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Ethiopian Mental Health: Challenges and Progress

Ethiopian Mental HealthThe world is becoming much more aware of mental health issues. Countries all over the world are looking for solutions to mental health issues. However, poorer countries are working at a disadvantage. Ethiopia has been able to overcome this disadvantage and improve its mental health care.

Ethiopian Mental Health Issues

Ethiopia has been looking for ways to improve mental health for years. As recently as 2021, it had included mental health services in the health extension package but had not implemented any changes. The lack of any action was due to many factors. Some include “low political commitment, lack of resources, non-functional referral system, lack of interest from private health care organizations,” stigma within the culture and poor reporting, according to Dove Medical Press.

One of the biggest factors is the stigma and discrimination of mental health issues in Ethiopia. A majority of the people in Ethiopia follow Ethiopian Orthodox Christianity. Some followers of this form of Christianity believe demonic possession is the cause of mental health issues, which could prevent people from speaking up on these issues. This presents a huge hurdle into addressing Ethiopian mental health.

The Ethiopian government is currently using the media for advocacy of mental health issues. Its strategy is to reach the Federal Ministry of Health, general and mental health physicians, mental health service users and providers and the general population.

The battle against the stigma is just half the battle. Even if the stigma issue was removed, Ethiopia does not have enough physicians to sustain an increased volume of patients. In 2022, Ethiopia had 1.08 physicians per 10,000 people.

Solutions

The Federal Ministry of Health in Ethiopia along with the World Health Organization (WHO), European Union and Foundation d’Harcourt have worked together to implement the Mental Health Gap Action Programme (mhGAP). This program aims to help low and middle-income countries scale up their mental health services.

Dr Tedla Wolde-Giorgis, Mental Health Advisor in the Office of the Minister of the Ethiopian Federal Ministry of Health explains that the program’s goal is “to integrate mental health in the existing primary health-care system by leveraging the existing health delivery platforms. The strategy that we developed emphasizes the training of health staff on mental health issues using the mhGAP programme and making sure that they are provided with close supervision and oversight at the different health centres. To this end, the mhGAP training materials and approach was very helpful to us.”

The program has made some huge progress quickly. As of March 2023, a total of 1,230 general health care workers received training from mhGAP.

The Future

The progress in the Ethiopian mental health landscape illustrates the challenges and opportunities that many low- and middle-income countries face. While there are many obstacles like stigma, resource constraints, and limited healthcare infrastructure, the collaboration between the Ethiopian government, international organizations and local communities shows that meaningful change is possible. By continuing to build on these efforts and fostering a more inclusive and understanding society, Ethiopia can pave the way for a healthier future. Furthermore, this is an example for other nations facing similar struggles. The journey is long, but with sustained commitment and international support, the vision of comprehensive mental health care in Ethiopia can become a reality.

– Matthew Mendives

Matthew is based in Colonia, NJ, USA and focuses on Global Health and Celebs for The Borgen Project.

Photo: Unsplash

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Mental Health in India: Community-Based Care

Mental Health in IndiaIt is estimated that 13.7% of the people living in the Southeast Asia region suffer from mental health conditions. When zooming in on India, the number rises to 15%, showing the need for reform for mental health in India. Most people suffering remain untreated in the country’s current mental health infrastructure. This contributes to the high suicide rates in Southeast Asia. When individuals remain untreated, personal and interpersonal relationships are negatively impacted. Furthermore, there are documented consequences at the individual’s socioeconomic level.

Mental Health in India

India lacks a unified health infrastructure, leading to exorbitant prices and unequal access to mental health care. High treatment costs have a detrimental effect on vulnerable populations, pushing some families into poverty as they seek treatment. While the country provides free health care to the most impoverished 40% of its population, significant gaps in coverage remain. Many people are left to pay out of pocket for up to 50% of their healthcare needs, including prescriptions.

This inconsistency in healthcare contributes to the 55 million people who are pushed back into poverty every year in India. Despite these numbers, India, the most populated country in this region, spends less than 2% of its gross domestic product on health care. Low spending has resulted in a shortage of medical staff and resources. To combat this mental health epidemic, leaders are looking toward implementing more community-based care models.

