Mental Health in TunisiaWith more than half a million of its inhabitants suffering from depression in 2019, the North African country of Tunisia has seen a rise in mental health conditions in recent years. Based on data compiled between 2018 and 2020, the 2021 World Happiness Report ranked Tunisia 122 out of 149 countries in terms of citizens’ overall happiness. Unfortunately, stigma and discrimination surrounding mental health in Tunisia deter those in need from seeking help and treatment, a problem exacerbated by a lack of mental health services and facilities. However, the Tunisian government and several national and international organizations are taking action to improve mental health in Tunisia and ensure its citizens have the resources necessary to lead happy, fulfilling lives.

Factors Impacting Mental Health in Tunisia

Over the last 10 years, Tunisia has been hit by social, economic and political turmoil that has led to a decline in mental health. Mental disorders are responsible for 98% of extended sick leaves among public service sector employees in the country. Yet, many Tunisians suffering from mental illnesses and disorders do not seek help due to persistent “stigma and discrimination against people with mental disorders,” which the WHO has identified as “a significant public health issue in Tunisia.”

Such stigma is prevalent, not only among the general public but also across the country’s health care systems and among health care providers, who receive limited training in mental health diagnosis, treatment and recovery. Similarly, there are limited public programs in place to raise awareness of mental health disorders and promote intervention, prevention and treatment, causing many to feel shame for seeking help for themselves or their loved ones.

Additionally, there are limited resources for those struggling with mental health issues in Tunisia. For instance, as of 2020, Tunisia had only 2.89 psychiatrists, 3.36 mental health nurses and 0.23 social workers for every 100,000 Tunisian citizens, according to the WHO’s 2020 Mental Health Atlas report. The lack of mental health care workers has been compounded by a lack of mental health care facilities across the country, which has only one mental health hospital and 10 psychiatric units in general hospitals.

Consequently, even those who want to seek help often lack access to it. Untreated mental illness can have detrimental consequences for individuals, families, communities and societies as a whole. It often results in unemployment, homelessness, substance abuse and incarceration, profoundly diminishes the quality of life and increases the risk of suicide.

Current Solutions

Fortunately, there is hope for strengthening mental health care in Tunisia and eradicating the barriers that prevent people struggling with mental illness from obtaining help.

With support from the WHO, a group of psychiatrists from Razi Hospital is now working to implement changes that will advance mental health care in Tunisia to a level consistent with its general health care system.

The only public hospital completely dedicated to mental health in Tunisia, Razi Hospital has launched the country’s first anti-mental-health-stigma training for medical students at Tunis Medical School. Introduced in 2017, the program called Responding to Experienced and Anticipated Discrimination (READ), centers on educating future doctors about mental-health-related stigma in order to reduce it and improve the quality and accessibility of mental health care. The program has already shown positive results. In Tunisia, the number of mental health workers per 100,000 citizens increased from 0.20 in 2017 to 8.77 in 2020. Additionally, there was a 1.31% increase in expenditures on mental health research between 2016 and 2019.

The Tunisian authorities are stepping in to improve mental health in Tunisia, as well. In 2020, at the height of the COVID-19 pandemic, the government implemented a Psychological Assistance Unit to address the growing need for mental health support. It also established a toll-free hotline that allowed people struggling with mental health issues to remotely access the services of 240 mental health professionals.

Looking Ahead

In the face of rising mental health challenges, Tunisia is taking significant steps to improve mental health care and reduce stigma. The implementation of the Responding to Experienced and Anticipated Discrimination (READ) program at Tunis Medical School has shown promising results, increasing the number of mental health workers and research expenditures. Additionally, the government’s establishment of the Psychological Assistance Unit and toll-free hotline during the pandemic demonstrates a commitment to providing accessible mental health support to those in need. These efforts offer hope for a brighter future where mental health resources are readily available to all Tunisian citizens.

