Tag Archive for: Mental Health

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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 PLOS Medicine reports that traditionally inhumane and outdated medical practices, ranging from biological treatment to high rates of institutionalization, heavily characterize mental health services in Georgia.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.

Photo: Unsplash

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Poverty and Mental Health in Djibouti

Mental health in DjiboutiIn Djibouti, one of the smallest but geographically strategic countries in the Horn of Africa, the relationship between mental health and poverty presents major challenges to individuals and communities. They are interrelated in such a way that economic deprivation increases mental health struggles, while poor mental health transfers them into cycles of poverty. Given this dynamic, it is clear that this challenge needs interventions that approach the issue with substantial social and health care dimensions.

Understanding the Link

Poverty in Djibouti is pervasive and much of the population lives below the threshold level of subsistence. The economy remains unstable, with scarce educational facilities and high unemployment rates. In such conditions, individuals and families have to endure many stressors emanating from lack of access to basic needs, housing insecurity and food insecurity. Stressors of this nature affect not only physical but also mental health.

According to the World Bank, “Using the lower middle-income poverty line, it is found that about two-fifths of the population lives below $3.20 a day. As the pace of economic growth declines due to the spread of COVID-19, the pace of poverty reduction is under threat.” Mental health problems are among the most common in Djibouti. Yet, they are barely noticed: depression, anxiety and trauma-related disorders. Among other causes, it is underreported and underdiagnosed because of the stigma, cultural beliefs and the lack of mental health professionals.

In addition, the deficit of reachable and affordable services for mental health increases the burden on individuals who already bear the burden of poverty. Organizations like the United Nations Children’s Fund (UNICEF) have led by example. According to the organization, in Africa alone, “nearly 37 million adolescents (aged 10–19) live with a mental disorder.” In Djibouti, UNICEF has found that 10.8% of boys and girls aged 10 to 19 are victims of mental disorders.

Multifaceted Approaches

Therefore, approaches that consider the complex interplay between mental health and poverty are essential. Poverty reduction strategies, in particular, reduce stressors that contribute to poor mental health outcomes. Similarly, improved access to education provides the tools for breaking out of the poverty cycle and enhances resilience against mental health problems. Furthermore, opening job opportunities, particularly for the most disadvantaged, improves economic prospects, builds self-esteem and increases the social integration necessary for better mental health.

In addition, social safety nets, which include cash transfer programs and food assistance schemes, make essential support for vulnerable households less burdensome on the pocket and ensure stability. These poverty reduction interventions could actually prevent risk factors that lead to poor mental health. At the same time, cultural sensitivity in mental health services will be supported by investment in the infrastructure for mental health. This will include training and deploying more mental health professionals, such as psychologists, psychiatrists and counselors, to build a strong workforce in the field of mental health.

De-stigmatizing mental illness will also help develop local support systems, including peer support groups and community health centers, helping mental health services reach unserved, far-flung areas. Therefore, the process has to consider reducing the stigma associated with mental illness. This is basically to ensure that people seek help without much stress or feeling embarrassed. Targeted awareness campaigns to dispel misconceptions and increase mental health literacy can reduce stigma and empower people to seek help openly in their communities. It is equally crucial for partnerships between the government, nonprofit sectors and international partners to share resources and expertise and coordinate efforts.

Combating Stigma and Fostering Collaboration

Reducing stigma around mental illness is the foremost strategy for enhancing help-seeking behavior and early intervention. In this regard, awareness campaigns like UNICEF’s #OnMyMind campaign can challenge misconceptions while improving mental health literacy. This can help lower stigma and increase open dialogue at the community level. Moreover, fostering the collaboration of government agencies, nonprofit organizations and international partnerships is vital to pool resources and expertise and harmonize efforts.

Given the strengths of government institutions, civil society organizations and humanitarian agencies, holistic and sustainable solutions can be devised. This collaboration could, therefore, ensure the elaboration of comprehensive policies on mental health, mobilization of resources for mental health programs and setting up mechanisms for monitoring purposes to ensure accountability.

Conclusion

The intricate relationship between mental health and poverty in Djibouti necessitates integrated and coordinated responses that address the social, economic and health aspects of the issue. Combining efforts to reduce socioeconomic stressors with initiatives to increase mental health services and reduce stigma will facilitate a pathway toward holistic and sustainable solutions for Djibouti. Ultimately, by placing human well-being at the top of the agenda, Djibouti can build resilient communities that succeed both economically and in mental health.

