ADDIS ABABA, Ethiopia — Sufficient mental health care is lacking worldwide. Mental health programs are even more difficult to maintain if the physical health of a population is poor as well. According to The Earth Institute at Columbia University, Ethiopia has the last developed health care system in Sub-Saharan Africa. Malaria and HIV account for a tremendous number of deaths in the country, threatening to lower the life expectancy to 46 years if no action is taken. These issues burden the already poor health care system, leaving very little room for consideration of the mental health care in Ethiopia.
Yeshashwork Kibour of the American Psychological Association noted a lack of resources for both doctors and psychiatric patients during her observation of an Ethiopian hospital. Ethiopia is home to very few psychiatrists. According to the World Health Organization, all of the country’s psychiatrists and the majority of psychiatric nurses work in the capital, Addis Ababa.
While these circumstances limit patient access to a certified psychiatrist, psychiatrists are also limited in terms of their resources. Kibour witnessed doctors using physical restraints on their patients because of a lack of medications. The WHO reports that just “half of the physician based primary health clinics have at least one psychotropic medicine of the antipsychotic, antidepressant, anxiolytic, and antiepileptic categories available.” However, non-physician based PHCs do not have any of these drugs available.
Kibour outlined the major barriers in mental health care in Ethiopia as lack of capacity, over-reliance on the medical model, social stigmas and the absence of an outlet for scientific debate about mental health.
Lack of capacity is deeply rooted in the lack of psychiatric training available in Ethiopia. According to Kibour, the current number of students graduating with careers in psychology or psychiatry is not enough to meet the demand.
While the medical model has its merits, strict adherence to it can do more harm than good. Kibour believes that alternative, non-Western approaches may help combat mental health issues before they reach extreme levels.
Stigma is quite rampant in Ethiopia as well. Many people in developed countries still find it difficult to reach out for help, and matters are not much better in developing nations. Kibour claims that she has many clients who are unwilling to accept much-needed advice because of fear that they will be judged by friends, family and others in the community.
Resources for learning about mental illness fuel the fire of stigma and ignorance as well. Medical journals exist in Ethiopia, but rarely ever broach the topic of mental illness. While urgent news about infectious disease outbreaks often overwhelm the headlines, the inclusion of mental health issues is essential in easing the burden that these problems have caused.
The WHO’s Mental Health Gap Action Program was established to form a stable infrastructure for mental health care in Ethiopia and other developing countries. The program has trained mental health specialists and supplied essential medications and equipment for treating patients.
Programs like the WHO’s are essential to insuring that foreign aid actually goes towards the building of the mental health care system. Kibour states that the majority of monetary assistance from the United States goes towards combating HIV or providing food assistance. While these are certainly important issues, time and time again, the needs of the mental health care community are left behind. The establishment of on-site programs is the single most effective way to guarantee that the system improves.
– Bridget Tobin