Destigmatizing Mental Illness is Essential to Improve Mental Health in Developing Countries and Everywhere
In Ethiopia, mental illness is viewed primarily as a curse or possession by evil spirits with the only remedy being spiritual interventions. The etiological misconceptions, stereotypes about the mentally ill, and lack of mental health resources result in stigma and marginalization of individuals suffering from these disorders. I know this personally; I have lived with someone with a mental disorder.
Mental illness is not an issue unique to Ethiopia or other low- and middle-income countries (LMICs). Rather its effects are broad, victimizing an estimate of more than 450 million people globally, and that number likely underestimates the true burden. However, the lack of access to care is substantially low in LMICs, where only 10% of those in need receive appropriate care. In low-income countries, approximately 85% of those suffering from depression receive no treatment.
Focus on Ethiopia, one of the poorest low-income countries. With an estimated population of 109 million, it has the second largest population in Africa. Although studies may have limitations because of underreporting, it has recently been shown that mental illness is one of the top 10 conditions that burden Ethiopia’s population. Recent reports in 2020 show that there are 111 psychiatrists nationally for 109 million population — an increase from only 40 psychiatrists as recently as 2016. Mental health services are not widely available in health care facilities and are not provided as a fundamental primary care service.
Similarly, it is postulated that from 2005 to 2015, the modest increase in suicide from 7.9 to 8.4 per 100,000 population grossly underestimates the actual increase. That fact should raise concern. Scarcity of data and information hinders the ability to diagnose the issue and identify the gravity of tackling mental health issues. This, again, is directly traceable to societal taboos and stigmas regarding mental health disorders. It follows that generating evidence and using respected experts to disseminate findings and initiatives to the community must become one of the first steps to improve mental health outcomes in the country.
Perhaps the most important way to attack this problem is by engaging those who are directly affected by mental illnesses. Normalizing and destigmatizing mental health conditions in the media will be the first step necessary to improve mental health not just in Ethiopia, but throughout the LMICs of the world. In this connection, people who provide care for mentally ill family members can be instrumental in rewriting the narrative, not just in Ethiopia, but everywhere. Media outlets should recruit them. Social support is a crucial factor in mental health. Those in the community can potentially serve as a vessel for early detection and proper access to appropriate care. The Mental Health Service Users’ Association (MHSUA) is one such organization. It was founded by a woman who suffered from bipolar disorder at a young age. She created this community as a platform to empower those with mental health conditions. Another important organization, based in Uganda and Zambia, is StrongMinds. Dedicated to expanding mental health services, this group focuses on vulnerable populations such as women and adolescents. StongMinds provides free group talk therapy and scales through peer-to-peer therapy, teletherapy, public education, and partnerships. From my own experience with a family member living with a severe mental disorder, the gravity of trying to make the best decisions for their care often leaves one feeling helpless and isolated.
Keep in mind that mental illness can strike any one of us at some point in our lives, precipitated by organic causes or sociopsychological triggers. It follows that people need to be armed with the proper tools to combat these issues when they affect them or those close to them. The proper tools should consist of awareness of mental illnesses, access to quality care and other social support services, and the proper language/terminology to discuss mental health in a non-deprecatory manner. Similarly, the need for these services and the efforts from the health sector can be amplified through traditional and social media campaigns throughout the country. This is key; traditional and digital media can play a vital role in normalizing discussions about mental health and destigmatizing those who are affected by such disorders. Efforts like StrongMinds and MHSUA, especially when married to the appropriate media campaigns, can provide a pathway to expertise, not only helping those who are afflicted but lessening the stigmas and taboos generated by ignorance.
About the Author:
Tsion Andine is an MD/MPH student currently pursuing an MPH at the Harvard T.H. Chan School of Public Health and a medical degree at Howard University College of Medicine. Born and raised in Addis Ababa, Ethiopia, Tsion became aware early that many in her community lacked access to quality healthcare. She recognized the value of health education and disease prevention as well as the need to increase access to health services in disadvantaged areas.