Mental Health Awareness Vol.1

Mental Health Awareness

Julie T. Soko

This work is produced and published by Julie Soko on behalf of the Haven Counselling Center, Zomba. Malawi.

Copyright © 2021 by Julie T. Soko

Permission is granted by the author to download, reprint, and distribute this booklet as long as it is never done so at a fee. This work shall remain free of charge through every medium.

First e book edition December, 2021

The Haven Counselling and Consultancy Center

P. O. Box 323. Zomba, Malawi.

Email: thehavencenter@protonmail.com

Phone: 0995 147 290

Acknowledgments

Mental Health Awareness is a topic that can never be exhausted in Malawi. We need to be more proactive in building knowledge so that people do not have to suffer in silence or give up on themselves because they do not know enough about their mental health to keep fighting.

Often it is what we know very little about that we judge, stigmatize, or ignore. Therefore, lets teach each other more about mental health so that we empower our societies in the fight for a healthy mindset.

Let’s talk mental health.

Special thanks to the editors of this book:

Dr Tiamo Katsonga Phiri, Clinical Assistant Professor. Graduate School of Professional Psychology, University of Denver, USA.

Chitsanzo Mafuta, Senior Clinical Associate Psychiatry, Kamuzu Central Hospital. Lilongwe, Malawi.

What is Mental Health?

Mental health is a combination of multiple factors that create a state of being.

According to the World Health Organisation, mental health includes our emotional, psychological, and social well being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence though to adulthood.

The term mentalhealthis often misunderstood in Malawi. It is usually used to describe a poor or unhealthy state of mind. However, mental health is a stateof beingwhere balance between all the mentioned factors is maintained at a healthy level.

What is Good Mental Health?

Good mental health is a balanced state between our emotional, physical, behavioural, and psychological well being. It is being able to have a basic understand on how each of these parts work within yourself, and be able to express yourself with self awareness.

For example, understanding how your emotions work will allow you to express them without fear, shame or self judgment. Most people believe that emotions are bad, shameful and should not be entertained. This is especially true for males in Malawi, who have been conditioned to believe that expressing emotion is a sign of weakness, or is feminine. Which is far from reality.

Good mental health does not mean a constant state of happiness. But rather being able to do the following;

Learnaboutyouremotions,howtheywork,whattheyarefor,and howyoucanhaveahealthyemotionallife .

Learnaboutyourmind,howdoyouprocessyourthoughts,doyou haveapositiveornegativemindset?Whatisyourworldview?

Onceyouknowhowthingswork,learntohavepatienceand empathyforyourself.Learntoregulateyourthoughts,emotions,andbehaviour.

Becomeawareofwhattriggersyounegatively,andlearntobuild appropriateboundarieswithunhealthyortoxicpeople/environments .

What is Poor Mental Health?

Poor mental health can be described as the state of being without a good balance between your emotional, psychological, social, and physical well being. For example, living with a chronic illness may lead to poor mental health. Being in an abusive relationship or being isolated from friends and family may lead to poor mental health.

When poor mental health is not addressed, it can lead to several negative coping strategies such as substance abuse, self neglect, and abusive behaviour towards others. Not being able to manage your life, not being able to cope with difficult life events are all part of poor mental health.

Mental Illness

To put it simply, mental illness is a condition of the brain that causes disturbances in thought, behaviour, energy, or emotion; which makes it hard to cope with the ordinary demands of life. Mental illness is a diagnosable condition that must be addressed by psychiatric services.

The most common mental illnesses amongst adults are:

Anxietydisorders such as post traumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), panic disorders (including panic attacks), generalized anxiety disorder (GAD), and certain types of phobias.

Mooddisorders such as different types of depression

Why is there very little known about mental illness?

Many people have a very distorted idea of what mental illness is; and have very little understanding of the differences between good mental health and poor mental health. According to some research done in the past, the general idea held by Malawians is that mental illness is mainly caused by witchcraft (being cursed or rituals gone wrong) and substance use (mainly Marijuana)

Most people do not want to associate themselves with any type of psychiatric label and would rather not get help due to this. Sometimes it is the cultural expectation for people to appear as normaland as highfunctioningas possible. This is one of the reasons why most adults, especially males, will avoid reaching out for help sooner since they feel the pressure to conform to the expectations of culture and society.