Paige Falk

Photo: Pxfuel

While the economic and social consequences of poverty are well-documented, policymakers often overlook the psychological impacts of poverty. It is vital to understand this, as those who experience poverty undergo changes in how they feel, think and act. Poverty acts as a self-reinforcing mechanism by increasing mental health problems, altering behaviors and worsening the cognitive functioning of those experiencing it. This makes it harder for individuals to escape poverty, perpetuating its cyclical and seemingly fatalistic nature.

Poverty, Mental Health and Substance Abuse

Poverty significantly impacts mental health, and should not be underestimated. Psychiatric conditions such as depression, anxiety, PTSD, mood disorders and schizophrenia are much more prevalent in areas with high unemployment rates and poverty, with the most drastic effect of poverty being increased rates of suicide.

There is also a strong association between poverty, social exclusion and problematic alcohol use. Individuals who are unemployed and living in poor or insecure housing have higher rates of substance abuse compared to those who are employed, educated and living securely. Substance abuse problems can consume someone suffering from poverty, entrenching them in lifestyles that often result in incarceration, health shock and homelessness.

The consequences of poverty also transcend nationality and ethnicity. Across 43 countries, low incomes uniformly predicted negative psychological states and behavior. These include apathy, decreased levels of trust in communities and governments, antisocial attitudes and mental disparity.

Economic Thinking

Poverty burdens the mind and induces high levels of stress. Stress can impact mental bandwidth, which refers to how much cognitive capacity and executive control one has available. Cognitive capacity allows for complex problem-solving, retaining information and logical reasoning, while executive control determines the ability to focus, shift attention, retain things in memory, multitask and self-monitor. Poverty reduces cognitive capacity and weakens executive control, specifically in abstract thinking, due to the mental burden of financial worries, which hinders problem-solving abilities.

Furthermore, individuals in poverty tend to rely more on automatic thinking versus deliberative thinking. This is less cognitively demanding but also makes individuals less likely to consider all possible outcomes due to restricted mental bandwidth. This means most people living in poverty are only able to deal with one problem at a time, sacrificing and prioritizing only what is immediate and necessary. This is known as the tunneling effect. Tunneling is a state of mind where one can only focus single-mindedly on managing the scarcity at hand, blocking out other sections of life. Tunneling also impacts time-discounting. Impoverished individuals are more likely to lose track of long-term goals or rewards, only paying attention to the most immediate reward. Middle-income and wealthy individuals are more likely to consider future rewards and plan accordingly to obtain those rewards.

Further effects include alteration of behaviorally revealed preferences, including a decreased willingness to take present risks and accept new technologies, policies and assistance that could lead to future benefits. Reluctance to accept new technologies contributes to a paradox where impoverished individuals may avoid the very resources that can aid them.

Cognitive Development

Growing up in poverty can severely undermine cognitive development. At around 3 years old, children in low-income households begin to exhibit cognitive and non-cognitive skill differences from their higher-income peers.

Poverty-induced stress can also lead to impaired cognitive functions, including negative effects on the hippocampal memory system. The consequences of increased cortisol levels due to poverty show up in diseases such as Cushing’s and Alzheimer’s. As the hippocampus is responsible for emotions, motivation and memory, persistent stress impairs decision-making abilities. It perpetuates behavioral patterns in people living in poverty. This creates generalized behavioral patterns: increased cortisol impairs hippocampal function, forcing people into mental tunnels and changing how they make and view decisions.

Stress also reduces people’s executive control over themselves. This can lead them to become more impulsive. Stress’s chemical effects on the brain, most notably a rise in cortisol, dictate that often the bad decisions made by those who are poor are not due to low levels of intelligence but a result of poverty itself.

Breaking the Cycle

Neither cognitive constraints created by poverty nor poverty itself must be final or condemning. Modern behavioral and social sciences can lead to the creation of new cost-effective interventions, especially through targeting economic behavior.

