Overview of mental health in Namibia

Welcome to this week’s edition where I will share information on mental health and illness. There is a lot to master under this topic because we all have differing degrees of mental health at different times in our lives.  There can be no health without mental health. Rural population is generally overlooked, such that within this segment of the society, mental health is often invisible when accounting for health. A combination of poor rural mental health care and poverty entertains a vicious circle of social violence and suffering. In this issue, I will focus on overview of mental, classification, factors contributing to mental health and then treatment and care approaches in Namibia. With this sound knowledge in mind, in my next edition I will focus on the barriers and challenges of clients with mental health issues and proffer some solutions to address these challenges. Most people aren’t at the extremes but fall somewhere in the middle. Anyone can become mentally ill, given the right circumstances.
 Mental illness occurs in all societies and cultures. We are all vulnerable. Some people are mentally healthy; others have specific mental disorders. There is a lot of ignorance, superstition, stigma and fear around mental illness especially among Africans. Mental illness refers to a wide range of mental health conditions i.e. disorders that affect a person’s mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. In 1996, Namibia’s Mental Health Program conducted a needs assessment and reported alcohol abuse, dependency on tobacco and other drugs as some of the causes of mental illness. Drug induced mental disorders are therefore a major concern. The individual, family, community and nation at large are all negatively affected by substance dependency. In particular, domestic and sexually related violence have been reported in print and electronic media and have been linked to substance abuse, especially alcohol. Recent increase in the rate of suicidal ideations and suicide in Namibia have also caused a great deal of concern. There appears to be a shift toward the younger age group especially with regards to the increase in suicide rate.
Emotional stress is dangerous to your health
Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function. A mental illness can make you miserable and can cause problems in your daily life, such as at work, school, home or in relationships. In most cases, symptoms can be managed with a combination of medications and counseling (psychotherapy).  The Diagnostic and Statistical Manual of Mental Disorders (DSM) tries to make psychiatric diagnoses more similar to medical diagnoses. Its strength lies in the fact that it’s a useful tool for medical practitioners, insurers, courts, agencies, since it allows for communication and offers consistent set of definitions. However, its main limitations are: it is purely descriptive, doesn’t indicate causes, and offers limited information about expected course of the disease and unfortunately it doesn’t suggest appropriate treatment. In our society, a mentally healthy person has the following key attributes: self-esteem, self-acceptance, is realizing potential, is able to maintain fulfilling relationships, has a sense of psychological well-being, has sense of autonomy and a sense of competence, mastery, purpose. However, other cultures may have different ideas about what mental health is. In my culture, the word “mental case” sends shivers down the spine of many, if you are mentally retarded the society labels you an outcast due stigma, discrimination, and social exclusion attached to it. However, as you are going to learn after this edition, we all fall short to some extent. Advocates of mental health believe that a broad range of mental health services should be available to general population, not just seriously mentally ill. They believe that prevention and education, as well as treatment, are important. What are your experiences of mental health illness in Namibia?
In physical medicine, to diagnose diseases, doctors orders laboratory tests, do body imaging, take medical history and do physical examinations. Once disease is diagnosed, doctor generally knows: its cause, how disease is likely to run its course and the appropriate treatment. Unlike the medical model, mental illnesses cannot be confirmed by objective laboratory tests or body imaging. Diagnosis in mental illness does not lead to an understanding of cause, of the course of the illness, or of the most appropriate treatment. Mental disorders represent a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability.” As such, some proponents of mental illness have argued that mental illnesses are not diseases because of the above problems. The cause, diagnosis and treatment of mental illness are imperfect. The medical model is insufficient as diagnosis is largely clinical and experiential and treatment is pragmatic. Prevention is about the politics of health giving considerations to population’s size, people pressures and issues of poverty. For example, is it logical to build a mental health facility whilst mentally healthy and able bodied people are starving to death? What your take on this one?
Classification of Mental Illness
•    Affective Disorders: Anxiety, depression, mania, obsession disorders (usually the patient retains insight and orientation; they experience deep distress and may commit suicide)
•    Schizophrenic: Simple, paranoid (the patient is disorientated, deluded, and lacking in insight)
•    Organic states: Delirium, dementia  (Progressive deterioration with loss of recent memory and deterioration of a normal personality. They may be primary or more commonly secondary to another condition e.g. alcohol, stroke)
•    Drug Problem: Addictive drugs, (Heroin, Cocaine, Amphetamines,) alcohol and drug related illness-psychosis
•    Personality Disorders: A personality and behavior that is damaging to the individual and/or to society and which is not tolerated by the dominant culture
•    Mental sub normality/learning disorders: Problems around intelligence and ability to learn on the basis of teaching and experience
Factors contributing to mental illness
1.    Possible environmental/social causation:
Chronic strains in the environment: Poverty, poor living conditions, dangerous neighborhoods, and overwhelming role responsibilities
Negative life events (social stress): natural disasters, unemployment, adjusting to new environments and roles
2.    Collective mobilization: Notion that society produces disabilities by how it: defines persons with impairments, limits access to community facilities and employment and discriminates against them
Impairments can become either a major aspect or minor aspect of a person’s identity, depending on how society and government respond to persons with impairments. Some problematic behaviors are given the status of disease in The Diagnostic and Statistical Manual of Mental Disorders (DSM) e.g. alcohol abuse and dependence, drug abuse, conduct disorders in children. They may not really fit into the disease model and therefore it will be more valid to consider them as problems in living. Most people who seek treatment for mental disorders do so because they feel distressed.  Some people, however, feel they do not need help but are identified by others (e.g., family, friends, police, schools, employers).  Evaluators have to make difficult judgments in such cases.
3.    Inheritance-Genetics/Intra-uterine environment e.g. Schizophrenia, Huntington’s
4.    Upbringing : Mothering, education, parenting
5.    Drug Abuse:  Alcohol, Heroin etc
6.    Neurological diseases:  Mucoskeletal, Brain tumour
7.    Biochemistry/metabolic : Diabetes
8.    Trauma/head injury
9.    Infections e.g. HIV (Mental illness among HIV infected people are very common in our communities), Syphilis

Treatment and care: Holistic approach

Hospital care
In Namibia, Windhoek Mental Health Care Centre is the National Referral Center. The Windhoek Mental Health Care Centre is a department under the Windhoek Central Hospital. This Centre provides outpatient and inpatient services to adults and children, with a civil psychiatry bed capacity of over 212 beds.
Namibia’s Mental Health Act No 18 of 1973
The goal of the mental health policy in Namibia is to achieve and maintain a high standard of mental health and well-being in the population of Namibia, and to reduce stigma against people with mental disorders. This is to be achieved through the development of a comprehensive community based mental health service that is decentralized and integrated into the general health service.

In my next edition, I will focus on the barriers and challenges of clients with mental health issues and proffer some solutions to address these challenges.

Till we meet again in the next issue, be blessed and let’s all stay mentally healthy and stress free. The writer can be contacted on: phcnamibia@gmail.com