Another reason may be fear of exposure. Living in a small country like Malawi means that it is very difficult to live a completely private life. At some point or another, details of your personal life may become known by other people. Thanks to social media and the tendency to over share private issues often without the consent of those involved. Choosing to trust others with your mental health challenges can therefore be intimidating because of this. Even sharing with a professional or a trusted friend can be difficult to consider.

Yet many people desperately need to share their concerns, learn more, and get help for poor mental health. The lack of disclosure makes it very difficult for the public to access the right care at the right time.

Ignorance is still a very powerful stumbling block to access of mental health care in Malawi. When people don’t know enough about a problem, it is very difficult to find solutions for it. Therefore, raising awareness is very important, both in order to know when something is wrong and to know where to get the appropriate mental health care.

Lack of mental health awareness may lead to …

Misdiagnosis often this is done by people who are inadequately trained. You may hear someone say they were diagnosed with depression by a random academic, or a friend who knows about psychology, and often Google search. When you question them further you will discover that their symptoms are not those of depression and their source is not qualified to do a complete evaluation and give an accurate diagnosis. When it comes to treatment, how can a person receive the right intervention without the right diagnosis?

Selfmedicating many people self medicate instead of investigating and treating mental illness. There are many people who are aware that something is not right with their mental health, and for whatever reason are not ready to seek help. Self medicating includes but is not limited to: over working, extreme exercise, promiscuous behaviour, substance abuse, alcoholism, over eating, obsessions that go beyond the normal hobby or personal interest activity.

Most self medicating behaviour is done to distract the person from their problem, is done excessively, and often with the person choosing to engage in the activity rather than seek help.

Self harmorharmtoothers this is a common thing to see amongst

adults. It is often the case that when we are not equipped to find healthy solutions for our problems, the next step is often to ignore it or try to destroy it. Since mental health is a problem of the mind, what better way to destroy this problemthan to harm the body in which it resides. This is where you find behaviour such as alcohol and substance abuse, reckless and risk taking behaviour, entertaining suicidal thoughts, promiscuous (often unprotected) sexual behaviour, poor self care, avoiding being around the influence of healthy people, and avoiding a healthy lifestyle.

The other way through which harm manifests is in how people who have poor mental health choose to hurt others, often their loved ones or those close to them. Consider a person suffering from depression, they are not getting any treatment for it, nor are they reaching out to people around them for help and support. They choose to drink heavily to stopfeelingor numbthepain . The result is that they become even more frustrated and begin to lash out in violent outbursts and frequent fights. They become even more isolated and feel guilty for their behaviour, which leads to more self medicating and even more harm to others. It becomes a vicious cycle.

Suicide one of the more obvious results of untreated and unresolved mental health problems. Suicide has become one of the most relied upon methods for solving problems for a lot of people across the world. Although highly stigmatised and misunderstood, suicide is often an attractive solution for someone who may be suffering through difficult life situations and is not equipped with resilience and the right tools to thrive through their dark times.

Sometimes people may face difficult times while they already have a mental illness such as depression, making it even harder for them to cope on their own.

What can you do?

The best tool any person can equip themselves with in any situation is knowledge. When it comes to mental health, one needs know themselves and discover what a healthy, functional mind looks like. One can even go further and learn about what to do and where to access the right help when things are not going well.

As Malawians, most of us know what to do when someone gets Malaria, or has a runny tummy. Nobody has to be told to find anti malaria drugs or Thanzi ORS because this is knowledge has been given to us through ongoing extensive media campaigns, civic education, and even in the school curriculum. Yet this is not the case when it comes to mental health matters.

When someone is suffering from mental illness we seem to draw a blank, many of us just don’t have the right information to help us make the right choices, and to find the best intervention in this area. Each person needs to know how to access care for themselves and their family when it comes to illness and disease. We all need to have access to healthcare for our mental health just as much as we do for our physical bodies.

Knowing more about mental health must include knowing the signs and symptoms of mental illness, as well as what treatment to look for once illness is happening. The best place to start is to know your family background. How do people in your family handle stress, trauma, and difficult life events? Does any

family member have a diagnosed mental illness? Information like this will give you a clue on how other family members will likely cope as well.

The next step would be to find out what your particular coping style is, do you have one? If not, it’s time to develop one (see the resource section for an example). Equip yourself with the right information on medication, a good diet, a healthy and positive lifestyle, and learn how to build good support systems especially if you find that you may be impacted by mental illness.

