Handling mental treatment
By Thokozani Chenjezi:
In light of growing concern over suicide in Malawi, mental health experts, advocates and stakeholders have called for the repeal of the 1948 Mental Treatment Act as well as adoption of the new Mental Health Policy as a strong step towards minimising suicide cases in Malawi.
The experts believe this will enhance understanding of suicide as a mental health problem and hence pave way for its decriminalisation.
Executive Director for Mental Health Users and Carers Association (Mehuca) Thandiwe Mkandawire argues that repealing Mental Health Act will create a platform to start a conversation that mental illness is a real problem that has the ability to affect anyone.
“This will create a platform that will reduce the shame, stigma and discrimination that is still attached to mental illness. Shame, stigma and discrimination are among the leading barriers to people to speak up about the mental health challenges they face,” Mkandawire says.
She argues that, among other weaknesses, the Act gives too much power to the minister as well as the judicial system in the assessment and treatment of persons with mental illness.
The Act also uses derogatory terms in referring to people with mental problems such as calling them “imbeciles” and people with “mental defects”, which mental health experts argue focuses on the medical model of understanding mental illness which classifies the individual as being the problem.
This approach, the experts say, dehumanises the person and does not take into consideration the different aspects of an individual’s life like school, work and family, that may lead to mental illness and how these same structures can be the support the person needs to recover.
Ombudsman Martha Chizuma observes that mental disorder is recognised as a disability in Malawi and, therefore, falls under the legal framework of the Disability Act. However, the treatment of patients with mental disorders is primarily governed by the Mental Treatment Act.
“This law was promulgated in 1948 and therefore out of touch with the current trends in mental health service delivery. In the absence of any known process for the review of the Mental Treatment Act of 1948, the National Mental Health Policy that is still in draft form provides an opportunity for revolutionalisation of mental health systems in the country,” Chizuma says.
Another mental health expert, Charles Mwale, says if the current Mental Treatment Act was revised, many things would also be amended as there are rights issues that need to be addressed.
“We have been working with the Ministry of Health and other stakeholders to develop a Mental Health Bill, a new one, but it has stuck somewhere, whether it is at the ministry or somewhere but it is not yet done,” Mwale said.
In 2017, Ombudsman Martha Chizuma directed the Secretary for Health to put in motion all the processes or steps required for the final adoption and implementation of the National Mental Health Policy by 30th June, 2018. It is not known if it is adopted yet.
“To date, mental health remains undeveloped, heavily underfunded and effectively ignored area of health service delivery in the country,” Chizuma said in her December 2017 report titled Out of Sight, Out of Mind which investigated allegations of maladministration in mental health service delivery and injustices on the patients with mental disorders.
Perhaps lack of seriousness in mental health service delivery in the country is evident in the closure of the second public facility, the Bwaila Psychiatric Unit in Lilongwe in 2017 following investigations and recommendations by the Ombudsman.
The country runs on a meagre 1.01 percent allocation to mental health from the national health budget which heavily cripples service delivery of mental health.
The mental health field has also attracted very few recruits due to lack of policies to spread specialisation among interns as well as government’s lack of interest to revamp the mental health sector.
“[Only] 1.01 percent of the budget goes to mental health which is evidently insufficient to manage mental health problems in Malawi. A percentage this small translates into lack of resources in terms of mental health staff including psychiatrists, psychiatric nurses, psychologists, clinical social workers, as well as medication,” Mkandawire laments.
Chizuma on the other hand says that despite the problems that have plagued mental health care being nicely laid out in various papers and reports, no comprehensive action is taken.
True to her words, many of recommendations she made in her 2017 report are yet to be adhered to.
Listening to stories of those who attempted suicide and witnesses of suicide, one gets a glimpse of how grave the problem has become.
About two months ago, Helen (not real name) received a phone call. Her mother was suddenly very sick. She rushed home to find her panicking with neighbours trying to give her first aid, thinking she had suffered high blood pressure.
“I only realised it was a suicide attempt when I arrived home. I engaged her privately to tell me the truth. She told me she had deliberately overdosed. She said she just wanted to die because she was tired of taking medication,” Helen says.
They took her to Mzuzu Central Hospital. On their way, one of the guardians warned Helen not to reveal to the doctors that her mother had overdosed in a suicide attempt because if she survived, she could be arrested and charged with attempted suicide.
When they arrived at the hospital, Helen told the doctor that they had just realised that her mother had suddenly fallen very sick and that they were not sure what was wrong.
“The doctor tested her blood pressure, sugar, malaria but everything was normal. So he summoned me privately and pressed me hard. That is when I revealed to him that she had overdosed in a suicide attempt,” Helen says.
Helen’s mother was treated and discharged after getting better. The doctor advised them to bring her mother back to Mzuzu Central Hospital for counselling.
But Helen says much as she was very worried, she was forced to give wrong information to the doctors for fear of imprisonment, the law taking its course on her mother if the doctors reported her to the police.
“I was very afraid because I didn’t want my mother to suffer in jail. I couldn’t reveal the truth that easily much as I was aware that I was equally putting her life at greater risk as misinforming the doctor could mislead him into giving her wrong treatment,” Helen says.
Such experiences are among those compelling activists and experts to push for the decriminalisation of suicide.
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