– Honorine Lanka Perera

Honorine is based in Highland, NY, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr

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Montenegro’s Mental Health

Montenegro’s Mental HealthThe World Health Organization (WHO) ranks a country’s health not only by the absence of disease but also by a measure of the “physical, mental and social well-being” of its citizens. Mental health is inherently linked to a society’s cohesion and the well-being of its inhabitants. Montenegro’s mental health support infrastructures are historically lacking. However, significant steps have been taken to improve public health care facilities and support services in the last 30 years.

Montenegro is a Balkan country in Southeastern Europe, bordering Croatia, Albania, Bosnia and Serbia. It is situated between the Dinaric Alps and the Adriatic Sea, making it an established tourist destination. Despite its popularity as a place of vacation and relaxation, Montenegro’s socioeconomic difficulties have had an inherent impact on the mental well-being of its citizens.

The Balkan War and Montenegro’s Mental Health

The Balkan War is still fresh in the minds of Montenegrins. For a decade, between 1991 and 2001, this violent ethnic conflict presided over the Balkan region and eventually culminated in a split from the former Yugoslavia in 2006. This bloody warfare, only recently resolved, left a legacy of trauma. Politically, Montenegro became a stable, peaceful democracy. However, the brutal civil war and Montenegro’s subsequent sovereignty had a significant impact on the economic development of the country, with its gross domestic product (GDP) falling from 45% in its Yugoslav era (1989) to 12% in 2000.

Historically, Montenegro’s psychological support has centered around patients whose serious disorders have symptoms of aggressive behavior, admitting them to Danilovgrad (Montenegro’s first psychiatric hospital, founded in the 20th century). The remaining nonviolent patients were left to “roam the streets.” A notable milestone in efforts to support community psychiatry and deinstitutionalize mental health facilities began in the early ’90s, with “Centers for Mental Health” inaugurated in 1991. Official mental health policies were implemented as late as 2004.

Mind and Money

Montenegro is ranked as one of the poorest countries in Europe, with a 2022 United Nations Children’s Fund (UNICEF) study declaring that “at least one-third of Montenegro’s children are at risk of poverty.” Economic welfare concentrates in urban and coastal regions, while much of the country struggles under economic pressures with little access to welfare support. A 2019 study showed only 44% of citizens living below Montenegro’s poverty line have access to welfare funds.

The impact of Montenegro’s conservative milieu on mental well-being is accentuated through the knowledge that 78% of those asked reported a complete absence of community mental health campaigns, while 97.2% thought support infrastructures would be a beneficial addition to their locality. This, in conjunction with a recognition of Montenegro’s conservative society that is “deeply ingrained in patriarchy,” provides context for the psychological pressures of its citizens.

Suicide rates in Montenegro can be correlated directly with insufficient support infrastructures and economic pressures. “The average crude suicide rate was 21.06 ‘for males 29.93 and for females 12.42,” with lethal suicide statistics correlating significantly with unemployment rates. In 2018, the rate of fatal suicide in the male population reached 4.29. In addition, Montenegro is recognized as having the highest number of “weekly hours worked [in Europe] at 42.8,” while the average European employee in 2022 worked just 36.2 hours a week.

These figures can be attributed to cultural roles, with men facing more pressures on having to financially contribute to households: an indisputable correlation between poverty and mental stability.

The EU4 Health Program

In January of 2024, the Montenegrin Health authorizations and the wider European health community established an agreement: the EU4Health program. This agreement allows both public and private sector health care entities access to funding and grant opportunities, increasing the accessibility and quality of support across the country. However, despite recent advancements in infrastructure and support, these goals are still recognized as only “partly realized,” with many of its objectives still awaiting accomplishment.

Open Mind

Nongovernmental organizations (NGOs) are working towards the political and social representation of mental health issues in Montenegro. The Open Mind project, co-funded by European Union’s (EU) grants, advocates for the inclusion of mental illness in political agendas, public debates and social sectors. Promoting dialogue for the social reintegration of those with mental health issues combats cultural stigmas.

The campaign aims to sensitize 5,000 individuals, conduct 10 awareness campaigns, train 20 CSOs and establish support groups in multiple communities. This project is one of 20 NGOs working to improve the lives of this target group and represents an optimistic future for Montenegrins suffering from mental health issues.

A Brighter Future

Recent governmental efforts to improve public health care in Montenegro represent a pivotal ideological shift, with Montenegrin citizens forecasted to witness “substantial improvements in their health care services.” Reflecting on the dualism between public mental health and the economy, an optimistic future is evident in Montenegro’s strong economic growth, estimated at 6% in 2023.

Traditionally, policy has neglected the implications of socioeconomic burdens on Montenegrin inhabitants. However, recent years have seen evident improvements in support infrastructures available for relieving the Montenegrin public mental health concerns. The inherent implications of mental health issues on social cohesion make the promotion of these efforts a priority.

