NYAPRS Note: The lessons one doctor has learned in Malawi are applicable in a US context toward constructing preventive, culturally competent interventions for young people that take into account stigma, the role of the parent and family, and community support. Involving teachers and local conceptions of health and wellness—rather than illness and poor performance—enables groups to work together toward resilience rather than work through a shameful concept. The use of radio, games, and social media also provides a realistic intervention for rural communities and places where resources like transportation are lacking but radio and internet waves are robust.
Doc Shines Light on Mental Health in Poor Nations
Canoe; Craig and Marc Kielburger, 11/28/2014
Stanley Kutcher was stumped. The psychiatry professor from Halifax’s Dalhousie University was in Malawi to develop a mental health program for rural communities when he learned from the locals there was no word in Chichewa for depression.
How do you diagnose and treat an illness that doesn’t linguistically exist? The upbeat Dr. Kutcher knew that stigma was a major barrier to mental health care in this southeast African country, but he didn’t expect to be playing a real-life game of Taboo. Digging deeper into Malawi’s national language, he found several phrases that described worry and other moods. He enlisted local counsellors and a Malawian psychiatrist to help find ways to broach the topic without provoking fear of ridicule and exclusion.
It was the first step in a stealth mission that Dr. Kutcher and another Canadian professor have undertaken to boost mental health in impoverished communities as an essential piece of social and economic development.
The World Health Organization predicts that depression alone will be the leading global cause of disease by the year 2030. Low- and middle-income countries have 86% of the world’s almost million yearly suicides, but just one psychiatrist for up to every two million people. Issues such as hunger and malnutrition, education and more visible diseases like malaria dominate the attention of the international aid community, leaving few resources for mental health. And the cultural stigma against mental illness is even more deeply ingrained than in the West.
Dr. Kwame McKenzie is a director at the Centre for Addiction and Mental Health at the University of Toronto. With a colleague from the University of Nairobi, he advises on a groundbreaking project for thousands of children in rural Kenya that creatively tackles stigma, screens those in need of help and provides local, affordable treatment. The key, says Dr. McKenzie, is to make mental health relevant by linking it to people’s life goals.
“When we meet parents and teachers, we don’t talk about mental health. We talk about improving their kids’ development, their performance at school, and their economic future,” Dr. McKenzie says. Mentally healthy children have more potential to succeed and contribute positively to society. Mentally healthy communities can break the cycle of poverty and move forward economically.
These arguments bring everyone on board. Students attend regular workshops to develop their “emotional intelligence”–resilience, self-regulation and how to deal constructively with conflict. Parent “clubs” learn about the psychological needs of their children and how to produce a nurturing emotional environment at home. Teachers are encouraged to re-think stress-inducing classroom practices like excessive testing and corporal punishment.
Especially in regions where health resources are scarce, “an ounce of prevention is worth more than a tonne of cure,” argues Dr. McKenzie. “So we focus mostly on what kids need to thrive psychologically. If we get that right, then it makes it easier to deal with mental illness.”
Once communities are more comfortable talking about mental health, most illnesses can be addressed locally through primary care. Among the 5,000 young participants in Dr. McKenzie’s project, the few who needed help were treated early. The very small proportion that needed a psychiatrist were quickly identified and referred through workers in schools, enabling the few psychiatrists in the region to focus their resources on those in greatest need.
Back in Malawi, Dr. Kutcher takes to the airwaves to teach communities about mental health. Partnering with Ottawa-based Farm Radio International, he uses radio dramas featuring characters grappling with mental health issues. Listeners can pose questions to mental health specialists via an online chat. Teachers, parents and traditional healers are enlisted to build supportive environments and help identify those in need of professional treatment.
When the importance of a healthy brain and mind is accepted, promoting mental health becomes part of a community’s development plan, whether or not there’s a specific word for depression. “If your children haven’t got their mental health, they’re not going to be that useful to you moving forward,” reasons Dr. McKenzie. “You must focus on producing a next generation that can deliver.”
— Craig and Marc Kielburger founded a platform for social change that includes Free The Children, Me to We, and the youth empowerment movement, We Day.
http://cnews.canoe.ca/CNEWS/Good_News/2014/11/28/22101176.html