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06 Jan 2004 00:00
The knot of morning commuters in Bulawayo’s working class suburb of Pumula North scattered as a frail-looking woman in ragged clothes, wielding a grass broom in one hand and a stick in the other, bore down on them shouting obscenities at the top of her voice.
As she passed by, the inevitable conversations sprang up in her wake about “those people” and what the government should be doing to protect “normal” citizens.
However disturbing the encounter with the raging woman, what the neighbourhood commentators failed to recognise was that the mentally ill are usually the vulnerable ones.
Apart from abandonment by their families and neglect as a result of shrinking spending on health, they also risk sexual exploitation and the increased risk of HIV infection as Aids awareness programmes have bypassed them.
According to the World Health Organisation, most middle- and low-income countries devote less than one percent of their health expenditure to mental health, which means that policies, legislation, community care and treatment facilities are dismally short of resources.
The public’s less than sensitive attitude towards the mentally ill is a cause for concern. But Elizabeth Matare, national director of the Zimbabwe National Association for Mental Health (ZIMNAMH), believes the government can do far more to enforce the rights of those stricken with mental, neurological or behavioural problems and has shirked its responsibility.
“Mentally ill or retarded people are always left out of national budgets, disease prevention and mitigation policies. The lack of laws and the reluctance of the government in playing its part in the implementation of the national mental health policy exposes the ill or retarded to disease, deliberate neglect, and various forms of abuse, including sexual, which gives rise to the issue of HIV/Aids,” said Matatre.
“The mentally ill people of Zimbabwe are not recognised in term of social care and support systems, so there has never been a budget for them. The National Aids Policy, which forms the guidelines for the operation of the National Aids Council [NAC] has no provision for the mentally ill, yet they are a group that suffers from Aids just as everybody does,” she recently told a workshop in Zimbabwe’s second city, Bulawayo.
According to ZIMNAMH’s estimates, more than half of the country’s 300 000 mentally ill are living with HIV/Aids.
“What is alarming, however, is that the despite this majority, the National Aids Council, which has been in existence for three years, has never [accepted] ZIMNAMH’s [argument] for their inclusion in the national anti-Aids strategies. There is no Aids education for the mentally ill, no distribution of condoms, contraceptives or other preventives, yet these people engage in sexual activities just like everybody,” said Matare.
A spokesperson for NAC said the organisation was aware of the plight of the mentally ill and was still considering the use of ZIMNAMH proposals as guidelines for the formulation of a special programme in anti-Aids campaigns.
He noted that NAC “now recognises this important segment of society we had left out. They might soon be considered in our quarterly budgets”.
NAC distributes funds to local anti-Aids campaigns through provincial committees, which supervise district committees all the way down to the ward level.
At the national level, ZIMNAMH’s advocacy campaign has targeted parliamentary portfolio committees on public health, labour and social welfare. Home affairs and justice committees have also been approached in relation to the treatment of the mentally ill while in police custody and inside the country’s prisons.
ZIMNAMH says Zimbabwe’s Mental Health Act of 1996 has never been fully implemented, resulting in the shoddy treatment and exclusion of the mentally ill. The act has also been criticised as being too vague—or outright insensitive—on gender issues relating to mental illness.
The organisation argues that despite the government being a signatory to a host of conventions on the rights of the mentally ill, mental health still does not feature as a priority in national public health policy formulation, and community-based health programmes remain on the drawing board.
Zimbabwe has two major referral hospitals with psychiatric sections in the capital, Harare, and one hospital specialising in mental disorders in Bulawayo.
However, the institutions have been hit by shortages ranging from food and fuel to drugs and the lack of specialised personnel due to a brain drain that has attracted some of Zimbabwe’s best health professionals abroad.
Matare has called for consensus among all the role players and the creation of a Mental Health Policy Advisory Council to formulate an alternative policy.—Irin
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