Troubled minds

Troubled minds

In Lesotho, mentally ill people are increasingly becoming a common sight in every town, some walking naked while others wear dirty, torn clothes. In 2016, Partners-In-Health reported a study which revealed that one in five people suffer from mental illness in Lesotho. It is said this is the highest rate of mental illness of any country in which Partners-In-Health works. Last year, the Maseru district administrator, Mpane Nthunya, rounded up mentally ill people in the city and took them to Mohlomi Hospital.

But the problem required more than a round-up of affected people. A critical shortage of facilities and experts are some of the country’s biggest challenges in providing clinical help to mentally ill people. As Lesotho joins the rest of the world in October in observing the Mental Health Awareness month, our reporter ’Mapule Motsopa interviewed the hospital’s clinical psychologist, Serialong Mokitimi. Below are excerpts from the interview.

There is fear that people taken to Mohlomi are likely to be worse than before because of the stigma attached to the hospital.
Indeed, the stigma surrounding the hospital makes people fear visiting the hospital. This is not just because they fear getting worse but because of the stigma associated with mental illnesses as well. Lack of psycho-education is one of the reasons why the hospital is stigmatised. People are unaware that mental illness can affect anyone – poor or rich. Mental illness can be caused by a lot of things and it is painful that people don’t understand that there are different types of mental health.

The facilities, as old as they are, also cause the stigma. The facilities are inadequate considering the huge number of people who visit the hospital either monthly or yearly – it leads to overcrowding and we don’t have adequate staff and things don’t go accordingly due to resources. Patients suffer because of that.

I do not agree that medication or treatment makes our patients worse because as much as we work with them, they have the responsibility to voice out should the medication not sit well with them. It is their right and all those involved should work together for one’s recovery – it’s an ongoing negotiation and discussion unlike being treated for physical illnesses. We do tell them about the side-effects as well and what they can do about them.

What does Mohlomi as an institution do to dispel myths that people who go to it are actually mad or have gone nuts?
We have a community mental health team consisting of nurses, psychologists, an occupational therapist and social workers. On a weekly basis, we have programmes to teach Basotho about mental health and the hospital.

Also, the team does community outreach in public gatherings. The hospital is very important and unlike any other hospitals, our services are free. Even our expensive medication is offered for free and sessions are free as well. We are understaffed but services are still available. I wish Basotho understood the importance of the hospital and that mental illnesses need to be dealt with like any other sickness. Mental illnesses are manageable and can be controlled.

How many become better or totally get healed?
I don’t know the exact numbers but people do get healed. However, some don’t get totally healed so they have to take their treatment for the rest of their lives. We do encourage continuous usage of medication. Life problems can be the cause of mental illness. Some do relapse because of the nature of particular situations or even usage of drugs.

How many patients whose illness is caused by drug abuse?
Drug and alcohol abuse are the cause of mental illnesses in most of the cases although I can’t provide figures. Marijuana users at times deny that it causes that and at times it’s a combination of things, such as historical mental illness in the family. It is a major problem.
Are there any special projects through which Mohlomi is advertised as a hospital for mental illnesses not a madhouse?
I don’t know about any special projects but we always talk about it and ask people to refrain from referring to our patients as mad. We condemn it.

Are there any outreach projects in which the institution helps people so that their situations do not become worse to an extent that they can end up being admitted?
There is none other than Mohlomi. Mohlomi is not just an in-patient hospital. It also has an outpatient clinic and the majority of people coming for check-ups were never admitted. They are just able to access the services without being admitted. In other districts there are Mohlominyana (the hospital’s external facilities) offering mental health services without people being admitted in the hospital. Most services are offered for outpatients.

How prevalent is the mental health problem in the country and do we have enough manpower to deal with it?
I don’t know about the prevalence but we don’t have enough manpower. We don’t have a psychiatrist in the country. We don’t retain our health professionals. The salaries are not enough for people who furthered their studies for them to decide to stay in the country. When they go to other countries, they get double the salary they get here.

Our politicians don’t want to hear about the plight of health professionals. There is a lot of brain drain. People leave as soon as they find opportunities in other countries. Most hospitals are understaffed including Mohlomi. Not enough staff is hired and not enough is done even when there are vacancies, they end up not being filled. It’s unfortunate but that’s the state that this country is in. There is absolutely not enough staff on many levels.

How are relatives of a patient dealt with? What kind of help do they get?
We expect relatives to be able to support our patients. We do bring them in and give them psycho education for them to know the signs they should look out for and try to make them not to take things too personally when one is sick. But most importantly, we try and help them understand how they are supposed to support our patient and their family member. We have amongst others social workers, psychologists and nurses who give psycho education. Generally, we have all these staff members that are able to have family sessions.

How many psychiatric doctors and nurses do we have?
We don’t have even a single one in the country but general medical officers who after working at Mohlomi for a while, gain enough experience. But the training they have is not of psychiatric training. We really do need Basotho who train to become psychiatrists and come and work here. When they come back, they shouldn’t be fought or even those who want to further their studies shouldn’t be fought. The problem with the Ministry of Health is that people are always fought and I wonder for what good reasons and I am certain it’s not in the Ministry of Health only.

How do you deal with religious beliefs surrounding mental health in that some religions say one is bewitched or is possessed by demons when mentally sick?
We deal with it all the times and at times our patients don’t take medication with the explanation that “o s’alo lula toroneng” (we will pray for him in church). We try and give psycho education to the family, pastors and traditional healers. We always ask them to finish their medication and those traditional ones will follow. We always emphasise our services and that treatment should be prioritised.

We believe life has to be balanced, it doesn’t have to be about spirituality only. We definitely cannot view everything with just the spiritual eye as much as there is a place for spiritual health but there is that of mental health and we don’t mix the two. We balance everything and if there is a need for a physical healing, we inform them and ensure it is dealt with.

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