Expanding Mental Health Care Services

A mental illness is a health problem that changes the thinking, emotion or behaviour or a combination of these in an individual. Globally, mental disorders are common, with over a third of patients in many countries reporting sufficient cases. As a result, countries employ multifaceted strategies to treat the illness.
Introducing the first metal health strategy in 2010, Ethiopia embarked on addressing the problem. Unlike the past, where patients receive treatment only in St. Amanuel Mental Specialized Hospital, all public hospitals, health centres and some private medical institutions are giving treatments for mental illness as of recently. EBR’s Hiwot Selalew explores this new development.Yonas Geberstadik, 31, has been suffering from anxiety disorder ever since his girlfriend disappeared seven years ago. His condition got worse as time goes. He finally had to start taking medical treatment at St. Paulo’s Hospital Millennium Medical College two years ago. Yonas recalls “All of a sudden, my girlfriend disappeared and I just could not know her whereabout. Eventually, I started to experience much stress. That’s why I had to come to this hospital for mental care.” Yonas has often a stressing situation when he gets to know someone new. Though he had started work, absenteeism and less productivity became his defining character which finally resulted in his suspension. Yonas is attending treatment with the support of his parents.
Like Yonas, many people in Ethiopia suffer from mental illness. According to the Ministry of Health, the problem is persistent among adults between the age of 20 and 40 years. The National Mental Health Strategy issued in 2012, estimates that 11Pct of the population to have some form of mental illness, with Schizophrenia being the most common mental disorder in Ethiopia. Schizophrenia is a disorder that affects cognitive, behaviour and mood of an individual characterised by thoughts or experiences that seem out of touch with reality, disorganised speech or behaviour and decreased participation in daily activities.
One in ten pregnant women and one in twenty post-natal women suffers from undetected depression. Kathryn Rost (PhD), Research Professor at the Department of Mental Health Law & Policy, University of South Florida, conducted a research that included 98 patients diagnosed to have major depression. Surprisingly, for 32Pct of them, their depression went undetected by their own primary care doctors. According to the same source the consequences of such problem can be grave with at least half of them entertaining thoughts of suicide. Clinical depression and schizophrenia or bi-polar disorders are major types of mental illness in Ethiopia.
According to a cross sectional study entitled ‘Depression among Ethiopian Adults’, conducted in 2015 in Ebinat town of south Gondar Zone involving a total sample of 779 people, the prevalence of depression was found to be 17.5Pct while 10.7Pct of the sample population had mild depression. The prevalence of moderate depression, moderately severe depression and severe depression also stood at 4.2Pct, 1.9Pct and 0.6Pct, respectively.
The American Psychiatric Association defines mental illnesses as health problems that change the thinking, emotion or behaviour or a combination of these in an individual. According to the same source mental illnesses take many forms. Some are fairly mild and only interfere in limited ways with daily life, such as certain phobia or abnormal fear. However, other mental health conditions are so severe that a person may need care and treatment in a hospital.
In the past mental health patients in Ethiopia had only a chance to visit St. Amanuel Mental Specialized Hospital, the sole institution responsible for providing mental health services in Ethiopia since 1938. However, that has changed in recent years due to policy changes which expanded mental health services in all public hospitals and health institutions. The sector is also attracting private investment in Addis Ababa and a few other towns.
Sitota Mental Health Centre, formerly known as Addisu Michael Psychiatric Clinic was established in 2006. Located around Torehayloch Hospital in Kolfe Keranyo District, the Centre was founded by Yonas Bahiretibebe (MD). The Centre has 12 psychiatrists, four permanent and eight part timers, and also 12 nurses at the moment. According to Kaleab Werku, a psychologist at this centre, up to five patients receive treatment at weekdays per day. The figure increases to 10 in weekends. “What makes this centre different is that we have an art therapy, which helps patients while getting treatment,” explains Kaleab. “Such treatments are useful to know more about the patient’s history since it helps them to recall their past.” added Kaleab.
Yonas, the founder, is also an associate professor in the Department of Psychiatry at Addis Ababa University and a consultant psychiatrist at Tikur Anbessa Referral Hospital. He has been practicing psychiatry for 26 years. “We give treatment for the middle class people. Most of the mental health patients we serve are substance users. Thus, they get rehabilitation services,” says Yonas.