Community-Based Care

Traditionally, institutionalization has been the mainstay in treating people with mental disorders. This was first thought to provide people with a safe place to heal while struggling with a mental disorder. However, new research has shown that it is not the most effective method. New understandings push public health leaders to advocate for and develop a new community-based care system. The care system will center the individual and their community at the core of treatment. The Southeast Asia Director of the World Health Organization (WHO), Ms. Saima Wazed, explains how “as our understanding of mental health has evolved, so too must our methods of care.”

As WHO Southeast Asia transitions to a community-based care model, it is emphasized that this shift will reduce the negative impacts of institutionalization. It will provide more community support for individuals with mental disorders. This new model of care will increase the number of people with access to mental health care and offer improved treatment outcomes. In March 2024, a three-day meeting was held in Bangkok, Thailand, to discuss how best to implement community-based care in the region.

Those working to create more awareness and implement community-based care are also fighting the deep stigma that surrounds mental health in India. Often fueled by misinformation, the stigma prevents many people from accessing the care they need for fear of social marginalization. This is contributing to an underutilization of available resources.

Final Words

India, having one of the highest percentages of individuals affected by mental health disorders, stands to gain the most from implementing community-based care as a pillar of mental health treatment. This new development from WHO Southeast Asia will aim to eliminate institutionalization as the region’s focal form of therapy and instead explore community as a highly researched alternative.

– Carlee Unger

Carlee is based in Pembroke, NC, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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How Poverty in India Makes It Difficult to Seek Support

Poverty in IndiaAcross the globe, the discussion surrounding mental health has become more accepting in recent years. By reducing stigma and increasing access to potentially life-saving care, people are now more than ever encouraged to get the help they need. India is no exception to this. The Indian government launched the National Mental Health Program (NMHP) to improve mental health services in 1982 and aims to provide community-based mental health care.

A watershed moment in awareness for those struggling with their mental health in India was the Mental Health Care Act 2017. The act ensured that every person has the right to access mental health care and treatment from services run or funded by the government; this treatment must be of good quality, affordable and available without discrimination.

The Role of Poverty in India

These acts alone cannot overcome the exceptionally disadvantaged position impoverished individuals in India face. People experiencing poverty in India often reside in rural or underserved urban areas where mental health services are scarce or nonexistent. Even these government-run mental health facilities are limited and unevenly distributed around the country. According to a National Mental Health Survey (NMHS) conducted in 2015-16, about 70-80% of those suffering from mental disorders in India did not receive treatment, an unsettlingly high statistic.

Additionally, communities are unable to band together to support these individuals, with almost half of persons surveyed by the NMHS attributing mental health struggles to personal weakness. This deep-seated stigma surrounding mental health is prevalent in India, which leads struggling children and adults to blame themselves for disorders rather than seeking the help necessary. In these areas, school systems also tend to have less information to speak about mental health, unknowingly allowing deep-seated cultural beliefs and superstitions about mental health to persist to the detriment of struggling citizens.

In fact, the literacy rate in rural India stands at around 68.91%, compared to 84.11% in urban areas. This disparity limits the dissemination of mental health information. Even online means fail, with those in poverty-stricken areas only accounting for about 25% of the country’s total internet database, hindering access to online mental health resources and telehealth services.

Perseverance

Because of India’s shortage of trained mental health professionals, telehealth services are absolutely vital yet inaccessible to those who need them. Despite the government’s attempts at change, their reach has been limited; however, this isn’t to say that all hope is lost. Mental health services are currently being integrated into primary health care to ensure that mental health assistance is accessible at a base level.

The Central Board of Secondary Education has made another example of the attempts to raise support. Schools are essential in shaping children’s foundational beliefs, which is why discussing mental health topics in the school curriculum and providing training for teachers to identify and support students with mental health issues is the best way to bring change to the country.