– Thea Carter

Thea is based in London, UK and focuses on Global Health for The Borgen Project

Photo: Flickr

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The Intersection of Poverty and Mental Health in South Korea

The Intersection of Poverty and Mental Health in South KoreaMental health in South Korea is a critical issue that often falls under the radar due to the nation’s global reputation for economic prosperity and technological innovation. Despite these achievements, South Korea faces high rates of suicide and mental health challenges, exacerbated by intense societal pressures such as academic demands and workplace stress.

The Context of Mental Health in South Korea

South Korea has one of the highest rates of suicide among developed countries, with 26 deaths per 100,000 population. This devastating statistic stands in contrast to the global downward trend as South Korea’s suicide rate nearly doubled over the past 20 years, becoming the sixth leading cause of death in 2022. This crisis is exacerbated by intense societal pressures such as academic and workplace demands, with what is referred to as examination hell, in which breakdowns and suicides become frequent with students during exams where failure would lead to economic and social hardships. Moreover, South Korean culture often frowns upon seeking help for mental illness, with reports stating that only seven percent of those affected by poor mental health seek therapy or psychiatric help. Furthermore, those who do attend therapy, often pay out-of-pocket in cash to avoid any effect on their insurance.

Many South Koreans follow Confucianism, a philosophy grounded in honoring your ancestry, leading many South Koreans to forgo mental health treatment to preserve their family’s ‘dignity’. Furthermore, this philosophy emphasizes individual will, spiritual strength and self-discipline, suggesting that mental health should be tolerated rather than cured.  These factors create a challenging environment for addressing mental illness, particularly for the economically disadvantaged who face amplified societal pressures and cultural stigma as well as the financial burden that places them at the forefront of examination hell.

Poverty in South Korea

Despite its remarkable economic growth, South Korea grapples with a significant poverty rate of 14.9% as of 2022, a number that is relatively high by global standards. Furthermore, this poverty rate is particularly evident among certain demographics such as the elderly and single-parent households, with 40% of Koreans above 66 years old living below the poverty line, the highest elderly income poverty rate among the Organisation for Economic Co-operation and Development (OECD) nations.

According to Kang So-Yoon, a volunteer at a Buddhist temple in Seoul who gives out free lunches, “the economy is in bad shape and older people are struggling to find work,” and, “many elderly people were unable to put aside savings for later in life because they spent too much on their children’s education.” There is a societal expectation that children will support their parents in old age. However, due to social competition and income inequality, many are struggling financially, making it harder to help their parents financially. 

Poverty as a Determinant of Mental Illness

The intersection of poverty and mental health creates a complex and reinforcing cycle in South Korea. Financial instability and the daily struggle to meet basic needs such as food and shelter drive individuals living in poverty to experience heightened levels of stress, anxiety and depression. A BMC Public Health study identified low income, unemployment and financial difficulties as risk factors for all suicidal behaviors. Furthermore, socioeconomic disparities often result in reduced access to mental health services, further entrenching the cycle of poverty and mental illness.

The stigma associated with mental health issues through deeply rooted cultural and societal norms compounds these socioeconomic challenges. Individuals in poverty face a dual burden which may discourage many from seeking psychiatric help for fear of societal ostracization. Addressing this intersection requires a multifaceted approach including more access to mental health care, reduction of stigma and implementing policies to provide financial support. 

Government Policies and Initiatives

As of December 2023, South Korean President Yoon Suk Yeol, vowed that the government will begin proactively addressing mental health issues through the Mental Health Policy Innovation Plan calls for the state to actively manage the entire cycle of mental illness, from prevention to recovery. Under this plan, a total of one million people are expected to receive psychological counseling funded with government support by 2027. Furthermore, the government will increase national mental health checkups for young people aged 20-34 from every 10 years to every two years, aiming for early intervention of mental health risks. Through this policy, the South Korean government aims to reduce the suicide rate by 50% by 2033. 

Grassroots Initiatives and NGOs

Nongovernmental organizations (NGOs) also play a crucial role in addressing mental health challenges in South Korea. The Korean Ministry of Health and Welfare supports the Korea Foundation for Suicide Prevention, an NGO dedicated to educating policy establishment, analyzing causes of suicide and improving awareness while managing high-risk groups and bereaved families. In doing so, the Korea Foundation for Suicide Prevention aims to systematically implement suicide prevention, working alongside the government’s plan to halve the suicide rate within 10 years.  