A recent establishment Abichu (Liju/the boy in Afaan Oromoo) is located around Semit/Safari area in Bole District. Abichu started services in 2016 with two permanent and one part time psychiatrist. It sees an average of 10 mentally ill people per day. Tadesse Bedassa (MD), a psychiatrist in the centre underlines that there is no definite cause for mental disorder. Some researchers say that it is inherited while others stress that it is environmental, or is caused by infections.” Tadesse has been in this profession for 12 years.
Since 2014, the Department of Psychiatry at St. Paul’s Specialized Hospital Medical College has also launched a psychiatry service integrating mental healthcare with four primary care centres in Addis Ababa. Specialist mental health professionals from the department regularly supervise the centres and provide support. The hospital has been providing treatment for patients with disorders due to substance abuse. Its five beds in its inpatient units have been used since 2003. It also renders consultation services at Geferssa Rehabilitation Center and Mother Theresa’s Missionaries of Charity in Dire Dawa. In 2015 a three-year specialisation programme in psychiatry was also launched to solve the scarcity of skilled professionals in the sector.
Although the exact cause of most mental illnesses is not known, studies indicate that many of these conditions are caused by a combination of biological, psychological, and environmental factors. According to WebMD, an American corporation known primarily as an online publisher of news and information pertaining to human health and well-being, biological factors in the development of mental illness include heredity, infections, brain defects or injury and substance abuse.
Severe psychological trauma experienced during childhood, loss of a parent or parents and neglect can be considered as psychological factors that may contribute to mental illnesses. Certain stressors such as low self-esteem, anxiety, anger, loneliness and changing jobs or schools may also trigger mental illness.
Sara Bekele, 37 is a patient who has been getting mental care for two months due to her addiction to cigarette and Khat. “I use to smoke a pack of cigarette a day. This worsened my health situation. That’s why my family brought me here for fear of losing me.” Sara told EBR. Sara used to live in America but failed to secure citizenship that puts her in stress and a smoking habit that further worsened her conditions. Upon return to Ethiopia she joined friends who convinced here to chew Khat. Though the two gave her temporary relief from the stress she has been through, she eventually found herself in a deteriorating situation.
Dereje Asefa (MD) is a mental health programme officer at MoH. He says the number of private mental health medical centres is increasing in recent years. According to the Ministry there are 76 mental health facilities with 5 more in plan that give different services depending on the kind of problems. The facilities include general psychiatry centre and clinic, in-patient psychiatric unit, out-patient psychiatric clinics, nurse-led psychiatric units, children and adolescent services, centre for substance abuse and centres in police and prison faculties.
Though St. Amanuel Specialised Mental Hospital and Gefersa long stay unit were the main facilities in Ethiopia, “there is also a provision of mental health services in some specialized and non-specialized public hospitals and all health centres in Addis Ababa. But, we cannot conclude that there is sufficient medical care comparing the achievements with the magnitude of the problem.”Dereje Explains.
To address mental health problem, the MoH is currently running community based mental health services in four phases throughout the country. Information available indicate that the first phase has already been launched in Addis Ababa in 2014 while the other phases are expected to start in the soon to begin budget year.
The Ministry also partnered with St. Amanuel Mental Specialized Hospital training department and World Health Organization to expand the training programme for psychiatrists and nurses in all the private medical care centre and public health centres in Addis Ababa. So far, 446 psychiatrists and nurses got trained. Mental health strategy of Ethiopia (2012-16) presents that there are 40, psychiatrists, 461 psychiatric nurses and 14 psychologists engaged in clinical services with insignificant number of social workers and occupational therapists. Health Sector Development Plan projects that the number of psychiatrists will increase to 410 by 2020.
Yodit Abel is a nurse in Kazanchis Health Centre in Kirkos District. She took training at St. Amaneul Specialized Mental Hospital. She believes that it is necessary to integrate mental health care services in the entire private and public health care institutions to enable patients easily access the service. “People with mental disorder would like to avoid going to specialised medical care centres especially to Amanuel Hospital for fear of being identified.”
“The number of patients with Epilepsy is high in our health centre.” stresses Yodit. It also can cause mental illness. This health centre has been providing mental care for the last six months. However, it only has three nurses and the services are provided only on Fridays.” Yodit added that the support from a nurse psychiatrist from St. Amanuel Hospital on every Friday is immense. Using similar strategy, the St. Amanuel hospital is reaching out as many patients as possible. EBR