Learning about yourself will help you to notice changes as well as early warning signs of poor mental health or mental illness, pre dispositions (such as being predisposed to addictions like alcoholism or drug abuse), changes in personal development, and healthy or unhealthy cycles in your life. Once you become consciously aware of how your internal process works, you can be prepared to make the right adjustments towards better mental health. Our mood and emotions are never constant, therefore do not expect yourself to feel the same all the time. It is worth finding out some of the factors like how does your mood change on a daily basis? Who and what are around you when this happens? If you are a female, does your menstrual cycle have something to do with the changes in your mood or behaviour? Are you physically healthy? Are things going well at work? Are you feeling lonely? What did you eat, did you eat at all?

There are so many factors that need to be considered when it comes to poor mental health. It would not be fair to ignore symptoms or try to suppress them. What would be fair is to give

yourself some empathy and compassion while you actively look for help from people close to you, or from professionals in the mental health field.

Nobody is fully happy all of the time. There is no standard of the perfectlyhappy lifeout there that everyone seems to have except for you. Learn about what happiness looks like for you. Learn when and how you feel what you feel so that when something changes whether negatively or positively, you will pick it up right away.

Not every person who is experiencing poor mental health needs to see a professional. Sometimes it is a matter of changing your lifestyle and learning how to treat yourself when you are struggling. However, when you become overwhelmed and struggle to cope, it is wise to reach out to someone who can help you find your way again. Psychologists and Counsellors are there to offer support in these cases. However, when you are experiencing symptoms of mental illness, you need to get in touch with a doctor right away, and get referred to psychiatricservicesin order to get the right treatment.

Public Institutions Offering Mental Health Interventions

Mzuzu Central Hospital – Mzuzu City. +265 1320 916

Kamuzu Central Hospital Lilongwe. +265 1754 420 Zomba Central Hospital Zomba City. +265 1526 266

Queen Elizabeth Central Hospital Blantyre. +265 1630 333

Mental Health Workers and their Services

There are different kinds of experts who specialize in different areas of mental health. Each of them plays a key role in identifying and treating psychological and psychiatric health issues. All mental health workers are bound by professional ethics and a code of conduct which includes confidentiality of client information as well as personal details. Confidentiality is a must unless otherwise discussed and agreed upon by the practitioner and the client.

The different types of mental health professionals are: Psychiatrists

Psychologists

Counselors

Social workers

Psychiatric nurses

Here is a brief description about each expert and their area of proficiency.

Psychiatrist

Psychiatry is the branch of medicine that deals with assessing, diagnosing, treating, and managing various mental disorders which affect emotion, cognition, and behavior.

A psychiatrist will have completed an MBBS and gone on to study psychiatric medicine. They specialize in the diagnosis and treatment of mental health issues. During their specialized training, psychiatrists study the brain's functions and the complex relationship between the body and brain. They are qualified to distinguish between physical and psychological causes of mental and physical distress. They are also the only type of mental health professional who are licensed to prescribe and monitor medication.

Psychologist

Psychology is the scientific study of the human mind and behavior. All aspects of thoughts, feelings and emotions that motivate our actions are scientifically evaluated through various assessments and tests. Psychological knowledge is applied to understanding and solving problems in different spheres of human activity; and is also used in the assessment and treatment of mental health issues.

Psychologists have a degree in psychology and are experts in human behavior. They use scientific methods to study the factors that influence people's thoughts, perceptions, emotions, and actions. They use their clinical skills to work with people who have mental health issues like anxiety, depression, eating disorders, panic disorder and substance abuse.

They use evidence based strategies and interventions to help people overcome challenges and cope with life issues such as:

Relationship problems, challenges in parenting, challenges in adolescence and puberty, lifestyle effects on health, chronic illness, trauma, and bereavement.

Counsellor

Counseling is a type of applied psychology therapy that focuses on helping people resolve emotional, behavioral or social problems arising from various life situations. This could include working through such as problems at the workplace, school or college, relationship problems, and conflict within the family.

Counseling focuses on working on current and specific problems while helping people regain functionality in their lives. This process can involve working to understand thought processes, beliefs, and emotions that have an impact on behaviour.

Therapy can also help to improve self awareness, to teach emotional knowledge and understanding, to raise social consciousness, and to help build resilience.