– Abby Collins

Abby is based in Westwood, MA, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Tonga

Mental Health in TongaAccording to the World Health Organization (WHO), as of 2022, one in every eight people globally suffers from mental health disorders and diseases. However, the effects are seen disproportionately, as developing countries face higher rates and poorer treatment options than more developed countries. A look into Tonga highlights this.

Causes

Mental health challenges that people in Tonga face mainly stem from difficulties or trauma, even from natural disasters. Tonga’s Prime Minister Hu’akavemeiliku Siaosi Sovaleni, in 2022, tells of the trauma people faced during the aftermath of the volcano and tsunami attacks on their motherland. Disasters have resulted in destroyed homes and infrastructure, leading to a significant toll on mental health.

Another major cause is substance usage and abuse. The Guardian, in 2022, talks about the drug crisis in Tonga, where between 20% to 70% of hospital admissions are because of drug usage and abuse. It further says that drugs have now become a major contributing factor to the onset of mental illnesses and the frequent relapse of individuals with chronic psychiatric disorders like schizophrenia and bipolar disorder.

Stigma

There is a great stigma around receiving mental health treatment in Tonga, a major reason why many who suffer from mental health conditions choose to keep the illness to themselves and don’t seek help. That’s because of Tongan traditional views of being possessed by spirits or cursed if one has a mental illness. Moreover, Tongan culture has a larger role in this in that family image is very important. Ali Latsu, in a Medium article, explains that Tongans rarely embrace an individualistic mindset, if at all. For Tongan parents, hearing their child confess to mental illness can feel like a veiled criticism of their parenting.

Services

Tonga lacks the extent of resources needed to support the growing population of people who are increasingly struggling with mental health challenges. Besides that, instead of resources increasing and progressing, they are decreasing and regressing. The Mental Health Atlas in 2020 found that the number of mental health workers per 100,000 population decreased from 21.62 in 2017 to 17.23 in 2020. Similarly, the number of community mental-based mental health services per 100,000 decreased from 5.67 in 2014 to just 3.83 in 2020. This downward trend is alarming.

Efforts

In 2022, the University of Auckland announced a groundbreaking partnership. This partnership involves researchers from the university, Te Poutoko Ora a Kiwa I Center for Pacific and Global Health and the Tonga Ministry of Health. The New Zealand Ministry of Health Polynesian Health Corridors supports it. The partnership aims to provide essential population-level insights into mental health and mental health services in Tonga. This information will offer much-needed insight and information to improve the mental health resources available in Tonga.

Furthermore, in March 2024, Tonga’s Minister for Mental Health, Matt Doocey, announced the launch of a new initiative to implement mental health and addiction peer support services in hospital emergency departments. The initiative aims to improve outcomes for individuals seeking crisis help while enabling clinical staff to concentrate on clinical work.

– Shreyan Singha

Shreyan is based in Coral Springs, FL, USA and focuses on Global Health for The Borgen Project.

Photo: Wikimedia Commons

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The Impact of Mental Health in Czechia

Mental Health in CzechiaThese days, the mental health landscape of Czechia is undergoing significant changes. Recognition of mental health issues has increased, and efforts to improve services and support are expanding. According to the World Health Organization (WHO), mental health disorders are very common worldwide: one in every eight people is suffering from a disorder. In the Czech Republic, trends are highly comparable to the worldwide situation, but specific problems and developments well deserve to be addressed.

Causes

These include socioeconomic conditions, lifestyle changes and the historical context. Approximately one-fifth of the population suffers from mental-health-related issues and problems, according to the National Institute of Mental Health in the Czech Republic. Depression, alcohol-related disorders and anxiety are the leading disorders reported or diagnosed in this area. Indeed, many more people could be silently suffering from these mental health disorders during times like this.

The economic transformation after the fall of communism also contributed to this factor here. As a result of rapid changes in society, increased stress levels have been created among people, which can further give way to mental health complications. Additionally, poverty strongly correlates with mental health challenges, where those in lower economic strata experience higher rates of mental health disorders and face significant barriers in accessing mental health care.

