Trends and current status

The provision of mental health activities is guided by the Mental Health Act of 1996, the Mental Health Regulations of 1999, and the National health policy of 2005. The Mental Health programme includes the care for the mentally ill, forensic care and the care for mentally retarded (learning disabilities).

Mental illness remains amongst the major public health concerns in Zimbabwe. The objective to be achieved over the last ten years was to create an environment that promotes the mental well being of individuals. The last ten years, especially the immediate last five years, have seen the development of an environment completely working against this objective due to the socio-economic challenges the country has been going through.

Stress associated with life in Zimbabwe is more pronounced as reflected by increased emotional and mental illnesses resuling from several factors including: HIV and AIDS morbidity and mortality and the subsequent increase of orphans; socioeconomic challenges with its accompanying increasing unemployment and poverty levels; and effects of natural disasters, in particular the droughts and floods. However no studies have been done to show the extent of this stress and the new burden of mental ill health due to the current socio-economic environment. Furthermore the national health information system is not capturing stress disorders.

In 2004, the commonest causes for admissions in Psychiatric Institutions were Schizophrenia and Epilepsy. While epilepsy is not a mental illness, it is captured together with mental illness. The large number of epilepsy patients admitted is the result of lack of specific services for epileptic patients, in particular the community or outreach services, which remain undeveloped and the stigmatization of epileptic patients remains a problem.

Figure 23: New Mental Disorders by Type: 2004

Depression is amongst the top five mental health illnesses seen in public health institutions. For a long time, the breakdown of family structures and social values have been reported as the contributory factor to depression, leading to abuse of alcohol and use of illicit drugs (Brudtland 2001).

While it has been believed that Zimbabwe was a transit state for illicit drugs/ substances, this is no longer the case as these drugs are now sold and consumed in the country. Various surveys have shown that the problem of both alcohol and drug abuse are increasing (WHO, Mental Health ATLAS - 2005).

The first point of contact of mental ill patients is the primary care level with possible referral upwards as and when the need arises. This was made possible through in-service training of nurses and integrating mental health care into primary care activities. Support to the primary level was provided by a psychiatric-trained nurse found at each district hospital and also by the provincial psychiatric nurse. Psychiatrists provided the specialists care of treatment and are found at provincial and specialists tertiary institutions. Recently this well designed mental health delivery system has not functioned well.

Forensic /detained mentally ill patients are catered for in Special Mental Institutions, Chikurubi Prison in Harare, and Mlondolozi Prison? in Bulawayo and these have been similarly negatively affected to the extent that the Mental Health Review Tribunal and the Special Mental Health Boards were not able carry out their duties regularly.

The provision of adequate care and support for the mentally ill requires multi-disciplinary, multi-sectoral, community and corporate involvement and participation. Many stakeholders support and complement the ministry’s efforts in advocacy and service provision. There is however need to strengthen partnerships for maximum benefit. There is also need to strengthen community based mental health services with the aim of reducing the custodial concept of psychiatric care.

Community based psychiatric rehabilitation and occupational therapy contributes to the continued care at home and has been noted to play a pivotal role in reducing re-admissions. However, the existing facilities remain under resourced.

The Mental Health and psychiatric services provide expert guidance and leadership in the care of the mentally ill. Training of Psychiatric Nurses, Psychologists, Clinical Social Workers and Psychiatrists is undertaken in country, but there remains a critical shortage of these cadres with a fifty percent vacancy rate amongst psychiatry trained nurses and over 90 percent of the available psychiatry trained nurses employed at Ingutsheni Central Hospital. While the need to train mental health professionals is clearly essential, empowering existing general health professionals, with basic mental health skills is critical. Integration of the programme with the mainstream PHC activities remains the best option.

Zimbabwe has participated in the implementation of the WHO – Assessment Instrument for Mental Health Systems (WHO - AIMS), a new tool for collecting essential information on mental health information systems of a country. Similarly, the implementation of the WHO- Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST V3.0) will enable the country to ascertain the burden of abusers and to detect the problems early and to intervene promptly.

The main focus of the mental health activities for the duration 2008 –2013 will be on prevention of mental illnesses, promotion of good mental health, provision of curative and rehabilitative services for those already affected by mental disorders, and ensuring specialists drug and equipment availability.

Key issues

· Review and revision of the Mental Health Act no 15 of 1996 and its Regulations.

· Erratic availability specialist medicines and equipment.

· Human resources for mental health care.

· Standards and guidelines for the management of common mental health disorders.

· Destigmatization of mental illness and epilepsy.

· Mental health services for the children and the adolescent

· Specialized institutions for alcohol and substance abuse

· Reestablishment and integration of community based mental health rehabilitation programmes including half way homes for the mentally ill.