Looking Ahead

South Korea’s commitment to addressing the intertwined challenges of mental health and poverty promises to transform countless lives through comprehensive policies and robust support systems. As the government and NGOs actively collaborate to break the stigma and provide accessible mental health services, they renew hope for reducing disparities and enhancing societal well-being. These ongoing initiatives aim to destigmatize mental health care and integrate it into the fabric of community support, ensuring no one is left behind in South Korea’s journey toward greater social equity.

– Emily Weir

Emily is based in Bath, UK and focuses on Global Health and Celebs for The Borgen Project.

Photo: Flickr

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5 Facts About Mental Wellness in Bulgaria

Mental Wellness in BulgariaBulgaria is a country known for its rich cultural heritage and picturesque landscapes. The population is roughly seven million and the nation is part of the North Atlantic Treaty Organization (NATO) and the European Union (EU). It is a hotspot country for historians and anthropologists alike, as it is one of the first European countries in existence. Bulgaria is dotted with mountains and dense with forests and it borders the sea, so there are several tourist attractions and opportunities for outdoor adventure. Here are five facts about mental wellness in Bulgaria.

5 Facts About Mental Wellness in Bulgaria

  1. Historically, Bulgaria has not prioritized the mental health of its citizens, with very few mental health facilities in existence before the ’50s. After the regime change in 1944, psychiatrists in Bulgaria began to advocate the “dispensary system,” which meant to integrate and normalize psychiatric intervention in the broader citizen sphere. This mentality was born at a time when psychiatrists began to see the direct influence of “social conditions” on the mental well-being of citizens. Thus, psychiatry and outpatient treatments were introduced more readily to accommodate mental wellness in Bulgaria.
  2. Social stigma is a significant barrier to addressing mental health in Bulgaria. Despite psychiatric efforts in the 20th century to incorporate psychiatric care into society, attitudes surrounding mental illness and disabilities in Bulgaria do not reflect these efforts. Seeking help can often target individuals and warrant social scrutiny – “Mentally ill are socially discriminated.” It is believed that the mentally ill themselves are guilty of their doom and they should not expect society to share the burden of disease with them.”
  3. Regardless of rampant social stigmas, mental illness is highly prevalent in Bulgaria. According to the United Nations Children’s Fund (UNICEF), about 20% of children and adolescents experience mental health complications each year. Bulgarian youth are also ranked number one in Europe for unhealthy coping mechanisms, such as nicotine intake and drug/alcohol abuse.
    Though many doctors are not readily diagnosing mental health disorders in Bulgaria, it is estimated that nearly one in five Bulgarians experience depression to some degree: “People are told to just snap out of it and get on with their lives and are branded as sensitive and fragile.” Every year, nearly eight hundred Bulgarians succumb to suicide.
  4. Several factors contribute to poor mental health in Bulgaria, the foremost being the lack of assistance for those in need, as previously mentioned. The health care system in Bulgaria does not prioritize mental wellness, which is often seen as separate from physical well-being and not as immediate. Additionally, though substance abuse is usually a result of mental health disorders, it can also be an instigator of such ailments.
    “According to data from the Bulgarian Methadone Association and the Bulgarian Institute for Addictions, there are more than 300,000 drug addicts in Bulgaria.” Health care is also widely inaccessible, with almost half of all medical payments requiring “out-of-pocket” compensation. Finally, nearly 40% of the population is impoverished to some degree, which amplifies mental health struggles disproportionately.
  5. Luckily, steps are being taken to combat social stigmas around mental health disorders and provide resources to those affected. In 2018, the World Health Organization (WHO) implemented mental wellness interventions in Bulgaria. These interventions included providing mental health training to medical professionals, donating funds to support mental health services, creating programs to raise awareness and collaborating with policymakers to establish sustainable solutions. 

WHO’s initiative made a sizeable impact: “In 2018 and 2019, the suicide rate in Bulgaria decreased by 7% compared to the previous biennium.” Similarly, UNICEF is creating an app for young Bulgarians to provide information about mental struggles, personal care advice, links to mental health resources and more. It also strives to create a website that connects Bulgarian youths with mental health professionals.

Though efforts are being made to promote mental wellness in Bulgaria, more can be done to address the ongoing mental health crisis. Government intervention, as well as assistance from WHO, UNICEF and related organizations, is essential in steering the population to a more healthy and optimistic future. With the reduction of social stigmas, a decrease in barriers to health care and the integration of psychiatric care into everyday medicine, Bulgarians can begin to heal themselves holistically for years to come.