Stigma

Despite increasing mental health awareness worldwide, stigma remains a significant barrier in Czechia. According to a report by the European Union Agency for Fundamental Rights, many individuals with mental health problems in Czechia experience discrimination, particularly in employment and interpersonal relations. Cultural factors and historical contexts contribute to feelings of isolation, making it challenging for people to seek support and discuss their mental health openly.

Services

Czechia had made plans to develop and improve its mental health services, although gaps still exist. The Mental Health Atlas of WHO in 2020 indicated that approximately 30 mental health professionals per 100,000 population in the Czech Republic. The government has responded by initiating various programs to strengthen the mental health infrastructure, such as the integration of mental health services at the primary care health services and expansion at the community level.

Recent initiatives in Czechia’s mental health care include efforts to improve access to services for children and adolescents, enhance mental health education and reduce stigma. International cooperation has also facilitated the exchange of best practices, contributing to the development of mental health services in the country.

Czechia is at a critical stage in managing mental health, with significant strides being made in reducing stigma, enhancing services, and integrating mental health into broader healthcare.

– Ansha Gupta

Ansha is based in Apex, NC, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Andorra: A Country Focused on Improvement

Mental Health in AndorraWhen people think of European countries, they most likely don’t think about health issues, considering that these countries are frequently world leaders in terms of health. However, countries always have their issues and Andorra is no different. Thankfully, Andorra has demonstrated commitment to resolving its issues with mental health.

The Lack of Data

Despite being nestled between France and Spain, Andorra has a surprising lack of data on its mental health services. As of 2020, there was no data on the total amount spent on mental health per person, the suicide mortality rate or the community-provided mental health services that are available.

Even though nearly one-fifteenth of Andorra’s population has a mental disorder and a quarter of the country’s research focuses on mental health, data on the subject is scarce. This lack of information is concerning, given the vital importance of mental health.

As of 2019, a study found that for more than 20 years, consistently, 14% of the population or around 14,000 people, reported having a mental disorder in Andorra. During COVID-19, Andorra saw an increase in anxiety and depression symptoms. Of note, the World Health Organization’s (WHO) 2020 profile on Andorra found that only one program is available to the public and this program could not be determined as either effective or ineffective.

Moving Forward With Hope

Despite the lack of available data, there is good news in terms of treatment options. The Andorran government covers the cost of various mental health treatments and care. It is committed to strengthening its early child developmental programs. Additionally, it has shown its support in deepening mental health aid available to the public.

The main Andorran hospital, Our Lady of Meritxell Hospital, provides professional help, including options for medication, psychiatrists and therapy. Similarly, a private psychological center, Andorra Psychological Center, offers workshops and various therapies run by licensed professionals.

Many nonprofit organizations are also helping to combat mental health challenges in Andorra. These include Caritas Andorra and the Andorran Red Cross, which both offer mental health aid through their social services. Specifically, they provide support groups and various talk therapy options. However, according to a 2011 study, inpatient services are rarely available, if at all.

What Else Is Being Done?

The Andorran government implemented the National Plan of Action on Children and Adolescents 2023-2026 to protect the world’s future through children. This plan was highly successful, to such an extent that a United Nations (U.N.) Special Representative and pediatrician Dr. Najat Maala M’jid praised Andorra for its child protection efforts. According to M’jid, a part of this program’s success is due to two specific protocols: the identification and prevention of child abuse.

In 2022, the European Social Charter published conclusions on Andorra’s social policies. The report highlighted the need for Andorra to implement various protections for its population’s civil rights. Specific concerns around mental and physical medical aid are mentioned. The primary focus was on Andorra’s response to COVID-19. The European Social Charter found that Andorra could offer more programs and assistance to people struggling to maintain a healthy mentality.

Final Remark

Andorra has committed to fulfilling the rights and requests of the European Social Charter, as evidenced by the Andorran Minister of Health (Albert Font) cosigning a memorandum. This memorandum will deepen cooperation and improve the environment for both Spain and Andorra regarding mental health conditions. It is evident through this memorandum that Andorra is fighting for better mental health services for its people.