Counselors can have very varied lengths of training, from a year long intensive training to a few months by correspondence. A counselor is trained in the art of listening and has skills to help a person analyze their problems and find a solution. Counselors deal with various issues that are as broad and varied as those undertaken by psychologists, psychiatrists and psychotherapists.

If the counselor observes that counseling isn't addressing the person's needs because the underlying condition is severe and may need other interventions, they refer the person to a more qualified mental health expert for diagnosis, treatment, therapy, or medication, as the case may be.

Social Worker

Social workers are mental health professionals trained to help patients find solutions to life challenges including mental illness. A patient's relationships, career, and quality

of life are significantly affected due to mental illness; and this can be a very difficult situation to navigate.

As part of their work, social workers may help to assess emotional and mental health needs; provide psycho education for the patient and their family on the illness and treatment

The also make sure to evaluate the patient's socioeconomic status and look for community resources that would be useful for them. They facilitate individual, group, and family therapy sessions to help improve the relationship between the patient, their family and community. Overall, they play an important role in helping patients have a smooth transition back to family and community.

Psychiatric Nurse

A psychiatric nurse is a mental health professional qualified to assess, diagnose, and treat individuals with psychiatric disorders. They work with individuals, families, groups, and communities, and assess their mental health needs. They also help families understand the challenges of the mental illness and help them offer the appropriate care their loved one needs.

*LayCounsellors

Lay counselors are people that have a spiritual calling to care for others and volunteer their time to provide their services under the guidance of their local religious body.

Like licensed counselors, they typically meet for an hour in a counseling office on a regular basis, they maintain strict confidentiality with their clients, they keep notes and files on their cases, and they regularly receive supervision from licensed counselors.

How to take care of poor mental health?

When to see a Mental Health Practitioner

As you have already noted, there are many types of mental health practitioners catering to different mental health conditions. Here are some general symptoms that should alert you to the need for their intervention.

Intense emotions or a numb emotional experience

A traumatic experience

Unexplained physical aches and pains, and poor immune system

Self medicating behaviour eg. Substance abuse

Negative feedback from work or school

A feeling of disconnection from yourself and others

Strained or broken relationships

Psychologists, counsellors and lay counsellors will help you to begin to understand yourself. They are trained to help you navigate the difficult and confusing times in your life. They help you to build resilience, find your inner strength and learn how to use it, identify negative thought patterns and negative behaviour cycles that are keeping you from living a positive and healthy life. Therapy is not there to fix you up and give you a list of things to do to be better. It is rather a process that helps you gain a deeper awareness of yourself so that you can make healthier choices for yourself and those around you.

When to see a Psychiatrist

Now that you have a clear understanding on what a Psychiatrists is, as well as the services they are likely to offer, here are some of the symptoms that could guide you on the need to see one.

Significant thoughts of self harm or suicide

Violent thoughts

Delusions

Hallucinations

Unstable moods

Social isolation

Significant changes in behaviour

Cognitive decline and poor functioning that is getting worse Eating and body image problems

When other interventions (such as counselling) are not helping

Doctor or physician’ s intervention is not helping

If you are experiencing some of the symptoms mentioned above, you need to get an evaluation with a psychiatrist as soon as possible. There is no need to feel ashamed or fearful about this, just as physical illness requires medical intervention, mental illness also requires the same prioritized treatment.

Current Status of Mental Health Services in Malawi

The reality is that the country does not have enough accessible and specialist mental health workers. Most referral hospitals, district hospitals, and health centers are usually the first point of contact for people struggling with mental illness and other mental health concerns. However, the smaller facilities are usually understaffed and have frequent drug shortages.

Adding to this, the country has only one public referral psychiatric hospital which is based in Zomba. Although it strives to provide the best services to the public, it is just not big enough to cater to the entire country.

That being said, the Zomba Psychiatric Hospital provides a high standard of psychiatric care for its patients (both in and out patients). Queen Elizabeth Central Hospital, Zomba Central Hospital, and Kamuzu Central Hospital provide mental health interventions at different levels. They are usually the most accessible point in treatment and are able to refer patients to the Zomba Psychiatric Hospital when necessary.

Resources

If you have any concerns over your mental health or that of someone you know, please make use of the contact information provided below. There are many more individuals and organisations that provide mental health services in the country. You would have to do your research on the internet to find contact details. Some are listed in our poster at the end of this book