– Anna Williams

Anna is based in Burlington, VT, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr

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Mental Health in Angola

Mental Health in AngolaAngola is a small country situated on the western-central coast of Southern Africa. Generous petroleum and mineral reserves support its fast-growing economy. Collectively, Angola shares a crucial concern for mental health with all 54 countries in Africa. However, the treatment of mental health in Angola has been neglected.

Angola’s Health Care Challenges

Limited funding, inadequate mental health care policies, shortages of health care personnel and deficient training of health care workers are some of the health care challenges in Angola. In terms of health care facilities, there are approximately 3,000 people per facility, indicating a strain on accessibility. Moreover, with only 1.01 beds available per 1,000 patients, there’s a concerning shortage of hospital beds.

The physician-to-patient ratio stands at 0.3 per 1,000 patients, equivalent to around 14,000 physicians, which falls below the World Health Organization’s recommended level. Similarly, the nurse-to-patient ratio is 1.1 per 1,000 patients, suggesting further strain on health care resources. These statistics highlight the urgent need to address funding limitations, reform mental health care policies and invest in health care personnel and training to ensure adequate health care provision for the population.

Further, Angola’s 2023 budget allocated 23% of all government expenditures to the social sector, with health care receiving approximately 7%. However, it falls short of supporting the health care needs of 34.5 million people. For the health development plan to be effective, current statistics and comprehensive data could be utilized to upgrade existing priorities. Comprehensive data would include current population growth, distribution of population, infrastructure needs, financial models and human resources that would upgrade priorities.

Programs Tackling Mental Health in Angola

  1. African Center for Disease Control (CDC): In March 2024, the CDC launched a new Mental Health Leadership Program (AMHLP) to address mental health challenges in several African countries, including Angola. Wellcome, whose mission is to “support discovery research into life, health and well-being,” funded the program. The program aims to “mobilize decision-makers to support countries in reforming services and advising on public health measures to promote and protect mental health and well-being.”
  2. Education: Doctor Alisha Moreland-Capuia is a leading trauma-informed care expert. Her nonprofit, The Capuia Foundation, is constructing the Institute for Trauma-Informed Systems Change in Angola. Counseling and educating the people of Angola about mental health will help them develop a realistic understanding of mental illnesses.
  3. Kassai: Kassai is an eLearning platform funded by the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI). This program trains health care workers in malaria, family planning and maternal and child health. By the end of 2022, the Kassai platform had 6,600 unique users and 31,000 course enrollments.

Mental health illnesses are a present-day concern in Angola. However, several programs are being initiated by both the Angola government and nonprofits to address mental health challenges in Angola.

– Pamela Fenton
Photo: Unsplash

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Addressing Mental Health in Lesotho

Mental Health in LesothoThe Kingdom of Lesotho is located in South Africa and has a population of two million. Right now, the country is facing its own unique set of struggles and issues. Concentrated areas are often poverty-stricken due to limited employment opportunities, lack of access to necessities and services, as well as high vulnerability to environmental and economic crises. About 24% of citizens in Lesotho live in extreme poverty, while around 580,000 citizens suffer from food insecurity. Additionally, Lesotho has one of the highest HIV prevalence rates in the world at 22.7% as of 2023, as well as a high rate of tuberculosis, which is greatly affecting the health of the country’s already limited health care workers.

These problems compromise the state of mental health in Lesotho. In fact, the latest report shows that the country had one of the highest rates of suicide in the world for that year, with 87.5 suicide-related deaths for every 100,000 deaths. These numbers are alarming and justify claims that state that there is a mental health crisis in Lesotho. The existence of such a severe mental health crisis serves as a testament to the challenges and stressors endured by the Basotho people.

Despite the acknowledgment of such a crisis, many Basotho will not seek help, whereas many others cannot afford to do so. Lesira Rampa, a Lesotho native, wrote, “Unfortunately, there are numerous challenges in accessing mental health treatment in Lesotho, as evident from the alarming suicide statistics. Despite facing stigma, we encounter several problems, including a shortage of mental health care services and limited financial resources to afford expensive treatments.” In light of these obstacles that prevent Lesotho citizens from accessing mental health services, many organizations such as Help Lesotho, Dolen Cymru and Sentebale are working within the country to assist those in need.

Increasing the Number of Mental Health Care Providers

Lesotho has been suffering from what experts call a “brain drain,” which is the emigration of trained professionals from their country of origin to other countries in order to find jobs. This brain drain has made it difficult for Lesotho to retain a stable number of health care workers, causing a great amount of strain on the physicians and nurses who choose to stay. This shortage has detrimentally impacted the quality and quantity of mental health services available to those suffering from mental illnesses.