– Paige Tamasi

Paige is based in Los Gatos, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Unsplash

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Poverty and Mental Health in Hong Kong

Mental Health in Hong KongDespite being one of the freest and most developed economies in the world, Hong Kong is a city characterized by high levels of inequality, with a significant portion of the population living in poverty. Not coincidentally, the city also faces prevalent mental health challenges, which are both a cause of poverty and a consequence. It was estimated that every one in seven people in Hong Kong experience a common mental disorder at any given time and 74% of mental health sufferers do not seek any professional help.

Even more concerning is the state of mental health of youth in the city: A 2023 survey estimates that about one in five participants experienced at least one mental health issue in the past 12 months, a rate significantly higher than the global average. In addition, more than half of the sufferers experience more than one mental disorder.

The Risk of a Vicious Cycle

Poverty and mental health in Hong Kong are deeply interconnected. Studies focusing on the city found that in comparison to their higher-income peers, working adults and children in low-income groups face poorer mental health and lower self-esteem. Research also suggests that poverty contributes to poor mental well-being by causing material deprivation. At the same time, income poverty does not directly correlate with mental health.

Besides the direct relationship between poverty, deprivation and mental disorders, lower-income individuals are also more vulnerable to other risk factors for mental disorders, such as the pressure to overwork. A 2016 survey found that workers in Hong Kong work an average of 50.1 hours per week, 35% higher than the global average among 71 other cities. As a result, 25% of Hong Kong workers suffer symptoms of depression and anxiety, 2.5 times above the global average. Another contributor to mental health problems is housing conditions and limited living space, an issue almost only faced by low-income individuals.

While low-income populations are more vulnerable to mental health problems, the symptoms of mental illnesses and the social stigma attached to them make it harder for sufferers to lift themselves out of poverty. Such a two-way relationship between poverty and mental health can lead to a self-perpetuating vicious cycle for low-income individuals, leading to chronic, intergenerational poverty.

Government Initiatives

In December 2023, in response to the city’s mental health crisis, the government launched a 24-hour mental health support hotline that coordinates the resources of about 20 related organizations. Earlier in the year, the Hospital Authority (HA) also promised to enhance support for patients with severe mental disorders by increasing the ratio between case manager and patient, exploring new treatments and reducing patient waiting time.

Grassroot Organizations

Nongovernmental organizations (NGOs) also play a crucial role in addressing Hong Kong’s mental health crisis. Mind HK, for example, provides free talking therapies and check-in services for individuals with mild to moderate mental health problems. The organization also engages in campaigns and events to raise awareness of mental well-being, as well as training sessions that educate people on mental health literacy. In 2022 alone, more than 6000 participants joined the nonprofit’s training sessions.

KELLY support group, on the other hand, focuses on the mental health of youth and adolescents. The organization organizes programs that promote peer support around emotional well-being and provides referral services to match youth with partnering organizations for counseling services and other support.

Final Remark

While the interconnections of poverty and mental health in Hong Kong are associated with the risk of a vicious cycle for sufferers of mental disorders, from a positive perspective, addressing the mental health crisis in the city also contributes to poverty elimination in the long term. Hong Kong’s ongoing initiatives protect not only the mental wellness of its residents but also social equity and economic development.

– Wangruoxi Liang

Wangruoxi Liang is based in Ann Arbor, MI, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Tajikistan: The Living With Dignity Project

Mental Health in TajikistanIn 2018, International Alert, an organization attempting to tackle community violence in societies with a history of conflict and extreme poverty, embarked on the Living with Dignity project, an effort to tackle economic insecurity and reduce domestic abuse, hoping to improve mental health in Tajikistan.

Poverty and Gender Inequality in Tajikistan

Declaring its independence from the Soviet Union in 1991, Tajikistan had a deadly civil war from 1992 to 1997, which greatly deepened social, economic and political inequalities already largely prevalent in the country.

Despite recent successful efforts to decrease poverty, Tajikistan is still the poorest country in Central Asia. As of 2019, approximately 26% of inhabitants lived in poverty, calculated based on income compared to the costs of basic necessities, with higher poverty rates in rural areas. In addition, around 6% of the population falls below the international poverty line. The Living with Dignity project has found that this widespread economic insecurity has profoundly negative consequences for mental health in Tajikistan.

