A sizeable number of Batswana experience some sort of mental health issue every year. But instead of visiting the doctor like they might for a leg injury, these folks face considerable patient access barriers keeping them out of the mental healthcare setting. Mental health research is particularly sparse in Botswana. In the sub-region, mental health is mainly dominated by a handful of countries such as South Africa. While there is ample evidence to show that mental health research is vital to improving health and health equity in low- and middle-income countries (LMICs), Botswana has not taken the all-important step to explore and generate the level of mental health research needed to inform policy.
A working paper entitled: Mental health research in Botswana: a semi-systematic scoping review prepared by Philip R. Opondo, Anthony A. Olashore, Keneilwe Molebatsi, Caleb J. Othieno and James O. Ayugi notes that Botswana has “comparatively limited research output on mental health”. Furthermore, they discovered that there “were only 58 articles over a 27-year period. A systematic review of psychiatric research in South Africa, an upper middle-income country neighbouring Botswana, identified 908 articles over a 31-year period (1966 to 1997). Our finding that research in Botswana is limited is consistent with other studies that have identified a paucity of mental health research in LMICs,” states part of the paper. The research also states that if this issue is not addressed, it might contribute to the neglect of mental health issues in countries such as Botswana.
Although the number of Covid-19 cases have reduced in Botswana, there is still no end in sight for Covid-19 virus. The pandemic is very much alive and experts are warning that it is just a matter of time before the country experiences another wave. The immediate problem facing the country as it looks ahead in a post pandemic world is mental health.
Speaking to The Telegraph in an interview, Thabang Kgosi who dedicates most of his time to raise awareness of mental health and challenges of mental health stigma said despite a surge in patient interest over the past year and half, courtesy of the Covid-19 pandemic which upended peoples’ lives, access to mental healthcare in Botswana is left wanting due to limited clinician availability and cultural stigma.
“There is critical need for mental healthcare access across all patient populations in Botswana. This is an all-encompassing issue that deserves the kind of attention other chronic diseases often receive,” he says.
Thabang says limited access to mental health provision is not happening because of lack of patient motivation, but because of barriers. “Limited health insurance access keeps a lot of people from visiting mental healthcare professionals. And even in situations where someone can find affordable healthcare providers, clinician shortages, fragmented care, and societal stigma are getting in the way of adequate care access,” he says.
One of the primary causes for limited mental healthcare access in Botswana is the absence of adequate qualified mental health professionals to meet demand. Data shows that only about 26% of Botswana’s mental health provisions are fulfilled, a figure basically estimated by dividing the number of available psychiatrists by the number Botswana needs to have filled its clinician shortage.
Mental health data collection in Botswana is patchy since almost two thirds of people with a known mental disorder never seek help from a health professional. This is worsened by the fact that Botswana has generally turned a blind eye to mental health since less funds have been directed to treatment and reversing societal stigmas toward those suffering from mental health.
Studies conducted the last few years show that Botswana lacks access to high-quality mental health services, struggles with stigma and has a fragmented service delivery models. It is also reported that suicides are likely to significantly go up. With a suicide mortality rate of 16.1 per 100, 000 population, Botswana has the third highest rate of suicide in comes in third in the Southern African Development Community (SADC) region. Kgosi says it is time to understand what prevents mental healthcare access in Botswana. “Understanding this will open the door to improving that access with better programs and policies,” he says adding that “Botswana historically has separated out mental illnesses from physical illness. The problem with this is that having two separate and uneven systems of care produces less than optimal treatment patients”.
The Mental Health Atlas 2020 which tracks progress in implementing World Health Organisation (WHO) Comprehensive Mental Health Action Plan 2013–2020 notes that there still exists inequalities in the availability of mental health resources.
“Despite steady progress seen in the adoption of policies, plans and laws, as well as improvements in capacity to report regularly across years on a set of core mental health indicators, the Mental Health Atlas 2020 shows massive inequalities in the availability of mental health resources and their allocation between high- and low-income countries and across regions,” notes the report.
Dévora Kestel, Director of the Department of Mental Health and Substance Use at World Health Organisation (WHO) says “The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care”.
In Botswana, social stigma of mental health conditions stops people from accessing treatment. Among other things, discrimination in social and professional circles is still a major problem. There are even reports of some parents hiding their children because they fear people will blame them for bad parenting which creates negative perceptions.
As recommendations, the Mental health research in Botswana: a semi-systematic scoping suggests the need “to strengthen the research capacity of individuals working in the mental health field. There is a need to develop a national database of research on mental health in Botswana and to set out research priorities. This would help to guide the mental health research agenda”.
Top barriers to mental healthcare access in Botswana include the lack of mental health education and awareness.
