With 4 to 6 out of 10 people facing mental health problems in Burundi, a 2019 Ministry of Health Report and a single neuropsychiatric centre ( with two subsidiary centres in Gitega and Ngozi) and three psychiatrists with a population of 11 million, there is a significant need to improve mental health in the country by 1,000 hills.
By Dr Jean Marie Blaise Migabo
Surrounded by myths and ancient traditions, the mental health of Burundian society has been faced with significant challenges for years. For a long time, believed to be a matter of witchcraft, mental illness is still subject to considerations and stereotyping. “Depression is witchcraft” “A black man can’t be depressed after all his ancestors have been through.” Dr Sarah gave some examples in her presentation during a workshop on mental health awareness and activism organised by Village Health Action. This, though psychological and environmental factors are among the risk factors for mental illness. And for African countries like Burundi, which have been faced with years of violence, mental wellbeing has been affected.
It is therefore with this concern that Village Health Intervention has been operating in the area of mental health in Burundi for two years. Starting with mental health awareness sessions co-hosted most of the time in the American corner of Rosa Parks, the organisation progressed to another level: activism. Under these leitmotivs, awareness-raising and activism, VHA organised a workshop on 21 November 2020 at Le Chandelier Hotel in Bujumbura.
Healthcare professionals for mental health
Medical doctors, psychologists, civil society activists in the field of health have gathered around the theme of “mental health is everyone’s issue.” This is because, with 4 to 6 people affected, out of 10 in Burundi, everyone has a sibling facing related issues, though “mental health seems to be on the agenda of health,” said Dr Pacifique Irakoze, VHA Deputy Chair in his opening remarks Calling on the doctors there also consider, when examining the patient, the mental aspect, in addition to the physical one, which is often the focus of much attention.”
As weeks ago, the world celebrated the World Mental Health Day on the theme of more investment in mental health. Our workshop provides an opportunity to focus on how the country has gone so far in offering mental health services to patients and what could be changed. We presented the audience with a number of presentations and offered the opportunity to collaborate as a group in order to suggest potential cost-effective mental health strategies. Invest in mental health through presentations and group sessions, particularly because only 0.43% of the budget is allocated to mental health in Burundi, according to the WHO 2008 report.
Integration of mental health care into primary health care
Suppose there is one investment that will cost less but pay more. In this case, mental health care is incorporated into primary health care, especially as “up to 85 per cent (in poor countries like Burundi) of people with mental health problems are not being treated,” said Dr Angélus Nindereye, a psychiatrist.
But with this integration, “cost-effective treatments that do exist can be successfully implemented in primary health care,” Dr Nindereye concluded. This can also be the most sustainable way to ensure that everyone has access to the mental health care they need. This is because the cost-effectiveness ratio is very beneficial, and even moderate investment can make significant progress,” he said.
This is because such incorporation is available both geographically (closer mental health facilities, patients living with their families and retaining their everyday lives and sources of income) and economically (less expensive than psychiatric hospital treatment, avoiding indirect costs) and acceptably (minimising the risk of stigma and discrimination.).
Key recommendations
- Primary health care providers need training in the diagnosis and treatment of mental illnesses by integrating the fundamental concepts of primary health care management amongst health professionals;
- This training is most successful when implemented through ongoing contact and cooperation with mental health service providers;
- Lively primary health practitioners need to be able to recognise and treat mental conditions (not an easy job, a variety of medical and social issues, mental illnesses are frequently overlooked during consultation);
- A shift in the attitudes and actions of healthcare providers;
- Increase community understanding of the need to pursue health care structures for identified cases of mental illness;
- Raising awareness and training of community health workers and families on discriminatory policies related to mental disorders;
- Enrol 2 to 3 psychologists in each health care facility;
- The establishment of mental health units: according to the WHO the creation of a mental health unit at the primary health care level over ten years will entail an increased expenditure of just USD 0.20 per person per year.
- Creating mental health units: according to the WHO, the creation of a mental health unit at the primary health care level over ten years would require an additional investment of only USD 0.20 per person per year.
