Mental health disorders constitute the major cause of disabilities worldwide, accounting for about 37 per cent of all health life years lost through diseases. Mental illness is a disabling chronic condition that poses numerous challenges in its management and serves as risk factor for other health problems.
As much as 13 per cent of the global burden of disease is due to mental illness while the majority of the people affected live in low and middle-income countries with very modest mental health care resources. This definitely has led to a treatment gap as four out of every five people with mental illness go without mental health care.
The World Health Organisation has therefore proposed the development of a community mental health service through the integration of mental health care into the existing primary health care system and mobilisation of community resources. These resources include the family support and the folk sector that provides the lion’s share of care in Africa.
There is usually an extended family to rely upon and even severely ill persons usually live with their families although a minority of mentally ill persons may move away from their families often ending up as vagrants.
Pioneers of African psychiatry took promising initiatives to collaborate with traditional healers and to adapt their services to the African socio-economic and socio-cultural settings like the model village of Aro developed by Lambo in 1954.
In many African countries, communities are not often empathetic towards mental health patients. The mentally ill face discrimination, social ostracism and the violation of basic human rights; all due to an ongoing stigma associated with mental health problems.
There are documented cases of individuals tied to trees and logs far from their communities for long periods without adequate food or shelter. In a study conducted in Northern Nigeria, respondents generally responded with fear, avoidance and anger to those who were observed to have mental illness.
The stigma linked to mental illness in that community can be attributed to a variety of factors including lack of education, fear, religious reasoning and prejudice. When surveyed on their thoughts on the cause of mental illness, many people cited drug misuse; including alcohol, marijuana and street drugs as the main cause. Divine wrath and the will of God were seen as the second most prevalent reason, followed by witchcraft and spiritual possession while a few cited genetics, family relationships or socio-economic status as possible triggers.
These socio-cultural issues invariably constitute the critical link between the health, seeking behaviour and utilisation of mental health services. Among the factors responsible for the gap are the absence of services, stigma and the belief that mental health issues are untreatable by the orthodox medical practitioners.
Evidence abounds concerning the role of stigma in accessing care and reintegration of the mentally ill back into the society. In a study that explored psychiatric stigma and discrimination, stigma was found to be perpetuated by family members and even health care providers. In Nigeria, for example, persons experiencing mental conditions belong to one of the most highly stigmatised and vulnerable cohorts since the society sees them as being violent, dangerous and unpredictable.
Derogatory social labels exist in our society such as Aro, Psycho, Kolomenta crafted by the lay public to identify psychiatric patients, caregivers, wards and hospitals in Nigeria. Stigma has been found to be associated robustly with a history of suicide attempt.
This is because stigma is a social construction that defines people in terms of a distinguishing characteristic or mark and devalues them consequently. A stigmatised person may be regarded as not quite human. This is not only derogatory but also dehumanising.
However, stigmatisation of the mentally ill does not occur in a vacuum; it is a product of a well-articulated postulation within the particular socio-cultural milieu. The source may be the sick role which is a term used in medical sociology regarding sickness, the rights and obligations of the affected. It is a concept created by an American sociologist, Talcott Parsons, in 1951. This emanates from a functionalist perspective that a sick individual is not a productive member of the society. The sick role prescribes rights that include the sick person to be excused from social roles and should not be held responsible for the illness while the obligations include that the sick person should try to get well and should seek technically competent help from the prescribed medical professional.
In societies like Africa which places emphasis on order and compels people to adhere to specific behavioural patterns, folks who fail to perform the sick role to the satisfaction of others are viewed as not deserving the exemptions. Folks with mental illness who refuse to take the prescribed medications by the society are stigmatised because, according to the sick role, they do not identify and follow a course of socially approved treatment.