Another key issue in the country is gender inequality. UNICEF reported a significantly higher rate of female suicide than male suicide, which by global standards is unusual, prompting questions as to the causes of this unique case. While official government figures report that approximately 31% of women from the ages of 15-49 have experienced forms of physical and emotional domestic abuse, research by International Alert indicates that the real figure could be greater than 60%. One key cause of this propensity to violence within many households is economic insecurity and the stresses it places upon families. The high rates of abuse have massively detrimental effects on mental health in Tajikistan.

Living With Dignity

International Alert’s Living with Dignity program focussed on transforming violent familial behavior through communication and reflection workshops, which provided a space for family members to understand each other’s experiences and needs better, according to the International Alert report. It found that a key cause of discord within the family was economic insecurity. So a key tenet of the project was the economic empowerment of women who generally have very little say in household financial management. The program also made use of gender sensitivity training and professional mental health services to challenge the patriarchal norms that dominated these areas and explore how they harm women’s mental health.

Economic Empowerment

International Alert found an increase in economic independence for women to be highly important in improving mental health, with participants reporting that they felt more heard in decision-making within the household. Moreover, an upturn in women’s participation in work led to greater economic security, which massively affects mental well-being. Throughout the Living with Dignity project, there was a 32% increase in families having enough food and money to support their needs. Moreover, at the beginning of the project 42% of women reported going to bed hungry at least once a week, while by the end of the project, that number was down to just 8%, according to the International Alert report. Many participants stated that an increase in economic stability was the key change in improving their mental health, given it made many women feel more valued and respected by their families.

Effects on Domestic Abuse

International Alert reports a 24% decrease in women feeling fearful in their household every week throughout the program. According to interviews conducted, this was largely brought about by an increase in respect between family members, fewer instances of domestic violence, greater economic independence of women and thus greater mobility. International Alert also found an increase in women feeling comfortable sharing their opinion on matters of household finance by 22%, and a 38% increase in women believing they now had more of a say in decision-making, both of which correlated strongly with improved psychological and emotional wellbeing.

Throughout the project, there was also a marked decrease in specific instances of violence and the amount of individuals who felt the use of violence in the home was acceptable. The gender sensitization training aimed to encourage families to deal with disputes in non-violent, diplomatic ways, which produces more comfortable home environments for women, facilitating better mental health outcomes.

The Living with Dignity project, then, has had a positive effect on the lives of many of these women, improving mental health in Tajikistan through tackling patriarchal, often abusive, norms and promoting both women’s safety and economic independence. Programs like this show that, by tackling global poverty we can reduce domestic violence and improve mental health outcomes.

– Billy Jardine

Billy is based in Liverpool, UK and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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Mood Over Matter: Mental Health in Malta 

Mental Health in MaltaMalta, the small island state at the heart of the Mediterranean Sea, faces an epidemic of undiagnosed mental health problems. As many as 120,000 of its citizens struggle with some form of mental illness. An article from Lovin Malta interviewed several Maltese individuals who shared their mental health struggles. Two interviewees described living with anxiety and stress, self-diagnosing as suffering from Post-Traumatic Stress Disorder (PTSD). Another two detailed their difficulties with neurodivergence—one with suspected Asperger’s syndrome and the other with inattentive ADHD—conditions that significantly impact mental well-being.

The mental health issues in Malta are as varied as in any other part of the world. Maltese people face similar challenges to those in more developed countries, not due to a lack of humanity or civility, but because of limited access to essential services and an unstable economy. Despite these challenges, “0.7% of all deaths among Maltese residents in 2017 were deaths by suicide” and the country ranks 40th globally in terms of national happiness.

Factors Affecting Mental Health Decline

Over the past decade, Malta has experienced a significant influx of migrant workers from within the EU and beyond. This population increase places pressure on society, particularly on the healthcare system, straining those responsible for its operation. This cultural shift forces the host nation to adapt inclusively to reflect the values of all its inhabitants. While this progression is often seen positively, it can be overwhelming for some, especially those already in a fragile mental state. The result is a society where some embrace change, while others feel abandoned by their culture.

