Mental Health in SenegalMental health is a critical aspect of well-being that transcends cultures. In Senegal, mental health practices are rooted in cultural and spiritual frameworks. It’s important to recognize the importance of fostering a unique blend of traditional and modern approaches to address the mental health needs of the Senegalese people.

The Stigma of Mental Health in Senegal

Although there are psychiatrists available, Senegalese people are often hesitant to contact them for support due to stereotypes and the stigma of needing help for one’s mental health. On average, there are 178 people per every 100,000 Senegalese admitted into mental hospitals each year.

Schizophrenia and hysteria are the top two mental disorders diagnosed in Senegal.

Many Senegalese people associate psychiatrists with psychiatric medications and serious mental health issues. Therefore, they are less likely to contact them for help for fear of social exclusion. Instead, people prefer to seek help from traditional healers in their community.

Local organizations are working with international partners to raise awareness about mental health. These efforts aim to dispel myths, encourage open conversations and promote seeking help when needed. By aligning these initiatives with cultural values, they are more likely to be accepted and embraced by the community.

Challenges for Mental Health Care in Senegal

Senegal’s first psychiatric unit was established at Fann Hospital in 1956 in the capital of Dakar. Today, only 6% of Senegal’s gross domestic product is spent on mental health in Senegal; resources and psychiatric units are minimal. In Africa, only $0.1 per capita is spent by the government on mental health.

A limited number of mental health providers presents a challenge. There are only “0.33 psychiatrists and 0.03 psychologists per 100,000 people in Senegal.” There is also little guidance available on how to integrate mental health services into primary care practices in Senegal. 

There has been limited research on mental health research done in Senegal. Additionally, the research suggests that there is limited mental health training in the country and there are significant knowledge gaps among Senegal’s medical professionals when it comes to mental health.

This does not mean that nothing is being done about mental health in Senegal. In fact, most of the work around mental health involves the Senegalese community.

Cultural Significance

Communal values play a significant role in shaping mental health practices in Senegal. The concept of “teranga,” or hospitality, underscores the importance of interconnectedness and support within Senegalese communities. Communal values extend to mental health concerns, with family members, friends and other community members helping address mental health challenges and providing a support network.

Spirituality and Healing

Spirituality is intricately woven into mental health practices in Senegal. There are traditional healers in Senegal known as marabouts. These marabouts hold positions of respect within their communities. They often provide counseling, guidance and rituals that are believed to alleviate mental distress. Some of the rituals used to address psychological health include prayer, herbal remedies and other holistic methods.

Senegal’s approach to mental health proves that cultural inclusivity is integral. By honoring traditions, the country is creating a holistic mental health framework that resonates with its residents. Senegal serves as an inspiring example of how culture can be a foundation for resilience and well-being.

– Joy Loving
Photo: Unsplash

Schizophrenia in the Developing WorldWithin the vast catalog of mental illnesses, there are few more debilitating than schizophrenia. The disease both distorts and impoverishes reality through a combination of “positive” symptoms, or symptoms that impose excess sensations and behaviors on reality (hallucinations, delusions, repetitive movements, disorganized thinking), and “negative” symptoms, or symptoms that detract from someone’s normal experience of and functioning in reality (dulled emotional responses, social withdrawal, inability to experience pleasure).

It is also a deadly illness. The onslaught of symptoms often cripples the sufferer’s ability to care for themselves. Passive neglect of health, poor coping habits, such as alcohol and drug misuse and a vastly increased risk of suicide contribute to a death rate among people with schizophrenia between two and three times higher than the general population.

Treating mental illness in the developing world is already difficult, beset by underfunding (less than 25 cents annually per person in low-income countries) and inadequate distribution of health care personnel (less than two psychiatrists per 100,000 people in many countries). 

Some challenges schizophrenia poses for the developing world are tied to these preexisting conditions. Others are unique to the disease itself.

Conflicting Visions

The so-called “outcomes paradox” is a major hurdle. Beginning in the 1960s, the World Health Organization (WHO) undertook a series of studies comparing the health outcomes of schizophrenia patients in developing countries, such as Colombia, India and Nigeria, and developed countries, such as The United States, Denmark and Taiwan. Surprisingly, patients fared better in the developing world than in wealthier nations, experiencing less social impairment and higher rates of remission and recovery, and all with far less antipsychotic-drug therapy, a standard first-line treatment in the developed world.

These findings were attributed to several factors, and subsequent studies have untangled and complicated the paradox. The third and last of the WHO studies, known as the International Study of Schizophrenia (ISoS), surveyed patients from the previous study after 15 and 25 years and attributed the paradox to the social and cultural conditions in which the patients received treatment, stressing the importance of early intervention with a combination of social and pharmacological therapy. 

