In Botswana mental health issues have never really been given much attention by either ordinary people or authorities.
In fact, mental health though increasingly frequently mentioned in casual chatter remains in many ways a stigmatized psychological malaise. The moment you introduce mental health to a social conversation people start thinking about madness, or worse immorality, even violence.
Not many Batswana will readily admit to suffering or experiencing mental health issues. In some family and cultural circles mental health is still taboo, or a social embarrassment. The attitude is: why talk about the mental troubles of others? That mental illness is a medical condition like any other is not something many Batswana accept. They would rather banish it to deviance or some incurable mental vegetation.
What exactly is mental health? By definition there is really nothing pejorative about mental health which can actually be defined as the moral economy of an individual; the human state of being and well-being in which an individual realizes or his/her own potential and abilities and work productively to make contributions to both their own well-being and the common good of community and society.
Looked at from this perspective mental health is the ability to apply personal attributes, resources and talents to the public good. Mental health includes our emotional, psychological and social well-being. There actually are many people suffering mental illnesses who make better and more rewarding contributions to their families and societies than those community members who suffer no mental illness at all. Mental illness does not always spell trouble or personal doom.
Mental health should be something that we talk about without shame. It affects what we feel. How we think. How we act. How we handle stress. The choices we make.
It is not surprising therefore that mental health issues and concerns are already becoming the focus of intense interest in scientific research following the coming of the coronavirus and Covid-19 pandemic.
This pandemic turned everything in society upside down.
To begin with consider the emotional and mental trauma inflicted on unsuspecting individuals, families and communities by the brutal invasion of this virus and disease. The whole world woke up from being one huge but still functioning machine to being an almost dysfunctional blob in less than three months between December, 2019 and the first heavy lockdowns in March, 2020. Since then we have lived in what can only be called a radically changed world.
We have lost loved ones to this pandemic. We have lost jobs. We have lost incomes. We have lost friends. We have had to abandon many cultural and spiritual underpinnings of society like gathering for worship and burying the dead. We have had to allow the sick to die alone, in painful solitude. We have had to allow the old to die in isolation.
We have been forced to choose who lives and who dies in the face of scarce medical resources. We have had to refuse the sick and dying from entering hospitals to seek help. We have had to turn out the severe sick from crowded hospitals and we have allowed the poor to bury their dead in flooded rivers because they could not pay for proper burials.
We have gravely sinned against ourselves and we have sinned terribly against God; are we still the people we were before this pandemic hit us? Are we the same people? Are our lives still the same? How about our societies and interpersonal relationships? Are we the same people? What about our mental health? How do we look at this new pandemic world? How are we coping? How are we managing the pandemic? How are we managing our lives? How are we dealing with grief and bereavement? What choices and risks do we take every day just to survive?
Let me go back a little bit, just to focus.
At the outbreak of this pandemic the World Health Organization and governments quickly recognized the seriousness of disease risks and infections. They acted quickly to avert spreading of the disease. Billions of people were forced into lockdown. International commerce came to a standstill. City and urban streets we denuded of human traffic and emptiness became the definition of public space everywhere.
But what resources and care were set aside to manage the pandemic’s effects on mental health and well-being?
Not much, nothing really. Our health systems prioritised testing, reducing transmissions, hospitalizations, critical patient care and a whole raft of prevention measures, and this they did rightly so.
What we must remember though is that we are dealing with a global health pandemic, a traumatic widespread health emergency that is emotionally terrorizing individuals, households and communities every second of the day, killing their loved ones, ruining their opportunities to succeed in life, destroying their economies and generally making life miserable, exhausting and almost meaningless. It is unfathomable how the psychological and psychiatric needs of people can be overlooked in a pandemic management of this magnitude.
It just doesn’t make sense.
But this is exactly what is happening right now as I write. Government has no plan, no budget, no programme to deal with mental health issues resulting from, related to or associated with the coronavirus and Covid-19 pandemic.
Forget the mental scars of the thousands of Batswana who actually contracted this disease and are now suffering the terrible after effects of infection on their own. How are these people doing? Nobody cares to know. Forget the mental scars of Batswana who have lost their jobs, businesses and other sources of employment and incomes. How are these thousands of Batswana doing? Nobody cares to know. How many health facilities do we have in Botswana for people struggling with mental health issues? Just one; the psychiatric hospital in Lobatse.
Private hospitals do make provisions for psychological and psychiatric services for their clients and customers but we do know not many Batswana can afford these services. The WHO constitution states that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It urges the promotion, protection and restoration of mental health under all human conditions, circumstances and situations. It particularly depicts violence of any form as a serious threat to mental health. It enjoins support to children, those economically vulnerable, the aged and marginal social groups.
But under the Covid-19 pandemic stable environments that are sensitive and necessary to children’s health and nutrition needs are daily threatened or destroyed. Children and youth development programmes are daily being pushed to the then back banner. Social support for elderly persons is terrible and still declining. Development programmes targeted at vulnerable people, including indigenous peoples, migrants and minorities are being scaled down. Even protections of the rights, opportunities and care of individuals with mental disorders is no longer supported with adequate resources. Any talk of mental health care and treatment is being stifled and discouraged. In some areas even knowledge of what to do with the escalating burden of mental disorders seem not to exist.
In short, this is a national problem that nobody wants to talk about.
The major problem with mental health management and treatment in Botswana, I think, comes mostly from the absence of effective leadership and governance for mental health. Even research for mental health does not exist in this country. If it does, why is it not in the Public domain?To be easily accessed to inform further research, policy and planning?
There can be no doubt that radical changes are daily taking place in the way we look at life under pandemic conditions, the way we live life, the way we see the world and the future, the way we see other people and the way we struggle to survive and retain some sense of sanity under these unprecedented assaults on our lives, our work, our happiness and our existence.
In many individuals and households mental illnesses or significant diagnosable dysfunctions in thinking, emotion and behaviour are daily becoming evident but nobody wants to closely look at this social problem. Drugs, addictions, joblessness and hopelessness are becoming major features of a mental health landscape that is deteriorating with shocking zeal. The people experiencing mental illness are retreating into silence and solitude. Many do not even know this is just a treatable medical condition like any other; diabetes or heart disease. They feel ashamed and neglected.
Within the Civil Society movement, we work with vulnerable Batswana; more than 300 000 Batswana living with HIV. These are people who have seen the worst of times, the hardest of human trials and tribulations…and survived; fighters. They are a living testimony that the struggle for human survival depends on the ability to adapt to changing situations. Covid-19 is teaching us the same lesson, to survive learn to live with near impossible situations and conditions and circumstances. It is a lesson we are learning well and we are ready and willing to share knowledge, experiences regarding such matters through collaborative efforts and networking with like-minded institutions and organizations.