Ironically, the push towards a more egalitarian society has disproportionately affected the vulnerable. As women increasingly enter the workforce, traditional care roles are diminishing, leaving the elderly and infirm to rely more on state support.

Until recently, the Maltese government did not prioritize open discourse about mental health. A lack of political will, consensus and leadership hampered efforts to address the issue, according to Health Policy.

Need for Change: Positive Developments

Significant improvements have been made in Malta’s approach to mental health over the past decade, building on reforms from the early 1990s. In 2012, Malta appointed its first Mental Health Commissioner, marking a turning point, Health Policy reports. Increased pressure from public bodies and media figures has helped to destigmatize mental health issues, prompting more open discussions.

Previously, Malta had the highest average length of stay for inpatients with mental and behavioral disorders in the EU. In 2013, the average stay was 57 days, which decreased to around 40.5 days by 2019. The number of hospitalized patients per 100,000 population also dropped from 144 to 89.7 during the same period, according to Health Policy.

The health care system now favors community hostel care or independent living arrangements over prolonged hospital stays, allowing patients to maintain their autonomy and human identity.

NGO Involvement

Several organizations are spearheading initiatives to combat mental health issues in Malta. These include the Mental Health Association Malta (MHAM), the Malta Federation of Organizations Persons with Disability (MFOPD) and the Malta Health Network (MHN).

Founded in 1982, MHAM supports caregivers of the mentally ill, educates the public to reduce ignorance and stigma and advocates for legislative changes to benefit caregivers and support workers.

Founded in 1970, MFOPD supports 41 member organizations and works on initiatives to reduce stigma, enhance societal understanding and improve integration and services for persons with disabilities. It advocates for the rights and needs of persons with disabilities, engages in lobbying efforts, and participates in relevant government structures and European events.

Established in 2007, MHN is an organization that focuses on promoting health-related interests for patients and the community in Malta. It collaborates with governmental, non-governmental, and not-for-profit organizations as well as patient representative groups to enhance health services and patient advocacy.

In February 2024, the organization launched a “To be seen and to be heard” (Arani u Ismagħni) campaign seeking to empower patients and equip them with skills of self-management and professional communication.

Future Directions

While Malta has made observable progress, the WHO is keen to draw attention to the work still to be done. Reducing poverty from its current rate of 9.2% to zero is crucial, but, according to WHO, so, too, is improving staff communication with patients and spreading information about mental health issues. 

Financial hardship and mental distress are interconnected. Studies suggest both poverty and mental health issues are still stigmatized, with some believing mental health is a middle-class issue. Research in Glasgow, however, indicates higher rates of mental health issues in deprived areas, though suicide rates are higher in affluent areas. This disparity highlights structural differences in access to resources, with the affluent having better access to mental health services, while the impoverished often face desperation and neglect.

It is challenges such as the above that an organization like MHA seeks to overcome; by combating the stigma that mentally ill people and their caregivers face in Malta and ensuring mental health services are both well-staffed and well-funded.

In September 2017, the MFOPD initiated a campaign comprising a series of educational modules that sought to assist those living with intellectual disabilities to engage in an independent lifestyle. The project’s mission statement was “Enhancing Social and Economic Inclusion Through Independent Living” and it reached 360 people by the project’s end.

– Thomas Johnston

Thomas is based in Dungannon, County Tyrone, Northern Ireland and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr
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Mental Health in Georgia

Mental Health in GeorgiaGeorgia, formerly part of the Soviet Union, garnered independence in 1991. From 1991 to 1993, following its break from the communist regime, civil war and unrest had wracked the country; its post-Soviet Union status still had not allowed the state to fully escape the shadow of its political past. PLOS Medicine reports that traditionally inhumane and outdated medical practices, ranging from biological treatment to high rates of institutionalization, heavily characterize mental health services in Georgia.