Targeting Economic Behavior

Understanding behavior and identifying effective interventions is a complex process. Interventions must come after careful diagnosis of what the defined behavioral default is. Examples of nudging interventions include social influence, coinventing products that are easy to use, feedback or reminders, micro-incentives and physical environment cues. Reminders have proven to be a simple and effective solution when employed in the correct circumstances. In Kenya, patients receiving HIV treatments have struggled with taking their medications when needed. After health workers began sending routine text messages reminding them when to take their HIV medication, the percentage of patients taking their drugs increased by 13%.

Breaking the cycle of poverty may require policies that go further than behavioral nudging, especially for those in extreme poverty. In cases of extreme poverty, multifaceted poverty reduction programs are an impactful way to create pro-poor growth.

Multifaceted Poverty Reduction Programs

Multifaceted poverty reduction programs combine several different interventions to create an integrated approach that leads to positive outcomes. Multidimensional issues such as poverty require multidimensional solutions. Multifaceted programs include cash transfers, skills training and food subsidies. These initiatives also provide access to savings, services for physical and mental health and scheduled check-ins with program managers to measure progress. With regards to helping the ultra-poor, these programs are effective. Frequently, these programs prove to be successful in improving food security, physical and mental health, financial inclusion and time use. Also, there are upsides such as increased income and revenues, productive and household assets, political involvement and women’s empowerment.

Looking Ahead

In recognizing the psychological impacts of poverty, there is hope for breaking the cycle and improving the well-being of those affected. By understanding the cognitive and behavioral constraints imposed by poverty, targeted interventions can be developed to address specific challenges. Nudging interventions and multifaceted poverty reduction programs offer promising avenues for supporting individuals and communities, from providing reminders for medication adherence to comprehensive initiatives that address various dimensions of poverty. By combining these approaches, policymakers and practitioners can make meaningful strides in uplifting those experiencing poverty and promoting long-term positive change.

Andrew Giganti

Photo: Unsplash

In developing countries like Pakistan, a nation that has faced violence, economic and political instability since its birth in 1947, mental health is a highly consequential yet invisible issue. Pakistan has one of the highest mental illness rates in the world — A 2016 article by DAWN says around 50 million Pakistanis suffer from mental issues. Pakistan also has a staggeringly low number of psychiatrists — a 2020 article published by The Lancet Psychiatry says Pakistan’s population stands at more than 200 million people yet the nation has fewer than 500 psychiatrists. A 2015 article by Inamullah Ansari says Pakistan has four psychiatric hospitals available to the whole country. This makes it especially hard for those who need help to find it, a problem only exacerbated in rural areas where there is only one psychiatrist per million people. For these reasons, improving mental health in Pakistan is imperative.

Mental Health Stigma in Pakistan

The topic of mental health in Pakistan carries a stigma, which deters people from seeking professional help. Many believe that mental health issues stem from “supernatural forces,” and as such, psychiatric patients seek help from religious healers. This is due to limited educational awareness of mental health conditions and minimal access to mental health professionals.

Mental Health Among Pakistani Women

Pakistani women face significant societal stigmas and gender biases, which marginalize women and serve as stressors exacerbating mental health issues among women. In Pakistan, violence against women is rife as society considers violence “one of the acceptable means whereby men exercise their culturally constructed right to control women.”

It is common for many Pakistani families to celebrate the birth of a boy but mourn the birth of a girl. Child brides, dowries and exchange marriages are common, especially in rural areas. And often, early marriage results in abuse, violence, and in extreme circumstances, some marriages lead to honor killings and acid burns. Marital violence is concerningly common in Pakistan. A United Nations study found that a staggering 90% of Pakistani women surveyed suffered mental and verbal abuse from their spouses and 50% of women endured physical abuse.

