist-population ratio is 0.19 to 100,000. The most common mental illnesses in Kenya are depression, substance use disorder, bipolar disorder, schizophrenia and other forms of psychosis. It is estimated that of all persons seeking health services in Kenya, a quarter of the inpatients and almost half of all outpatients suffer from mental illness. Fortunately, health organizations are working to make mental health in Kenya a priority.

Kenya’s Mental Health Policy

According to the 1989 Mental Health Act, Cap. 248 of the Laws of Kenya, all general hospitals are required to treat and admit persons with mental illness. Kenya’s 2015-2030 Mental Health Policy outlines a strategy for achieving mental health reform in the country. Using a multidisciplinary approach and guided by the Ministry of Health, the policy underscores the need for collaborative interventions. The policy also recognizes human rights in treating persons with mental, neurological and substance use disorders. Finally, the policy aims to provide quality, accessible and equitable mental healthcare services in accordance with WHO standards.

Mental Health Services in Kenya

There are at least 14 general and provincial hospitals in Kenya offering mental healthcare and psychiatric services. Mathari Teaching and Referral Hospital is the national psychiatric hospital with a 700-bed capacity. There are also various private clinics and rehabilitation centers as well as professional bodies and organizations whose members work together to provide mental health services.

The Kenya Psychiatric Association (KPA) is a professional body for psychiatrists. Its mission is to promote mental health in Kenya through training, governance, empirical research and mental health services. The Association contributed to the 2015-2030 Mental Health Policy and the 1989 Mental Health Act and has established national and international networks in the field. It also continues to provide mentorship to upcoming mental health professionals.

Another organization regulating mental health services is the Kenya Counseling and Psychological Association, which governs counselors and psychologists. The organization seeks to offer professional counseling psychology services in the country based on set standards in training, practice, research and advocacy.

The National Authority for the Campaign Against Drug and Alcohol Abuse (NACADA) is an organization under Kenya’s Government that tackles drug and alcohol abuse in the population, particularly among the youth. To achieve its goals, NACADA uses public education and advocacy, undertakes research surrounding alcohol and substance use in the nation, regulates the alcohol industry and offers counseling and rehabilitation services. As of 2020, NACADA had established 100 accredited rehabilitation centers, offered 20 life skills training programs and saved 8,000 lives.

Mental Health Research in Kenya

In November 2019, a task force was set up to report on the status of mental health in Kenya; the report was released in July 2020. The team was drawn from healthcare professionals, cabinet members, security service providers, politicians and youth representatives around the country. The task force detailed recommendations for mental health reforms, citing changes in administration, legislation and criminal justice systems.

Recommendations include declaring mental illness a public health emergency and increasing funding for the mental health sector to make services more widely accessible. The report also proposed providing healthy workspaces and mental health services in learning institutions and incorporating mental health literacy across school curricula.

Moving forward, it is essential that the Kenyan government and other mental health organizations in the nation utilize this research to improve policies and practices. Through research, collaboration and informed interventions, mental health in Kenya will hopefully improve.

Beth Warūgūrū Hinga
Photo: Flickr

Mental Health in BotswanaBotswana’s 1969 Mental Disorders Act, Chapter 63:02, describes a person with mental illness as a “mentally disordered or defective person” who cannot handle their own affairs and is a danger to themselves or others due to an existing mental condition; and in the case of a child, one who cannot benefit from ordinary education. The Act does not permit the detaining in an institution of persons with mental illness except where cases fall under the Criminal Procedure and Evidence Act.

A patient’s next of kin who is an adult or any other person at least 21 years of age who has seen the patient within the last 14 days may apply for a reception order to the District Commissioner, who in turn liaises with a medical practitioner on referral and treatment protocols. If the patient does not comply, the District Commissioner is allowed to use law enforcement and can choose to carry out the processes of the reception order either privately or publicly. The District Commissioner also has the responsibility to safeguard the patient’s personal belongings and to allow a willing person to provide caregiving in the case of a Class III patient (one who does not require skilled medical care, failure to which is punishable by law).

Currently, mental health in Botswana is guided by the mental health policy drawn in 2003 that is now fully implemented and in line with human rights agreements.

Botswana’s Mental Health Services

Botswana is an upper-middle-income country with a population of 2.3 million and a physician-patient ratio of 0.5 to 1,000. As of 2014, Botswana had a total of 361 inpatient mental health professionals and a ratio of 17.7 mental health workers to 100,000 people. Nurses made up the highest proportion of these professionals at 12.17, and psychiatrists were fewest at 0.29 to a population of 100,000 with one mental hospital and five psychiatric units across different general hospitals. In 2014, there were 46 mental hospital inpatients, 6% of whom were involuntarily admitted. Of all inpatients, 93% stayed less than one year.

The University of Botswana and the U.N. partnered to promote mental health in Botswana. In a 2019 forum, the university vice-chancellor reported that the most prevalent mental and neurological disorders were schizophrenia, schizoaffective disorders and depression, with the majority of patients being males. In 2010, 14,481 Batswana youth aged 15-34 had a mental disorder. The Ministry of Health and Wellness representative pointed to risks of alcohol abuse among the youth dealing with mental health challenges and the U.N. Regional Representative encouraged students to build stress resilience and coping. The university offers mental health services to students through a psychiatric nurse, who can also make advanced care referrals where necessary.