In 2009, Global Initiative on Psychiatry (GIP) reported that social exclusion, mental ill health and poverty were all correlative; the mental well-being of residents in poorer, more remote regions of the country proves a focal point for discussion. It was not until the Ministry of Labour, Health and Social Affairs (MoLHSA) introduced the 2011-2015 National Health Care Strategy that there was a key turning point in Georgian mental health services. The status of mental health underwent a momentous transformation, both in the realm of primary health care and in the community. This is a chronological breakdown of the reformation roadmap thus far.

1995-2009 Programs and Laws

The establishment of the 1995 mental health assistance program meant that officially registered mentally ill patients, according to the national psychiatric register, received free services, according to PLOS Medicine. These people received treatment at various hospitals as well as outpatient clinics. PLOS Medicine records show that six psychiatric clinics provided hospital care to these patients and have housed and cared for more than 1,000 people.

In 2007, a newly introduced law on psychiatric services resulted in the illegalization of the involuntary hospitalisation of mentally ill patients in Georgia, PLOS Medicine reports. A court decision was mandatory if one viewed institutionalization as the only remaining viable option. The EU has repeatedly berated Georgia on torture for the poor conditions of the country’s mental institutions; the violation of human rights was a huge motivation behind the upheaval of its mental health services.

In 2009, Georgia replicated the 2007 law on psychiatric care alongside several adaptations, carried out by psychiatric experts. This included the proposal of treatment management techniques such as physical restraint as well as treatment options relevant to forensic psychiatric treatment and prison mental health, PLOS Medicine reports.

2011-2015 National Mental Health Care Strategy

In 2010, Georgia announced the 2011-2015 National Mental Health Care Strategy with a specially curated team of psychiatrists prepared to implement these reforms. At the time of the strategy’s introduction, MoLHSA officially recorded approximately 80,000 mentally ill civilians but also admitted that they viewed this as an underestimation, PLOS Medicine reports. The program emphasized the importance of mental well-being; the strategy’s overarching objective was to improve the general population’s mental health by 2015.

By 2013, 18 outpatient psychiatric clinics were already in use but there was a negative correlation between the increased presence of available services and poorer, more remote regions; citizens of poorer regions could not access mental health services of the same quality, according to PLOS Medicine. The principal reform within this entire process was deinstitutionalization which occurred in early summer 2011 via the closing of the largest psychiatric institution at the time, the Asatiani Psychiatric Hospital.

2015-2020 Mental Health Care Strategy Plan

The country announced the plan in 2014 and prioritised the improved accessibility of mental health care services to the Georgian population. Georgia declared its obligations to care for all disabled civilians and safely keep their rights and freedoms. The strategy emphasized the destigmatization of mental health treatment and mental illness. The World Health Organization (WHO) report stated that, at this time, neuropsychiatric disorders were behind 22.8% of the country’s fatalities.

In 2016, there was an increase in funding for more mobile teams; 11 mobile teams received funding for their work across the country by 2018. The implementation of a separate scheme in this same year attempted to ensure the rights of mentally ill Georgian prisoners, specifically. 

2022-2030 National Mental Health Strategy

This national plan aims to emphasize child and adolescent mental health. The strategy further champions deinstitutionalization and the importance of community-based care for mentally ill patients. In 2022, 8.4% of the mentally ill population received treatment in a mental hospital with the remaining populace receiving care at a community-based service.

Moving Forward

Treatment for mentally ill patients has transformed in various manners since the Georgian state obtained its independence. Firstly, however, it appears that treatment is geographically discriminatory with only civilians who reside in the country’s capital being prioritized; citizens who reside in poorer, more remote regions find treatment is less accessible to them.

Secondly, it seems that treatment for mentally disabled prisoners is immensely stagnated, especially in comparison to services which are accessible to non-incarcerated civilians. The Public Defender’s Office (PDO) of 2022 noted the sub-standard conditions available for mentally ill inmates and reported a severe lack of services specifically for those with disabilities. The former Soviet Union state has made major progress since the early 1990s and will hopefully continue to make further steps to ensure all Georgian civilians, irrespective of their geographical location and incarcerated status, can access adequate mental health services.

– Naomi Finapiri

Naomi Finapiri is based in London, UK and focuses on Global Health for The Borgen Project.

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