Societal Stigma

Divorce in Pakistan also carries a tremendous stigma. Many women are afraid to leave their husbands simply due to social stigma, fearing their friends and families will cut them off. This stigma often traps women in a cycle of abuse. Around 70% of abused women have never opened up to anyone about their abuse, says a 2004 study by Unaiza Niaz.

This constant abuse puts women at high risk for depression, post-traumatic stress disorder, substance abuse and even suicide. Marital abuse also puts children at a higher risk for depression, anxiety, substance abuse and poor school performance. Children younger than 12 with abusive parents are up to seven times more likely to endure emotional, behavioral and learning difficulties, says the same study.

Several studies and surveys have shown that women, especially married women who have faced violence, are exponentially more likely to seek psychiatric care than men. Due to the gender-specific issues Pakistani women endure, promoting mental health in Pakistan, especially for women, is imperative.

Fighting for Change

Although the situation seems grim, many organizations and individuals are fighting to bring awareness and increase psychiatric care for those who need it the most.

Dr. Alaptagin Khan is working to raise awareness of mental health in Pakistan and established the Childhood Trauma Research Center in Peshawar in 2018 at Lady Reading Hospital, with the support of the Neurocare Foundation. This center collects data, hosts workshops and seminars and works to bring awareness to childhood trauma. The center aimed to collect data from 2,500 participants by December 2020. The data “will allow health professionals to assess the true disease burden of mental health disorders associated with childhood trauma in Pakistan.”

The Pakistan Psychiatric Society, founded in 1972, is the largest professional psychiatric membership organization in Pakistan. It represents more than 400 psychiatrists and continually advocates for a better system to combat mental health in Pakistan. It publishes scientific journals and magazines on mental health awareness and provides training for psychiatrists.

BasicNeeds Pakistan, started in 2011, is a nonprofit organization that “works to improve the lives of people living with mental illness and/or epilepsy in Pakistan.” It provides mental health training for community volunteers, brings awareness to mental illnesses and common symptoms and debunks myths or stigma. In addition, in 2016, it started the Centre for Women’s Enterprise and Development, which aims to create job opportunities for women suffering from mental illnesses. As of 2016, BasicNeeds Pakistan has provided support to 16,703 people who faced mental health issues or knew someone who did.

Looking Ahead

Mental health in Pakistan is a dire issue, one that political turmoil and instability continue to perpetuate. It is also one that women are at the forefront of, contributing to the oppressive standards of women’s living. It is an epidemic that continues to grow, affecting the entire population’s well-being and must be addressed for Pakistan to improve as a country.

– Padma Balaji
Photo: WikiCommons

Mental Health in VietnamWhile Vietnam’s growth and development have led to investments in infrastructure, but unfortunately not within the health sector, specifically in terms of mental health care. A 2011 study of “144 low and middle-income countries” ranked Vietnam last in terms of “the availability of mental health care,” with only “1.7 psychiatrists and 11.5 psychosocial care providers” for every 100,000 people. Recognizing the dire need for change, domestic and international organizations are working to improve mental health in Vietnam.

Beautiful Mind Vietnam

Beautiful Mind Vietnam is a nonprofit organization founded in 2015 with a goal of promoting mental health well-being across Vietnamese society. The organization offers cost-free “peer consultation” to people struggling with mental health issues. The organization specifically focuses on the mental health well-being of youth between the ages of 16 and 25 years old.

As Vietnamese society still stigmatizes mental health illnesses, Beautiful Mind Vietnam’s staff members consist of young people seeking to turn the tide of mental health stigma. From diverse backgrounds, the team “[specializes] in psychology, counseling, mental health, biomedicine and pharmacology.” Operating under the guidance of “professional psychologists and psychiatrists,” the organization aims to raise public awareness about mental health “and provide free support for people with mental health concerns.”

