Creating awareness about mental health issues and substance abuse through street theatre


This installment is a sequel of the previous issue which gave an overview of mental health, classification, factors contributing to mental and treatment and care of mental health issues in Namibia. Mental health and physical health are very separate in the health care structure, while people with HIV content with lots of mental health issues. There is tremendous stigma around mental health and HIV. As such, co-occurrence of HIV and mental illness poses a significant public health problem and represents a difficult challenge for those who treat and care for these clients. Research studies have shown that there is considerable overlap between HIV infection and several major mental disorders such as bipolar disorder and major depressive disorder. It has been estimated that the prevalence of HIV among individuals with serious mental illness ranges from 1 percent to 24 percent, much higher than the rates found among HIV-uninfected persons. Consequently, these individuals are also diagnosed with substance use disorder, which can make treatment and management of HIV and mental health problems even more challenging. 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 a concern. The individual, family, community and nation at large are all negatively affected by substance dependency. There is a lack of data concerning the most commonly diagnoses mental illness in Namibia. The findings from few studies on barriers in developing countries suggest modest of serves, costs, proximity of treatment centers, doubts of efficacy of care, stigma and beliefs in traditional healers and Namibia is not an exception. Protective factors help to promote a healthy mental status and make it less likely for a mental health condition or addiction to occur. Protective factors include:
•    Family and community support
•    Social coping and problem solving
•    Economic security
•    Parental supervision
•    Stable home-life
Risk factors cause individuals to be a great risk for developing certain mental health condition. Risk factors include:
•    Family history
•    Chronic medical conditions
•    Lack of parental involvement
•    Lack of available resources
•    Traumatic experience
•    Social isolation
•    Past abuse or neglect
•    Disconnection between family and community
Environmental factors relate to an individual’s surroundings and greatly affect mental health outcomes. Environmental factors include:
•    Local policies and practices
•    Community relations
•    Community attitude or stigma
•    Access to mental health services and resources
•    Population shifts
•    Situational factors

The Namibia’s National Policy on Mental Health, advocate for awareness programs based on the use of mass communication approaches rather than a targeted approach. Yet the later approach has been found more effective and cost-effective and is recommended for use in developing countries. Additionally, audience segmentation and targeted approach to segments is recommended for mental health literacy in Namibia given diverse cultures in existence. This approach is a well established best practice in health communication. With this in mind, I have a research team and in conjunction with the Ministry of Health and Social Services (MHSS) intent to pilot mental health awareness campaigns using street theatre in Katutura early next year. Our goal is to target rural community as there is evidence that they have poor awareness and prominent stigmatizing and discriminatory attitudes towards HIV/AIDS and mental illnesses. We propose to target the community members as people who may know someone with mental illness. We plan to address the significant gaps in not only improving awareness but also to do it in a manner that is appropriate (cultural-wise), effective and cost-effective.
Why use of theatre?
I have realized that unlike infections like HIV/AIDS, in Namibia mental illness has not acquired the desired attention as far as creating awareness is concerned. Additionally, the conventional methods of using pamphlets, posters or print or electronic media may have limited effect on rural population due to their low literacy levels and affordability. People with low literacy can be given health-related information by watching and listening, rather than reading alone. Theatre, especially folk theatre, or forum theatre are popular means of conveying educational information in resource limited areas like rural communities. There have been utilized for promoting awareness of various other public health challenges or emerging and re-emerging diseases like HIV and AIDS, malaria, tuberculosis and polio. Street theatre was used to promote awareness about HIV and AIDS in South Africa, forum theatre was used in Mali to successfully impart education and increase awareness about women’s health, severe mental disorders and HIV and AIDS. In Uganda, theatre was useful in spreading awareness and sensitizing community members about tsetse fly control in Uganda. Thus, there is need to explore the use of street theatre in raising awareness about mental illness in rural communities of Namibia. This initiative will take into consideration the socio-cultural and linguistic background of the participants and will deliver the message in a manner that is culturally relevant to the audience. The pilot study will target Katutura Township due to its accessibility, less time constrains and costs involved. The actual implementation once approved will be done in selected rural communities.
Application of theatre in mental health
Theatre as an education tool is used:
•    As creative method of public education
•    To challenge stereotypes, stigma and misconception
•    To personalize issues for audiences due to its live nature
•    As a feel of “direct contact” that film and other education forms lack
•    As it is often followed by discussion of issues and
•    Most importantly, it can be an effective approach to educate illiterate people through listening and watching
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: