June 6, 2018
As families abandon mentally ill relatives without consequence, Zambia’s largest mental hospital struggles to provide quality care to its growing number of patients. But advocates for updated mental-health legislation say the overcrowding points to a problem much bigger than one hospital.
LUSAKA, ZAMBIA — After Soft Sakala had what he calls a mental breakdown, his wife abandoned him.
He was left at Chainama Hills Hospital, Zambia’s largest mental hospital. But when he arrived, all the beds were full. So he did what many new patients do: He waited for a current patient to wander away from a bed, then got in.
“I was admitted to the hospital when there were no bed spaces; I had to wait for someone to wander off, before I could take their bed,” Sakala says.
In Zambia, there is no law that protects people with mental-health issues, so patients are often abandoned by their relatives at mental hospitals without consequence, leading to overcrowding and compromised care for the patients.
The Ministry of Health recognizes mental health as one of the country’s top public-health challenges. However, there have been no extensive studies to determine the extent of mental illness in Zambia.
The country’s latest statistics on mental health, from 2012, estimate that 20 to 30 percent of the population have mental-health problems.
Despite recognizing mental illness as a challenge, laws on mental-health care have not been updated since 1951. For years, lawmakers have been in the process of drafting a law to provide for the health and safety of those with mental illnesses.
George Tafuna, public-relations officer at Chainama Hills Hospital, says the absence of a law that compels quality mental-health care means that patient health is often compromised in both hospital and home care.
He says there are at least 15 patients who have been at the Chainama hospital for at least two years without any visits from relatives. It’s a problem that not only affects care, but also creates shortages of food and space, Tafuna says.
The hospital has a total bed capacity of 210 but regularly cares for more than 230 patients at a time.
“We have more patients than bed spaces, so we create floor beds, which is not supposed to be the case,” he says.
To provide for all the patients, the hospital spends in excess of 3,000 Zambian kwacha (about $300) every day, Tafuna says.
“We need patients to come in and go, but if they stay on and on, we end up not having space to house the new patients. The food is equally not enough,” he says.
Tafuna says he hopes lawmakers prioritize mental-health laws that will criminalize abandonment.
“Mental-health issues come along with a lot of stigma, hence most people, including family members, do not want to be associated with it,” he says. “But once we have a law in place that will prosecute those who abandon their mentally ill relatives, the quality of care both at the hospital and at home will change for the better.”
Dr. Ravi Paul, a psychiatrist at Lusaka’s University Teaching Hospital, says the lack of support that patients receive from their families has a negative impact on overall recovery.
“Patients may present symptoms of depression that can trigger other mental conditions, if they are not getting the support of close relatives,” he says.
While the hospital remains overcrowded, advocates continue to push for updated laws.
Potipher Gwai, president of the Mental Health Foundation of Zambia, says the organization has been advocating for years for laws to protect and treat those with mental-health issues.
“I can’t even remember when we started to push this law; it has taken too long. We hope that this time around we will have it as we have been promised,” he says.
The Ministry of Health confirms that it is working on laws to protect and serve those with mental illness in Zambia.
Dr. Kennedy Malama, a physician and the permanent secretary of administration in the Ministry of Health, says changes to the mental-health act have been delayed because it has to be a thorough law that won’t leave anything unaddressed.
“I admit that it has taken too long, but we want to have a law that will encompass all areas of mental health, hence the consultation has taken a long time,” he says.
Malama says the bill, which will establish care standards, will be presented for the process of enactment to Zambia’s Parliament this year.
Prudence Phiri, GPJ, translated some interviews from Nyanja.