Beautiful Mind Vietnam raises awareness on mental health issues and provides educational information to the public “by translating and writing high quality and reliable articles about mental health, mental disorders and related issues that are relevant to Vietnamese context.” In addition to the peer counseling support the organization offers, Beautiful Mind Vietnam offers a safe space for people to express themselves and feel heard. The organizations also sets up mental health workshops and seminars within communities in order to increase mental health awareness and share practices to promote positive mental health.

BasicNeeds Vietnam

BasicNeeds Vietnam is a non-governmental organization that facilitates the elimination of stress and emotional pain and emphasizes “joy and positive energy” in the Vietnamese mental health landscape. Founded in 2010, the organization seeks “to establish a system that supports community development,” nurtures people’s mental health well-being and educates the public on mental health. Through these goals, BasicNeeds Vietnam ensures that Vietnamese people have a deeper understanding of mental health along with tools to manage their stress and mental issues.

BasicNeeds Vietnam intends to provide accurate scientific information on mental and psychological health, contribute to developing Vietnam’s mental health care and advance “basic mental health knowledge professionally.” The organization develops training workshops for the public, provides mental services to those in need and collaborates with other organizations to better facilitate the conversation surrounding mental health. Through these efforts, the organization envisions a Vietnam where everyone can access proper mental health services.

Medical Committee Netherlands­-Vietnam (MCNV)

MCNV is a non-governmental organization founded “in the Netherlands in 1968 to support health development in Vietnam.” The organization seeks to confront the mental health services gap that the Vietnamese government struggles to address while combating mental health stigma in communities. To improve the quality of life for people with mental illness and their families, MCNV partners with “the INGO Global Initiative for Psychiatry and the Provincial Health departments” to implement community-based mental health care in several districts. This community-based model involves training health workers in order to advance their mental health care skills, among other efforts.

These efforts have seen success. The mental health services of health workers who received training improved and “home-based care and counseling” ensured more people can access mental health services. The development of self-help groups in communities helped provide “social support” to people suffering from mental health conditions while reducing societal stigma associated with mental health conditions.

Together, these three NGOs are fighting to improve mental health in Vietnam. Through these combined efforts, Vietnamese people struggling with mental health issues will receive the help they need.

– Tri Truong
Photo: Flickr

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

Suicide in GreenlandBetween 1970 and 1980, the suicide rate in Greenland was seven times higher than that of the United States. The high incidences of suicide in Greenland stemmed from the devaluing of local Inuit culture which occurred when Denmark pushed to modernize the island. Due to a lack of adequate resources, improvements have been slow. However, as mental health has become destigmatized, various NGOs and government programs have appeared over the last decade with promising solutions to address suicide in Greenland.

Suicide in Greenland Today

In 2016, the global average annual suicide rate was 16 persons per 100,000. In Greenland, the annual suicide rate was 82 persons per 100,000.

Suicide is not evenly distributed across Greenland’s population. Teenagers and young adults are at the highest risk of suicide. According to the Nordic Centre of Welfare and Social Issues, the prevalence of suicide in Greenland is three times higher among 20 to 24-year-olds than 25 to 65-year-olds.  Additionally, 23% of teenagers and young adults reported that they have self-harmed.

Recognizing Risk Factors

Due to the rapid modernization of the 1970s and 1980s, many people emigrated to the cities and larger settlements for economic and educational mobility. However, once there, they needed to assimilate to appear more Danish. The loss of identity that followed saw communities turn to alcohol, which in turn led to child abuse and neglect — two major risk factors for suicide. This erosion of family structure made it hard for individuals to cope with emotional and psychological hardships.

Combating Suicide in Greenland

Over the last couple of decades, the government and several NGOs created programs to combat this endemic.