Paul Myres, Vice-President of the nonprofit organization Dolen Cymru, told The Borgen Project in an interview that, currently, there are no psychiatrists in Lesotho. In order to remedy this issue, Dolen Cymru administers mental health training, which was developed by the World Health Organization (WHO), to upskill general health care providers within the country. Myres describes the training program as a WHO-designed, multi-professional training program that Dolen Cymru was tasked with implementing. It involved just five days of instruction and relied heavily on algorithms, with a structured approach of asking questions to gather patient information and proceeding accordingly based on the responses.

More than 100 health practitioners received this training, which has aided in improving the understanding of mental health among general Lesotho nurses and doctors. Myres says that the philosophy of Dolen Cymru is to capacitate rather than to provide direct care. Such a unique and innovative philosophy can prove effective in empowering citizens to seek out more information on mental health concerns while preserving their dignity.

One-On-One and Group Counseling

There are a generous number of organizations working in Lesotho to provide help during this mental health crisis, each with its unique approach. Help Lesotho is an organization that focuses on providing one-on-one and group counseling to those in need. Help Lesotho offers a range of non-intensive and long-term intensive self-help and life-skills programs. Its variety of programs is designed to benefit parents, children and communities. These programs address mental health concerns stemming from issues such as poverty, grief and loss, HIV/AIDs and much more.

In 2023, Help Lesotho’s long-term intensive programs had more than 2,000 participants and the organization had one-on-one psychosocial support conversations with more than 960 people. Those who received assistance and guidance from Help Lesotho noticed an increase in confidence, a new-found sense of belonging and a desire to inspire others.

Stigmas: Obstacles To Providing Mental Health Support

Although several organizations are addressing the need for mental health services in Lesotho, certain obstacles can stand in the way of their efforts. It is especially difficult to reverse the effects of the social stigmas surrounding mental health in Lesotho. Meyers mentioned in his interview with The Borgen Project that mental health issues are often seen as a punishment in Lesotho, either for the individual or even their parent’s behavior.

Ms. Mota, a psychiatric nurse at Mohlomi Hospital, has spoken out about these stigmas, stating that “Because of misconceptions and stigma surrounding mental health issues, people sometimes suffer in silence and do not seek treatment for their conditions.”

Thankfully, training and programs such as the ones offered by Dolen Cymru can help reduce the influence of such stigmas. Meyers says that when trainers ask doctors to come up with a list of words describing their initial response to mental health, fear is always at the top of the list. “The good news,” he says, “is that by the end of the week, we ask the same question and that’s all gone.”

Conclusion

Lesotho, just like any country, has its own unique set of stressors and difficulties. Fortunately, organizations such as Dolen Cymru and Help Lesotho are going to great lengths to provide Lesotho with the assistance it needs. However, there is definitely still work to be done.

– Kimber Peters
Photo: Pexels

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3 Initiatives Improving Mental Health in Kuwait

Mental Health in KuwaitIn the past, much of the stigmatization around mental health in Kuwait has stemmed from the idea that parents are to blame for the mental illnesses of their families and that those seeking help and relief have done so at the cost of their reputations. However, in recent years, Kuwait has been doing much to reframe this narrative in three major ways:

Kuwait’s First Mental Health Law

The Kuwait government issued Law No. 14 in February 2019 to protect individuals with mental health issues. This marked a major stride in the country’s efforts to improve its response to mental health concerns, mainly because there was no previous law governing mental health in Kuwait. Before the implementation of the Mental Health Law, individuals experiencing mental health challenges couldn’t be held at a facility, even if leaving posed a risk of harm. However, Article 11 of the Mental Health Law grants physicians the authority to detain patients for up to 72 hours during an evaluation period (the “Assessment Period”). This detention protects patients and others around them from danger. It also provides a clear guideline for what to do when one is incapable of self-care or consenting to voluntary assessment or treatment.

Additionally, the law sparked the creation of the Mental Health Coordinating Council (MHCC), whose members are responsible for following up on the application of the law and its regulations. The implementation of the MHCC means that for mental health in Kuwait, there is a body of individuals dedicated to protecting the rights of mental health patients by developing policies in their best interests. One of these rights includes the fact that, under the Mental Health Law, those with mental health conditions should not be prohibited from obtaining a job, marking the law’s intent to prevent stigma and isolation for mental health patients in the workforce.

