Zimbabwe: 14 million people, 20 registered clinical psychologists & 9 public mental health institutions

*Stephen is a 30 year old psychiatric inmate at the Chikurubi Maximum Security Prison’s psychiatric wing. His name has been changed to protect his identity.

While at home one day, Stephen heard voices from what he thought was the army. They told him to take his family and leave his home. These voices said that if he did not do this, the army would come and kill them all.

Stephen told his family, but they ignored what he said, and the voices in his head grew louder. They now told him that if he and his family didn’t leave, he was to kill his wife and children before the army arrived. His family, confused by Stephen’s ideas, again refused to leave their home.

By the next morning, Stephen had murdered his wife and three children.

The next thing Stephen remembers is finding himself at Chikurubi Maximum Security Prison’s psychiatric unit in Harare, Zimbabwe, where Doctors Without Borders (MSF) has been running a mental health programme since 2012.

As a new inmate, imprisoned in the mental health wing, Stephen was assigned a clinical psychologist – Emmerson Gono from MSF, who has been working at the prison for four-and-a-half years.

When Stephen first arrived, Emmerson asked him if he knew why he had been imprisoned. But Stephen’s psychosis had subsided and he couldn’t remember anything from the previous three weeks. After Emmerson’s careful explanation, and upon realising what he’d done, Stephen was inconsolable.

According to Zimbabwe’s Ministry of Health and Child Care, there are at least 1.3 million people living with mental illness in Zimbabwe. Despite the growing numbers, mental health services, including staff and drugs, remain in dire shortage across the country.

For a country with a population of over 14 million people, Zimbabwe has only 20 registered clinical psychologists and nine public Mental Health Institutions. This means that for many Zimbabweans, mental health support is out of reach, either physically or financially.

Stephen is one of about 300 inmates at Chikurubi Maximum Security Prison’s psychiatric unit. Emmerson says his story, while extreme, explains the situation many patients find themselves in, when their illnesses are left undiagnosed and untreated.

“When you are professional, you realise that the patient committed a crime because of mental illness and they need help. No matter how heinous their offences are, they still need help ... they are still human beings,” Emmerson says.

The gap in resources isn’t the only challenge patients’ face: for many, the stigma can be even more debilitating. Emmerson’s friends sometimes tease him saying, “If you work and play with kindergarten children for a long time you end up behaving like them. If you spend time with mental patients, you also end up being like them.” Emmerson says it’s words like this that remind him just how misunderstood mental illness is.

“I might think I am not worth working in prison but then again you ask yourself, if I don’t go into prison to help mental patients, who will?”

“My wish is to see a shift from institutionalised mental health services to community mental health services. I want to see patients getting services closer to home in their community rather than being institutionalised. The best form of treatment for mental patients is not coming from us professionals in a jail or hospital: it’s in their homes, and with the support of their family,” Emmerson adds.

MSF has been supporting the Zimbabwe Prisons and Correctional Services (ZPCS) to provide diagnosis, treatment, care and support to inmates with psychiatric disorders, HIV and TB at the Chikurubi Maximum Security Prison’s male and female psychiatric units since May 2012. MSF has also been supporting eight other selected prisons in the Mashonaland Provinces with mental health training programmes.

In October 2015, MSF launched a mental health project at the Harare Central Hospital’s psychiatric unit. The organisation has since constructed an Out Patients Department (OPD) and renovated the male and female acute and sub-acute admission wards with 100 beds. MSF also provides community mental health services through the discharge team which follows up discharged patients to review them at their nearest clinic in Harare.