The topic of mental health has only recently come into focus, even in the most progressive countries. It’s no surprise that many developing countries are behind when it comes to both defining and treating mental health conditions.
A student who went on one of our mental health placements abroad said:
“...local staff estimate that they are about 30 years behind the UK in certain areas.” - Karen Ollosson, Ghana
Some issues stem from a lack of resources — a low staff to patient ratio, limited specialised training, and a lack of equipment. Other issues, like prejudices and misconceptions surrounding mental health, stem from less tangible factors like culture and religion.
Defining and Acknowledging Mental Health Conditions
One of the root issues when it comes to establishing a system of mental health nursing abroad (especially in low-resource settings) is a lack of definition of mental health conditions from the start.
In Ghana, for example, mental health conditions are seldom acknowledged. To offer perspective, some local people believe that even medical conditions like epilepsy are caused by ‘bad spirits’.
Some even believe the sufferer must have committed a sin in a previous life and so ‘deserves’ the illness.
To give you a sense of scale, in the UK, there is roughly one psychologist per 3500 people. In Ghana, there is less than one psychologist per million people.
On the extreme end of that spectrum, people suffering from mental illnesses are socially ostracised and sent to prayer camps. Prayer camps are religious faith-healing centres — an alternative to hospitals that rarely have the appropriate facilities.
There is little evidence (if any) that prayer camps have any positive effect on mental health conditions. But, in the absence of evidence-based treatment, there are few alternative options.
Each camp is different, but many rely on prayer and forced fasting to try to ‘cure’ the patient. Conditions for patients are poor when compared with the UK, and it was only in 2018 that the Ghanaian government made it illegal to chain patients by their ankles.
If people don’t recognise mental health issues for what they are, there will be no public clamor for programmes that help the suffering.
Without fundamental change at the sociocultural level, there can be no systemic change.
Even once the need is acknowledged, there is so little healthcare funding available that it will be a fight to get government budget allocated to it. Treating mental health issues in many economically disadvantaged countries is a battle that has barely begun.
N.B. You won’t visit a prayer camp on one of our mental health electives abroad. But, you will see the stark differences in treatments in our low-resource partner hospitals.
Treating Mental Health Conditions in Low-Resource Clinical Settings
Some developing countries are much further along the path of progress than others. On our programme in Kandy in Sri Lanka, for example, you’ll see a more progressive approach to treatment.
However, there are significant limitations. One former student described how she went with a local doctor on a prison visit:
“One man we saw was 87 years old. When the consultant had finished talking to him, he explained that the man had severe dementia and that nothing he said made sense. He didn’t know where he was, and couldn’t comprehend anything the doctor said. It turned out that he had been arrested because he was found wandering the streets, speaking incoherently.
He went missing from his family six months prior after he walked out one night while everyone was sleeping, and never came back. The consultant explained they had to arrest him to put him in a place of safety, instead of allowing him to wander the streets.
In Sri Lanka, sheltered housing for the elderly isn’t common, so there was no other option for the police but to put him in prison.”
She also noted that staff had a relaxed attitude towards patient privacy:
“Throughout all the assessments and conversations, the office door was left open during patient consultations.
Patients stood in the doorway waiting their turn, well within hearing distance of ongoing consultations.”
Another student who travelled to Kandy reflected on the difference in practise:
“I observed the administration of ECT under general anaesthetic. It was the first time I had witnessed this treatment, which was regularly prescribed in Kandy.” - Richard Beston, Kandy
What does the future look like?
When it comes to developing robust mental healthcare initiatives, every country is at a different stage in the process.
What’s important is that all of the countries we work in are actively pursuing progress in one form or another. This is true of Ghana, who are right at the start of the process, and Sri Lanka, who are now only really fighting for more resources.
“I would say Sri Lanka follow the same basic theory as in the UK, but have limited resources. They do the best with what they have. Their treatment methods are the same, the patients receive the same therapies that we deliver in the community and have follow-up appointments after discharge.’ - Joanne Yates
If you want to learn how we can create a mental health placement abroad for you, click the button below.