The many years of work done by Dr. Vikram Patel, chair of Harvard’s Department of Global Health and Social Medicine, illuminate the bulk of this paradox and the path towards successfully and sustainably treating schizophrenia in the developing world. His 2008 analysis of 23 studies in low and middle-income countries showed wild variance in the incidence and severity of chronic schizophrenia across nations and time — a thicket of conflicting data further obscuring the underlay of the paradox. For instance, 4.5% of patients in India experienced chronic illness over five years, as opposed to 51.7% of twelve years in China. Many of the patients ricocheted between better and worse health outcomes and everything in between over the course of the analyzed studies, with disability and social outcomes for patients also varying widely by nationality.

A Clearer Path

Untangling this mystery is by no means superfluous to the here-and-now needs of the mentally ill poor. Still, in a 2007 paper co-authored by Patel, he outlines an approach that draws upon established knowledge about health care when it has to be built from the ground up. First comes identifying those in need, provided by networks of people familiar with the health of people in their community. Next, skilled health practitioners must provide treatment that focuses not only on the symptoms of schizophrenia but also on the overall physical health of each patient, which is so often affected by the illness. These efforts must take root within communities strengthened to cope with such a severe affliction. The empowerment of community health workers and the families and individuals they serve is key, supporting them with opportunities for paid employment and equitable systems of health care financing (voucher systems, insurance plans, fixed-monthly payments).

Many organizations around the world have taken up this mantle of community care and empowerment. The Schizophrenia Research Organization (SCARF), an Indian NGO based in Chennai, Tamil Nadu, socially reintegrates its patients by providing them with livestock, supporting their small businesses and providing rural patients with access to health care using telemedicine.

BasicNeeds, founded in 2000 by English entrepreneur Chris Underhill and recently merged with Christian disability foundation CBM UK, is one of the world’s most widespread and well-organized examples of community care. Its model of psychosocial support has already helped over 650,000 people in 12 countries throughout Africa and Asia. 

In their 2015 annual report, Dr. Syvanna Phompanya, a Laotian general practitioner working with BasicNeeds in Vientiane province, recounts a dramatic example of the healing work accomplished in his nation:

“One of my patients suffering from schizophrenia lived in a cage for 15 years. With regular medication and treatment, his symptoms have reduced, and he no longer lives in the cage. I’m so delighted with his progress and to see him living with his family. I’m pleased with the mental health work done in my district hospital, and I’m thrilled to be working in the area as there are a limited number of professionals in this field.”

– John Merino
Photo: Pixabay

Mental Illnesses in Developing CountriesAlthough many diseases plague those in poverty, mental illnesses in developing countries also wreak havoc. Mental healthcare for vulnerable populations cannot keep up with the demand of those suffering from mental illness. While the stigma even in the developed world is still prevalent, awareness must lead to action in order to treat mental illnesses in developing countries.

Mental illnesses in developing countries encompass diverse conditions and ages — from autism and mental retardation in early childhood to substance abuse and schizophrenia in adolescents, depression and bipolar disorder in adults and dementia in older people. Compared to developed countries, the developing world sees the same number, if not more, cases of mental illness. While the genetic disposition for developing most mental illnesses is universal, the social and environmental factors that trigger these diseases are more direct for those in poverty.

Most scientific studies show a close correlation between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education — a common factor in low-income societies. Other factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health also contribute to the greater vulnerability of the poor to common mental illnesses.

Apart from the innumerable symptoms associated with mental illness, including hopelessness, anxiety, delusions and so many more, these conditions have a big effect on other health issues and on the social and economic opportunities. The World Health Organization estimates that mental and neurological disorders are the leading cause of ill health and disability globally.

People who feel depressed, anxious, or cannot function without extra support are less likely to attend school, seek employment, and follow the laws. Too often, those stuck in this vicious cycle don’t have access to consistent treatment to prevent the negative consequences.

A common myth, even among those who accept that mental disorders are prevalent in poor countries, is that these illnesses cannot be treated affordably. With so many health issues affecting developing countries, tackling mental health tends to seem like a luxury. Foreign aid remains focused on the “big three” communicable diseases of HIV/AIDS, malaria and tuberculosis.

Many other health conditions, especially mental illness, thus receive only a fraction of the attention and funding. The gap between the number of people with disorders and the number who receive evidence-based care is as high as 70 to 80 percent in many developing countries. Almost half the countries in the world have no explicit mental health policy and nearly a third have no mental health program whatsoever.

Individuals, governments and organizations also currently lack interest to treat mental illnesses in developing countries. However, depression, anxiety, bipolar disorder, schizophrenia and all common mental disorders need to be placed alongside other diseases associated with poverty.

Mental health is just as important to a country’s stability as physical health. Regardless of ethnicity, gender, or income level, everybody deserves access and support for growingly common health conditions.

Allie Knofczynski