Sustainable mental health services in Zimbabwe. There is a surge in the need for mental health services globally and locally. This can be partly attributed to the Covid 19 disturbances and a rise in drug and substance abuse. The mental health service provision system in Zimbabwe is currently under strain as it is not only largely unavailable, but heavily relies on an unsustainable pharmacological approach which is under-staffed and under-resourced. This article presents sustainable mental health provision options for Zimbabwe and other developing countries.
- Policy reform
There is an urgent need for policy reform in order to fully integrated mental health within the primary health care system and public institutions. Primary health care is the foundation for high-quality and sustainable mental health care. According to the World Health Organisation (2009), the integration of mental health services into primary care includes the following: identification and treatment of mental disorders, referral to other levels where required, attention to the mental health needs of people with physical health problems, and mental health promotion and prevention.
Where mental health is integrated into primary care, access is improved, mental disorders are more likely to be identified and treated, and comorbid physical and mental health problems managed in a seamless way. To be fully effective and efficient, primary mental health care must be complemented by additional levels of care, (WHO, 2009). These include secondary care components to which primary health workers can turn for referrals, support, and supervision. Linkages to informal and community-based services are also necessary.
This integration will entail that the training of counsellors and psychologists is embedded in the health system. The students should be part of the system and should get paid during training. Fully trained psychologists should be engaged in all health care facilities and public institutions to offer training and mental health services. Besides health care facilities, psychologists, clinical social workers and counsellors should be engaged in public schools, district education offices, prisons, colleges and other public institutions.
The integration of non-pharmacological mental health options into primary health care facilities is a sustainable approach to the prevention, treatment and management of mental illness as these primary health care facilities are within reach of most people. Moreover, currently there is relatively high number of non-pharmacological practitioners who are fully trained and some still under training who can provide the services. The availability of these practitioners entails that the approach will be sustainable.
- Investment in non-pharmacological mental health service provision
A sustainable approach to provision of mental health entails the engagement of treatment plans that are affordable to the government. Currently, there is an over-reliance on pharmacological treatment plans which are not only largely unavailable to the majority of citizens but also too expensive to both the government and individuals. Therefore, government should invest in non-pharmacological mental health service provision. This can be partly done by employing psychologists and counsellors within the primary health care system and public institutions.
Zimbabwe’s mental health system is currently unsustainable as it is relying on a poorly resourced pharmacological approach hinged on only four psychiatric centres and very few psychiatrists and psychiatric nurses. The system currently does not seem to give any serious recognition to non-pharmacological practitioners who include psychologists, counsellors, occupational therapists and clinical social workers. Additionally, the need for investment in tools of the trade such as psychometric instruments which are necessary for screening and diagnosis of mental disorders cannot be overemphasised.
- Absorption of students at tertiary education level into the mainstream health sector
The government should absorb clinical and counselling psychology interns into the health sector as a matter of urgency. The proposal is that every Psychiatric Hospital should have at least ten (10) interns, every Provincial Hospital to have at least five (5) interns and at least one intern psychologist for every District Hospital. This arrangement will entail the engagement of fully registered psychologists at all the stated hospital to ensure proper supervision of the interns.
- A Psychologist for every school
The school system represents a greater chunk of the population of Zimbabwe therefore, a point of need for mental health care services. In that regard, it is necessary to ensure that educational psychologists are engaged at every public school. Currently, only some private schools are engaging psychologists at their schools and public schools access psychologists at the provincial level.
There is need to raise awareness on causes and treatment of mental illnesses so as to deal with the stigma currently associated with mental illnesses in our communities. To this end, psychologists, counsellors and social workers should be engaged on a full-time basis.
Dr. Herbert Zirima is a practicing psychologist and a senior lecturer in the School of Medical & Health Sciences at Great Zimbabwe University. He writes here in his personal capacity.