Kuwait’s Response to the Impact of the COVID-19 Pandemic

As a result of the pandemic, rates of anxiety and depression, especially among the elderly and those with disabilities, increased, possibly due to fears about harboring the disease in conjunction with isolation and lockdowns limiting access to medical support. In response, the Kuwait Ministry of Health, through the country’s Center for Mental Health and Central Administration for Primary Care, launched several new initiatives to both improve health care access and overcome the limitations of isolation and lockdowns:

  • The Kuwait Center for Mental Health launched a hotline (+965 2462 1770) that operates daily from 9:00 AM to 5:00 PM.
  • The Ministry of Health launched an interactive platform called “Shlonik,” which provides health information to patients, monitors their safety and provides psychosocial support.
  • Specialized psychiatric clinics delivered psychotropic medicines to patients’ homes, allowing for the continued progress of their treatment.
  • Mental health care providers working in the private sector utilized social media, newspapers and TV channels to provide education regarding coping with psychological problems. Some providers even offered frontline workers free remote psychosocial support.

Nonetheless, it’s crucial to acknowledge that migrant workers and stateless individuals residing in Kuwait, often living in close-knit communities, have disproportionately felt the impact of COVID-19. This is due to their disadvantaged position, as they do not have access to free secondary health care. Access to mental health services remains a significant issue for this demographic, given the steep costs associated with diagnosis, psychiatric consultations and therapy sessions, which are considerably higher than those for Kuwaiti nationals.

The Improvement of Mental Health and Wellness Services in Kuwait

The Fawzia Sultan Health Care Network (FSHN), founded in 2006, is Kuwait’s first and only nonprofit mental health provider. It has been providing many health care services, including family medicine, cardiology, physiotherapy, occupational therapy, speech therapy and psychological services in research and education settings.

While it started as a specialized physiotherapy clinic, the organization soon realized that the health care needs of Kuwait ran much deeper. So, its approach expanded and became much more multidisciplinary. This expansion marked a shift in attitudes regarding mental health in Kuwait and is likely one of the factors that ultimately led to the creation of the Mental Health Law in 2019. The early efforts of FSHN and the later development of the Mental Health Law serve as evidence of the impact that dedication to a specific cause can have, even if that impact is only realized years later.

Final Remark

In a region where mental illness is still considered taboo, the Mental Health Law, along with the impact of health organizations and wellness services, highlights a continuous effort in Kuwait to improve protections for patients with mental illnesses.

– Avery Fuller
Photo: Pexels

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Creative Writing Helps Isolated Individuals Find a Community

Creative WritingCreative writing often emerges as a valuable coping mechanism for mental health challenges. With many individuals experiencing situational depression, such as isolation, creative writing can serve as a means to connect and find solace within a community. Writing groups have increasingly become a famous avenue for individuals to gather, share their passions and support one another. In Brazil, where mental health services are overseen by the Psychological Care Network, i.e., Rede de Atenção Psicossocial (RAPS), incorporating creative writing initiatives into existing support structures could offer isolated individuals a pathway to community connection and emotional well-being.

Challenges in Mental Health Care: The Landscape in Brazil

In Brazil, individuals with disabilities are categorized as disability-adjusted life years (DALY), accounting for more than 7.5% of the nation’s mental health patients. Additionally, there are individuals classified as Institute for Health Metrics and Evaluation (IHME), encompassing a range of physical and psychological health conditions. Regrettably, the prevalence of mental health disorders has been increasing by 0.5% annually, resulting in 57.7% of the population experiencing such conditions as of 2023.

With more than half its population grappling with mental health issues, Brazil finds itself among the nations with the most significant challenges in mental health care. Despite efforts such as World Mental Health Day and other awareness campaigns, considerable strides are needed to address the nation’s mental well-being. In 2020, the COVID-19 pandemic profoundly impacted the globe, imposing lockdown measures in many countries and exacerbating isolation for individuals battling depression. Among the people of Brazil, those residing in the northern regions bore the brunt of the pandemic, with around 84% experiencing depression or anxiety induced by isolation.

Strategies for Coping With Severe Depression

Individuals grappling with severe depression are frequently provided with coping mechanisms aimed at alleviating their anxieties. These strategies encompass a range of approaches, including breathwork, engaging in physical activities, practicing mindfulness and seeking support from loved ones or professional therapists.

Many therapists and mental health advocates endorse writing as a means to express and manage emotions, particularly anger or sadness, offering individuals a sense of empowerment over their narratives. The University of Cumbria promotes writing poetry as a therapeutic activity for National Poetry Day, encouraging students to explore a common theme and gather to share their creations.

In the United Kingdom (U.K.), poetry clubs have emerged as popular venues for isolated individuals to connect with like-minded peers and bond over shared literary interests while enjoying tea or coffee. Established organizations like the Poetry Society, which has been operating since 1909, offer platforms for writers worldwide to showcase their work, including through competitions. Notably, the organization has expanded its reach to publish the works of poets from countries beyond the U.K., such as Brazil, featuring poets like Adelia Prado.