The country also has mental health promotion programs for children as well as an alcohol abuse prevention program for all age groups across the country. The Botswana Network for Mental Health, a subsidiary of the global Mental Health Network (MHN), aims to promote mental health in Botswana through advocacy and community empowerment activities. The organization further addresses the stigma associated with mental illness and helps people access mental health care.

Traditional Systems

Botswana’s constitution makes provision for the House of Chiefs, or Ntlo ya Dikgotsi, a 15-member non-partisan system, of which seven of the members are Dikgotsi (chiefs) representing the different tribes. Eight are elected by their jurisdictions, four of whom are Dikgotsana (sub-chiefs). At the grassroots is the Kgotla, which serves as a local court system and informs parliament on community affairs, a go-between on local and tribal matters including property and customary law.

This Kgotla further encourages free expression in the community by providing a platform for open dialogue for conflict resolution. The Kgotla also handles minor criminal offenses and can take disciplinary action on wayward behavior. The Kgotla thereby promotes community cohesion and psychosocial health for overall mental health in Botswana.

Reforms in Mental Health in Botswana

Despite some human rights inadequacies in the 1969 Mental Health Act, mental health in Botswana has improved over the years, becoming increasingly compliant with WHO’s directives as stipulated in the 2003 mental health policy. The traditional systems of government have also boosted social cohesion, thereby promoting mental health in Botswana.

– Beth Warūgūrū Hinga
Photo: Flickr

Mental Health in ChinaThe World Health Organization (WHO) reports that about 54 million people in The People’s Republic of China have depression and about 41 million have anxiety disorders. The psychiatrist-population ratio is at 1.49 to 100,000. This article discusses the obstacles and the plans to improving mental health in China.

COVID-19’s Impact

During the COVID-19 outbreak, China’s National Health Commission mobilized mental health workers and increased the volume of services. The Commission produced guidelines on mental healthcare protocols to curb psychosocial effects arising from the pandemic. The interventions included outreach programs by psychiatrists and other professionals. Additionally, hotline services offer psychological support to patients, survivors, as well as affected families, and healthcare workers alike. The most commonly reported psychiatric conditions associated with the outbreak were depression, PTSD, and anxiety disorders.

A nationwide survey of people, most of whom on lockdown, found that 16.5% had depressive symptoms, 28.8% had anxiety symptoms, and 8.1% had stress symptoms. Nevertheless, 71.5% of them were satisfied with the health information provided during the outbreak. The highest psychological impact was felt by women, students, and those who reported poor physical symptoms. During the lockdowns, psychiatric patients experienced more intense symptoms such as anger outbursts, insomnia, and suicidal ideation.

Alcohol and Tobacco Use Disorders

In China, alcohol is traditionally consumed during social functions and holidays. Over time, however, the WHO noted a rise in regular alcohol consumption and a subsequent impact on mental health, including alcohol dependence and alcohol use disorders (AUDs). A Beijing study showed that 2.4% of people with alcohol dependence were treated overall with only 1.4% receiving treatment from mental health professionals. Further research in China pointed to the need for early intervention in treating alcohol disorders. The WHO recommended educating both the public and healthcare workers on the importance of seeking mental health treatment for such issues.

Tobacco smoking has also negatively impacted mental health in China. With over 300 million cigarette smokers, China has the highest number of tobacco users in the world. The WHO partnered with the Chinese Government to control tobacco consumption and thereby reduce diseases and premature deaths arising from exposure to the harmful chemicals in cigarettes. The WHO also launched an initiative to curb tobacco dependence, training healthcare workers, and providing informational guidelines to tobacco users.

Promoting Mental Health in China

China needs reformations in its healthcare delivery system. The 2016 Policy on Building High-Quality and Value-Based Service Delivery details such reformations, aiming to move from a hospital-centered approach to a people-centered one that canvases both rural and urban areas. These changes call for a multi-tiered health care delivery system that strengthens primary care. China’s new delivery system aims to better monitor such quality of care, specifically by improving integrative management practices, building a strong healthcare workforce, and investing in community health. Additionally, the nation has made progress in attaining universal health coverage according to the UN 2030 Agenda for Sustainable Development.

In the Global Conference on Health in 2016, stakeholders emphasized the need for healthy cities to improve mental health in China and the world. Since the majority of Chinese people live in urban areas, many would benefit from interventions such as people-centered urban design, “greening”, and recreational spaces. To further promote mental health, China also targets to treat 80% of people with depression by 2030 and 30% by 2022.

To prevent AUDs, the WHO has recommended China strengthen policies that regulate alcohol commerce and increase education about safe alcohol consumption. In line with the WHO’s Framework Convention on Tobacco Control, China enacted a law that banned tobacco smoking in indoor public spaces and the mass media advertising of cigarettes. In a social media campaign dubbed #RUFREE, China supported smoke-free spaces while altogether decreasing tobacco use and curbing associated disorders.  Hopefully, China will continue to take steps to improve the mental and physical health of its citizens.

– Beth Warūgūrū Hinga
Photo: Pixabay