TPC-Journal-V6-Issue1

The Professional Counselor /Volume 6, Issue 1 3 Existing mental health care in Africa is under-resourced and overburdened (Bradshaw et al., 2006), with enormous gaps between the degree of mental suffering and the number of people receiving care (Becker & Kleinman, 2013; Hinkle, 2014; Saraceno et al., 2007; Weissman et al., 1997; Weissman et al., 1994; Weissman et al., 1996; WHO, 2010a, 2010b). Chorwe-Sungani, Shangase, and Chilinda (2014), as well as Pence (2009), have indicated that mental health problems in Malawi “are often not identified and treated, because health professionals do not believe they are sufficiently competent to provide mental health care” (Chorwe-Sungani et al., 2014, p. 35). Unfortunately, mental health professionals might not have the “requisite public health skills for effective national advocacy” regarding mental health (Jenkins et al., 2010, p. 232). The numbers of primary care and specialist mental health workers are in general decline because of training costs and migration from frontier or rural settings to urban areas, and from low-income countries like Malawi to higher-income countries (Jenkins et al., 2010). In general, collaborations between mental health organizations and health agencies are weak (Gureje & Alem, 2000). Low salaries and poor working conditions, as well as lack of training and recognition, are major demotivating factors for existing health workers’ involvement in mental health care (Bach, 2004; Manafa et al., 2009). Higher salaries in the private sector have resulted in few incentives for health care workers to work in rural areas where most people live in low-income countries (Saraceno et al., 2007). Overreliance on medical solutions to address psychosocial issues has a disempowering impact on communities (Jain & Jadhav, 2009), including their schools. Furthermore, primary health care providers cannot adequately intervene with the numbers of mental health cases confronting communities, and medicine has not yet developed sufficient answers for chronic mental health and lifestyle problems (Swartz, 1998). Depending exclusively on medicine to deliver mental health care services risks an overreliance on a medical model and its medications, and less reliance on psychosocial interventions and influences, such as talking with people and problem solving (Patel, 2002; Petersen, 1999), especially for school children. Ten percent of children are considered to have mental health problems, but pediatricians are not generally equipped to provide effective treatment (Chisholm et al., 2000; Craft, 2005). The evidence reveals significant psychopathology among sub-Saharan children, with one in seven children and adolescents experiencing significant difficulties. The most common mental health problems among this age group include depression, anxiety, post-traumatic stress disorder and behavior issues. In addition to a general lack of mental health workers (Chorwe-Sungani et al., 2014), one psychiatrist served the entire country of Malawi (Chorwe-Sungani et al., 2014), only 2.5 psychiatric nurses were available for every 100,000 people (WHO, 2005), and only one psychiatric unit was available, but not always open or at full capacity. A variety of settings must be used in Malawi, and not all of them are within formal health care. For far too long, the concentration has been on an overburdened medical system and not on the development of local community mental health care (Becker & Kleinman, 2013; Hinkle, 2014; Patel, 2013). For a review of the global impact of untreated mental health problems, see Hinkle (2014). Recognizing the importance of community and family support and using general lay workers equipped with fundamental mental health skills can have positive outcomes (Gureje & Alem, 2000; Saraceno et al., 2007; Swartz, 1998). Saraceno et al. (2007) have reported, “Non-formal community resources will need to be recognized and mobilized to ensure access to care” (p. 1172). Likewise, in low- to middle-income countries, community workers are often the first line of contact with the health care system (Anand & Bärnighausen, 2004; Hinkle, 2014; Hongoro & McPake, 2004).