  • SAAFIK – Established in 2011, this nation-wide counseling center extends medical, psychological, social and legal support to child victims of sexual abuse.
  • Break the Silence, End the Violence – In 2014, The Ministry of Family, Gender Equality and Social Affairs launched a three-year campaign to raise awareness about domestic violence. To this end, the Ministry established a web page about violence and information campaigns.
  • SAPIIK – This peer mentoring program is focused on reducing the number of children who drop out of school. Through social activities and outings, SAPIIK focuses on improving a child’s intrapersonal and interpersonal skills.
  • School Fairy System – This program places a social worker, known as a School Fairy, in schools to help students who need social support. The School Fairy engages students through conversation and activities. The School Fairy also reports concerns and observations to the school when he or she deems that special interventions are required.
  • TIMI ASIMI –  Founded in 2011, this is an outdoor-based intervention program geared toward at-risk teens and young adults, ages 13 to 21. Throughout the course of three months, participants engage in educational courses, community service, academic counseling and physical activities.
  • Project CREATes – Over the course of two years, this project utilized storytelling as an effective way of eliciting personal experiences related to both suicide and resilience. These workshops were safe spaces for the arctic’s youth to come together and share their experiences with suicide and mental health. Facilitators worked with youth to help them to write, audio record, photograph or film their own stories as a way of healing. Though Project CREATeS ended in 2019, it was just one part of a series of programs created by the Arctic Council to combat suicide in the arctic. It was succeeded by Local2Global, another suicide prevention program focused on fostering community and creating digital projects for storytelling.

Greenland has come a long way since the 1980s. People are now able to talk about suicide and get help for mental issues. With more initiatives and resources, suicide in Greenland can decrease to match the global average or even undercut it.

Riley Behlke
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

Period Poverty in Singapore
Period poverty in Singapore is not only detrimental to the poor, but it is particularly detrimental for women in poverty. Unfortunately, many do not see period poverty as a substantial issue. Rather than appropriately encouraging and educating adolescent women about their menstrual cycles, many women receive shame for it. Mental health and physical issues are also apparent due to period poverty in Singapore. The lack of access to proper menstrual materials pushes Singaporean women into using unsafe materials for their cycles. As a result, women develop a number of health issues such as bacterial vaginosis, urinary tract infections, green or white vaginal discharge and vaginal and skin irritation.

Mental Health Issues

Mental health issues are also important to consider when discussing period poverty. It is a serious necessity to one’s overall well-being and when overlooked, it can have drastic consequences. Individuals who experience severe aversive conditions such as shame and guilt are more likely to experience negative mental issues such as post-traumatic stress disorder (PTSD). In Singapore specifically, it is taboo to discuss one’s menstruation cycle.

This resulting cultural attitude that egregiously directs shame toward Singaporean women and children can make women more likely to develop PTSD. Even in cases when PTSD is not present, findings have determined that the absence of proper menstrual products is due to higher rates of depression, anxiety and distress. Naturally, the issue with period poverty also has links to issues of other forms of poverty. Vanessa Paranjothy recounts that this is especially arduous in areas where there is a lack of running water, plumbing and electricity. Another issue regarding menstruation mishandling in Singapore involves women’s lack of access to the materials necessary to overcome period poverty.

Freedom Cups Helping Women

However, women in Singapore have found their own ways to address the period poverty crisis. One example includes a group of sisters, Joanne, Rebecca and Vanessa Paranjothy and their creation of Freedom Cups. These devices function as reusable tampons and pads, effectively containing menstrual blood. As long they receive proper washing, these devices are re-usable for a span of up to 10 years, without the high risk of infection as with reusing pads. Moreover, these items are able to gather menstrual fluid for up to 12 hours per individual use.

Due to the reusability of these Freedom Cups, women are able to better afford the product, without furthering their fall into period-related poverty. Additionally, the Paranjothy sisters supply one freedom cup to another woman in need for each cup sold. So far, the sisters have distributed Freedom Cups to more than 3,000 women. This, however, is not the end of the sisters’ efforts. They continue making efforts across the world to end period poverty, such as in the Philippines.

