I’m the discharge mental health nurse here at Harare Central Hospital Psychiatric Unit. Our team works with patients in the community, after they’ve been discharged from a stay in hospital.
In the communities where we work, stigma and discrimination against patients with mental illness is rampant. People lack information on mental health. The care given to mental health patients is not the same as the care given to patients suffering from other conditions like HIV, and there are very few champions for mental health, if they are there at all.
Norman and a nurse discuss medication options. Photo: David Brazier / MSF
People here have many misconceptions about mental illness. Some people associate mental illness with traditional harmful practices. Some attribute it to evil spirits. Others blame the patient for the illness. Often you’ll hear people say that patients with mental illness have committed a crime against somebody and the illness is their punishment for that.
All this means that when people suffer from mental illness their relatives often take them to traditional healers before they think of going to hospitals and clinics. And some patients with mental illness are rejected by their relatives because of their condition. Some people just dump their relatives with mental illness at the hospital and never come back to see how they are coping.
Some patients with mental illness are rejected by their relatives
Part of my job is to conduct psychoeducation sessions with patients, relatives and the community at large, raising awareness about mental health issues. For patients’ relatives, I give them insight into their relative’s illness and how they can offer support as family members.
Since the introduction of our MSF discharge team, which follows up on patients in the community, the number of people seen at the out-patient department at the hospital has reduced – this is because many patients are being seen at their local clinics instead. As MSF, we trained clinic nurses to provide treatment and care to patients with mental illness, so part of my job is coaching and mentoring them. For example, when we visit the clinics we give nurses the chance to review patients in our presence so that we can assess how they’re doing and if there are any areas where they need assistance.
Norman prepares medications before a visit to the local clinics. Photo: David Brazier / MSF
Working with mental health patients gives me gratification. This is the most neglected area which many health workers do not desire to venture into. There is stigma even among health professionals.
I have seen many patients who are now engaged in work. Some are doing their self-help projects and some are employed as professionals. That actually motivates me.
There is stigma even among health professionals
There is a lady who was admitted at Harare Central psychiatric unit who was suffering from bipolar affective disorder. She was given leave of absence and later discharged to her local clinic. We supported her and supplied her with medication. This lady already had a degree, and after some time, she got employment and she is now working. We met her recently and she was really grateful about the work the discharge team, and MSF more generally is doing. She is living like any other person and supporting herself. That is something that gives me pleasure.
The challenges that we encounter as the discharge team include staff shortage at the clinics. Patients sometimes can’t get the medication they need if we do not have them on our caseload as the discharge team. Some medications are not available at the clinic. Some patients are not employed so it is difficult for them to buy medication on their own and they relapse.
Photo: David Brazier / MSF
We are also noticing the substance abuse is increasing in the community. If we analyse the number of diagnosis of patients we receive at Harare psychiatric unit, the majority of them have something to do with substance abuse disorders.
When the discharge activities were first introduced, there was resistance at the clinics towards mental health because mental health was not prioritized instead, preference was given to other conditions like HIV, TB, antenatal care (ANC), malaria etc. The situation has changed now. We feel like we are part of the team.
We feel like we are part of the team
Another challenge is that, relatives who do not understand mental illness stigmatise patients. The fact that we see some patients with mental illness roaming in the streets, dirty, eating from the bins, nobody caring, is also evidence of stigma and discrimination. To combat stigma, we need to mobilise the community on mental health. Awareness campaigns should be done at all levels, from the ward, district, provincial and national level.
Mental health is a neglected condition. I feel organisations and individuals should campaign about mental health issues. There should be commitment by all ministries if we want to uplift the standards of care for mental health patients.
Mental health is directly linked to many other physical conditions. Through mental health, one could be exposed to HIV. For people with HIV, adhering closely to their drug regimen is vital so that they stay well, but mental health problems could make this difficult. So mental health is the basis of all preventive medicines in terms of physical illness.
For more information about the discharge team, or if you're a member of staff in Zimbabwe who would like to share their story, please contact Gloria Gayani at MSF Zimbabwe.