Wednesday, January 06, 2016

Congo's stigma of mental illness

Years of conflict in the Congolese province of North Kivu has created a host of mental health challenges that the region is ill-equipped to deal with. Fledgling organisations try their best to fill the gap, but without systemic change, there is scant hope of progress.

According to a 2014 study by Médecins Sans Frontières, “mental health needs run high in the conflict affected areas of North Kivu,” with many patients displaying post-traumatic symptoms including “constant fear, flashbacks, insomnia, suicidal thoughts, feelings of despair, heart palpitations and breathing difficulties.”

Despite the high needs, provision of mental health services is limited. Less than one percent of the government’s health budget goes towards it. There are six mental health hospitals in the entire country and only one mental health outpatient facility, in the capital, Kinshasa. In North Kivu, a province with a population of more than six million inhabitants, the only mental health centre, Tulizo Letu, is situated in Goma. Smaller private clinics like Centre for the Protection of the Destitute and Mentally Ill, known by its French acronym CEPIMA, the only mental health clinic in Beni Territory struggle to stay afloat, depending on contributions from donors and patients’ relatives to survive.

Benoit Ruratotoye, who has a doctorate in clinical psychology and is the managing director of a private training centre, the Goma-based Institute of Higher Education in Mental Health, explains,  “Most mental health professionals in the country are trained in general health and don’t have in-depth knowledge. When you compare with other countries, the quality of care here is not good.”

In addition to the scarcity of service provision, there is also a prevailing social stigma associated with mental health problems. When confronted with symptoms of mental disorders, many believe them to be associated with witchcraft and sorcery and rather than seek medical treatment, they turn to traditional healers.  “Although educated Congolese will laugh if you ask them if they believe in witchcraft, this is the first resource they will go to before coming to the hospital,” said Charlotte Sabbah, a mental health supervisor with MSF who worked in South Kivu. People with mental health illnesses also regularly visit pastors. At CEPIMA, a pastor is part of the regular staff and prays for patients once a week.

François Polepole Maheshe, a psychiatrist who returned to Congo after training in Senegal, believes more needs to be done to change attitudes. “People do understand that the conflict in this area has an impact on mental health. At the same time, paradoxically, there is a lot of stigma,” he told IRIN. “As long as they don’t understand that mental health problems can affect anyone, the dignity of the mentally ill will not be respected. In Senegal, I would see someone leaving the hospital after treatment and the same day he would get married. The understanding of the population is very different. I would like to see that here.” Maheshe added that effective medical approaches to mental health needed to be more holistic, taking into account socio-cultural factors and involving the families of patients. 

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