The report this week that more than 1,3 million people in Zimbabwe suffer from some sort of mental disorder will startle many, although it must be recognised that the report ranges from mild problems that can be treated by counselling and inexpensive drugs to serious disorders that need expensive in-patient treatment and drugs that are beyond the financial reach of most families.
This is perhaps the most important point, just about every mental disorder can be treated and just about every sufferer can live with their families and in society with a high degree of functionality. The incredible advances made in mental health treatment over the past 60 to 70 years mean that only in the rarest of cases does a sufferer need life-long in-patient care.
But in many cases sufferers need to be closely monitored, often in an in-patient facility, while they are stabilised and while a suitable medication regime, which they will often have to follow for the rest of their lives, is found and tested. And then they need to have the support from family and others to follow that regime when they go home, they need periodic check-ups and many need free or highly-subsidised access to their medication.
Mental disorders include alcoholism and addiction to other mind-altering drugs. These addictions also destroy lives, wreck families and damage society. Yet again they can be treated effectively. One problem is that society tolerates alcoholism without realising the appalling lives that lie behind this addiction and too many assume that it just needs willpower to overcome the addiction.
There has to be a desire to move forward; Alcoholics Anonymous, a long-established self-help group requires just two things before it helps, an admission that the person is an alcoholic and a plea for help. But even then, AA often advises that the addict needs in-patient care while they “dry-out” and the medical problems of the physical addiction are treated, and AA notes that the first year of their programme can be very tough, despite the help others can offer.
In Zimbabwe those able to afford treatment, and they are regrettably a small minority, can and are helped with world-class treatment. Those, of whatever background, who have very severe mental illnesses are usually helped through the State system.
But a large number who need help are not helped as thoroughly as they need to be helped and even those who have gone through in-patient care are often returned to families who desperately need more help and more support to cope.
The report highlights the main problems, and they are the usual ones, as lack of money and lack of manpower. Yet for physical illnesses we overcome these. A person who is injured or is hit by some bug can and does receive appropriate help, most through the State referral system.
We now need to do more within that system for mental health. This might require more in-patient beds, it almost certainly requires the far cheaper addition of facilities in every community where discharged patients and those not requiring hospital care can still spend time while their progress is closely monitored, perhaps by trained psychiatric nurses who know when to summon the doctor, as they move towards their life-long medication.
And even more important, money has to be found for appropriate medication for those who cannot afford this just as we do now for those with physical chronic illnesses from HIV down.
Zimbabwe has the knowledge, has the competent manpower and can train more, and modern treatments can help almost every mental health patient lead a reasonably functional life. It just needs the resources to do a lot better.