It is now a year since the National Assembly enacted the Malawi Mental Health Act of 2025. What are the implementation gaps and how can they be filled? In this article, nine mental health experts weigh in on these two questions. Michael Udedi, Action Amos, Alex Zumazuma, Mzati Nkolokosa, Charles Masulani, Olive Liwimbi, Mwawi Ng’oma, Kazi one Kulisewa & Chiwoza Bandawe write.
It is now a year since the National Assembly enacted the Malawi Mental Health Act of 2025. What are the implementation gaps and how can they be filled? In this article, nine mental health experts weigh in on these two questions.
By Michael Udedi, Action Amos, Alex Zumazuma, Mzati Nkolokosa, Charles Masulani, Olive Liwimbi, Mwawi Ng’oma, Kazione Kulisewa & Chiwoza Bandawe Malawi’s Mental Health Act of 2025 demonstrates a landmark shift in approaches to mental health. The Act seeks to protect dignity and improve access for people with mental health conditions. The Act also seeks to regulate treatment processes.
It is both comprehensive and progressive.
Yet reality is more complex.
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For example, who is a mental health practitioner? How should practitioners exercise power over clients and patients? Can the system manage the unregulated practice feared to be on the rise?
One year after Malawi embraced this determined legal framework, it is time to take a critical look at what has been achieved and what remains unresolved.
The act redefines mental health governance by prioritising human rights and personal dignity. People with mental health conditions are entitled to the same fundamental freedoms as all citizens. These freedoms include access to quality healthcare, employment, and social participation.
The explicit prohibition of inhumane treatment and exploitation signals a decisive commitment to aligning national law with Malawi’s values and global human rights standards. But the question remains: Do we have resources and structures to ensure full implementation of provisions of the Act?
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A key weakness is that, as with many other laws, most people are not aware of the rights and protections provided for in the Act.
Without adequate knowledge of these provisions, patients may be unable to advocate for themselves, identify violations of rights, or seek appropriate remedies when their rights are violated.
Targeted awareness and civic education initiatives are needed to address this gap. Equally commendable is the introduction of supported decision-making.
By allowing individuals to appoint a supporter to assist with choices on treatment and care, the law acknowledges that mental capacity is not absolute. It can vary over time.
Another notable strength of the Act is its recognition that mental health is not purely a medical issue but also a social and economic one. This provision has the potential to reduce stigma and promote reintegration into jobs and society. The Act places significant emphasis on procedural safeguards, including time limits for emergency treatment and requirements for consent.
While these provisions are essential, they also require efficient administrative systems and reliable record-keeping.
Fortunately, the establishment of a Mental Health Board and Facility Visiting Committees is intended to address this concern. These bodies are tasked with overseeing services, inspecting facilities, and handling complaints.
In theory, the Act creates a strong accountability system. The inclusion of civil society representatives and mental health service users on the board also enhances transparency and inclusiveness.
Yet, the effectiveness of these institutions depends heavily on resources and political will. Even the strongest legislation cannot be implemented without adequate resources.
Regarding professionals, the Act defines a mental health practitioner broadly, including a psychiatrist, psychologist, mental health clinical officer, mental health nurse, clinical social worker, clinical psychotherapist, psychosocial counsellor, and even a general health practitioner. On the surface, this inclusion reflects the reality that mental health care is multidisciplinary.
However, the most pressing challenge is not inside the Act but outside it. Malawi, like many countries, is witnessing a rapid rise in self-proclaimed counselors offering mental health services and motivational speakers and social media therapists and social media influencers acting as mental health advisers. The rise shows the professional gap inherent in the mental health service delivery system.
The uptake of such readily available practitioners is a positive indication of a growing appreciation of the importance of mental health. Yet it has the potential to create a dangerous gap. Anyone can claim expertise without credentials. Vulnerable individuals may receive harmful or misleading advice. Misdiagnosis or delayed treatment may become likely and the credibility of formal professional mental health services risks being undermined.
At the same time, the Act appears to understate the important role already played by community based actors. Community leaders and traditional healers are often the first source of support for people experiencing mental health challenges, particularly in rural areas. Their contribution is indispensable, given the severe shortage of trained professionals.
But recognising this reality does not diminish the importance of formal services; rather, it highlights the need for stronger connections between formal and informal systems. A key priority, therefore, should be to develop a framework that empowers community-based actors with basic mental health literacy.
Such an approach, grounded in respectful engagement and appropriate regulations, would both safeguard patients and strengthen the overall mental health system.
The Act also assumes that those responsible for implementing it possess adequate knowledge of mental health rights and ethical principles. Where this knowledge is absent, there is a risk of inappropriate decision-making, coercive practices, and violations of patient autonomy. Continuous training and professional development are, therefore, essential to ensuring that the Act’s protections are respected in practice.
In effect, the Act strengthens formal care but leaves the informal mental health marketplace largely unregulated.
The Act criminalises false certification by unqualified individuals, but it does not clearly regulate the growing informal mental health sector. As a result, informal mental health practice outside clinical settings, online counselling and non-medical interventions marketed as treatment continue to operate in a largely unregulated space. Much of this responsibility remains with the professional regulatory authorities.
In conclusion, Malawi’s Mental Health Act of 2025 is a bold and forward-looking legislation.
It reflects a shift towards dignity, inclusion, and rights-based care, positioning the country among those adopting modern approaches to mental health law.
Yet its success will depend not on the strength of its wording but on the strength of its implementation. The Mental Health Board is essential for effective oversight, coordination of stakeholders, and establishment of credible standard of care.
In the absence of a fully operational board, there is no institutional mechanism to monitor compliance, investigate complaints, advise government, coordinate stakeholders, or steer implementation.
For Malawi, the law is not the destination but the starting point. The Act’s success will depend on whether the country can translate legal principles into everyday practice by ensuring that rights promised on paper are truly lived experiences for those who need them most. Parliament’s role does not end with passing the legislation but extends to oversight through monitoring progress, scrutinizing budgets, and holding institutions accountable.
The rapid growth of unregulated mental health practitioners presents a serious challenge to public safety and trust, making active regulation by professional bodies increasingly urgent. Ultimately, the true test of the Mental Health Act is not whether it exists but whether it is implemented.
Without sustained investment, effective oversight, public education, and regulatory action, the Act risks becoming another progressive law that remains powerful on paper but weak in practice. What is urgently required is decisive action to fully constitute and fund the Mental Health Board, an indispensable step towards ensuring accountability.