Further Initiatives

Widespread organizational efforts also address period poverty in Singapore. Groups such as The World Federation of United Nations Associations had marked success with its Mission Possible: Singapore or Pink Project. This project involved the mass donation of menstrual and other health products to the Star Shelter as well as the Tanglin Trust School and the advertisement of the issue of period poverty to the areas.

However, of all of the efforts done to alleviate period poverty, foreign aid and involvement are the most crucial. The issues that exist regarding menstruation mishandling in Singapore are reflective of many of the issues across the world. Many women still experience feelings of shame and a lack of adequate care when it comes to their menstrual cycles. Vanessa Paranjothy recounts that, despite their efforts to initially provide Freedom Cups to women in the Philippines, only married women received them.

Without the continued investment into education regarding how to perceive their bodies and access to suitable menstrual materials, women will continue to suffer the adverse effects of period poverty. However, actions involving donation and innovation of feminine hygiene products, such as those the Paranjothy sisters made, and a greater emphasis on sexual education can help alleviate period poverty in Singapore and other developing countries.

– Jacob Hurwitz
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

Mobile Applications Aiding Mental Health in AfricaAccording to the International Review of Psychiatry, nearly 70% of African countries spend less than 1% of their health funds on psychiatric aid and substantially overlook the mental, neurological and addiction disorders affecting the population. However, the rapid development of smartphone technology and mobile applications—generally known as apps—has gradually provided aid to the African population’s mental health.

Since traditional one-to-one basis mental health care methods are not always available in developing countries, the World Health Organization states that mobile health technologies are beneficial resources for underserved individuals without access to mental health resources in developing countries such as Africa. With such a large variety of apps, varying from patient self-assessment to virtual sessions with healthcare specialists, support is offered to those who have access to any mobile devices. Here are three mobile applications aiding mental health in Africa.

3 Mobile Applications Aiding Mental Health in Africa

  1. The mental health Global Action Programme Intervention Guide app (mhGAP): As created by the World Health Organization, the service delivery tool known as mhGAP comprises numerous features that support those with mental, neurological and substance abuse (MNS) in low- and middle-income countries. The interactive, user-friendly app identifies multiple clinical care options catered to patients’ conditions varying from depression, psychosis, suicide and more. Additionally, the app encourages cognitive-behavioral therapy (CBT), a problem-solving therapy used to alter patients’ distorted thinking to further modify behavior through self-direction and assessment.
  2. WhatsApp—An Instant Messaging app: WhatsApp, an instant short messaging service (SMS) used by approximately half of mobile phone users in Kenya and over a million users in South Africa, allows users to virtually receive quality assurance and comprehensive information through text messages, photos, video and other multimedia. According to the South African Journal of Psychology, mobile messaging services have become just as, if not more, popular than telephone calls. It is also stated that SMS services are comparatively inexpensive resources that can potentially improve adherence to therapy and can drastically enhance relations between patients and doctors. WhatsApp and other SMS apps alike are possible solutions to strengthen the therapeutic alliance, yet further research is to be conducted to confirm such findings.
  3. MEGA mobile app—Mental health services for children and adolescents: The MEGA project, an effort co-funded by the Erasmus+ Programme of the European Union, has developed a mental health assessment app designed for primary healthcare (PHC) specialists serving children and adolescents affected by mental disorders in countries such as South Africa and Zambia. MEGA states that areas with a concentration of poor and ethnic minorities are highly vulnerable to poor environmental conditions, especially adolescents who are affected both directly and indirectly. Therefore, non-communicable disease prevention and treatment are highly encouraged by the MEGA project. The app has the potential to benefit PHC workers with the provision of adequate tools to screen mental health problems, such as depression, in adolescents.

These three mobile apps, and many others alike, are convenient forms of technology that have the potential to improve mental health conditions in Africa and other regions around the world. The implementation of mobile applications into psychiatric practice can provide patients with the utmost care by utilizing thorough assessment, open communication and careful supervision, which can ultimately save lives.

Isabella Socias
Photo: Flickr