Empowering Mental Health Initiatives 

Regrettably, the mental health campaign in Brazil has not reached as many individuals as intended, possibly due to inadequate funding for mental health services and historical reports of patient mistreatment in psychiatric hospitals during the ‘70s and ‘80s, which has left many Brazilians distrustful of such institutions.

Establishing a creative writing society in Brazil is an attainable goal. Taking inspiration from organizations like UK’s Poetry Society, a Brazilian-based website dedicated to creative writing, could gain traction swiftly and independently without relying on government funding.

 With access to the internet and basic computer skills, individuals can learn to set up and publish their websites, showcasing their literary creations to a global audience. Utilizing website builder tools like HubSpot, WiX, Adobe and IONOS, individuals can customize their platforms and even feature works from friends and family. This endeavor can evolve into a prominent creative writing platform, fostering community engagement and artistic expression. Pre-made platforms like YouTube or TikTok dedicated to content creation can be viable alternatives for those hesitant about website creation.

Individuals without internet access or those who prefer in-person interaction can distribute invitations via community boards or public information centers to promote poetry or creative writing gatherings. Numerous community facilities across Brazil offer spaces for both educational and recreational purposes, serving as ideal venues for hosting writing groups.

In 2018, an exceptional community center called Community Center Camburi was opened. It was built entirely from bamboo! Building the center from bamboo it saves Brazilian financial resources. Centers like Camburi can be used to serve as a place for creative writing groups and those artists can use their creative writing skills to influence others to be more environmentally friendly.

Conclusion

Through diligence, commitment and leveraging available resources, individuals in Brazil can unite around a common theme, fostering connections and reducing feelings of isolation as they exchange thoughts and ideas. Socializing can provide a reprieve from negative thoughts for those experiencing depression, igniting their interests and engaging with others, ideally leading to a more optimistic, vibrant and innovative future.

– Phoebe Vaughan
Photo: Unsplash

Social Health Insurance and Health Care in Indonesia

Health Care in IndonesiaIndonesia still needs to improve its health care. Data from the U.N. in 2022 shows that the median life expectancy in Indonesia is 68.25 years, reflecting an increase in life expectancy in the country. However, this figure is still relatively low. The main health problems in Indonesia are rooted in economic issues.

Access to Health Care in Indonesia

The unequal distribution of health services has resulted in an inability to access health services. With 9,599 health centers and 2,184 hospitals concentrated in the city center, rural dwellers face challenges in reaching these facilities. The slow development of infrastructure has a significant role in the need for health facilities. Data from the “Ministry of Health records that 52.8% of specialist doctors are in Jakarta, while in NTT and other provinces in Eastern Indonesia only around 1-3%.” Health funds in the health law must be 5%, but unfortunately, the Indonesian government only allocates 2.4% of the APBN.

Getting To Know BPJS

Indonesia Health Coverage Program, BPJS, was formed in 2014 to provide health and employment insurance for the public, civil servants and private employees. The legal basis for its implementation is Law No. 24 of 2011. Presently, 249 million Indonesians are registered as BPJS members, making it one of the most extensive programs globally.

One of the BPJS programs is the National Health Insurance (JKN), “an insurance system, where people are required to pay a small contribution as savings for treatment costs when they are sick in the future.” BPJS members receive comprehensive health care services, encompassing treatment and prevention. This includes access to necessary drug services based on medical needs and promotive and preventive services. The latter involves health education, primary immunization (BCG, DPT-HB, Polio and Measles), family planning services (including counseling, essential contraception, vasectomy and tubectomy) and health screening for early disease detection and prevention.

BPJS and Mental Health

Mental health is a big issue in Indonesia. According to data from Basic Health Research, in 2018, 19 million people aged more than 15 years experienced emotional disorders and 12 million aged more than 15 years experienced depression. Additionally, data from Litbangkes indicates an annual suicide rate of 1800 people. The government addresses mental health issues through the JKN program, ensuring comprehensive coverage for every member. This includes consultations, therapy, outpatient care and medications, all of which are fully covered by the JKN program.

The Impact of BPJS on Poverty and the Economy

Health is closely related to poverty and the economy, serving as the first energy base for economic development. When individuals are in good health, they are better prepared for work, contributing to increased productivity and a thriving economy. According to BPJS data, JKS-KIN protected 15.9 million people in 2015 and 14.5 million in 2016. The data from BPJS indicates that JKS-KIN has helped poor people in debt get adequate health facilities and reduce the inequality rate.

– Afra Amirah
Photo: Flickr