Trends and Approaches Towards Women and Girls' Mental Health
Across the African Region, more than 116 million people are already estimated to be living with mental health conditions pre-pandemic. Suicide rates remain particularly concerning, as are the exponential rates of alcohol use and abuse among adolescents as young as 13 years of age. Most of these trends are particularly affecting young women from marginalized areas . The subject of mental health is largely taboo in most developing countries such as Zimbabwe, and often associated with witchcraft and being cursed. However, issues of mental health are on the rise and Zimbabwe and other African countries cannot afford to ignore these.
More than ever before, suicide rates, cases of gender based violence, substance abuse and child sexual exploitation are on the rise and these are very much associated with mental health issues which have not been addressed. The causes of this escalation are the many social changes in the past 50 years. In Africa, traditional or religious practices have for a long time been the only known methods of addressing mental health issues. As a consequence, the proportion of Africans who receive treatment for mental health problems is extremely low. While the global annual rate of visits to mental health outpatient facilities is 1051 per 100 000, in Southern Africa the rate is 14 per 100 000. Between 2000 and 2015 the continent's population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%. The demand for mental health services is increasing in the African continent, particularly among vulnerable populations like women and girls.
Each and every year Zimbabwe puts out a country budget and mental health issues are allocated an estimate of not more than one percent which is not enough to cater for the mental health needs of its citizens. In my role as a social worker who is a mental health advocate, I have gotten the chance to directly interact with women and girls from marginalized communities like Mbire, Goromonzi and Shamva for the past 2 years. Women and girls suffer a lot as they do not have anywhere to go if they face social ailments that destructs their mental wellness.
The issue of child marriage is on the rise and most of the women who are now above the age of 50 have a had a traumatic situation when they were married off and never got the chance to deal with their traumas as the local health facilities do not encompass mental health care and support. I recently supported a research project as a counsellor, and my observation from being a service provider was that there are so many gaps in relation to mental health response in Zimbabwe. Most of these gaps affect women and girls, especially those who are victims of all forms of violence. Women are expected to carry every day care work and little has been done to make sure that they get psychological help.
Mental health care and support is not always predictable in terms of timelines. There is need for continuous engagement once a person starts to get help. Child marriages and gender-based violence trigger mental health issues, and general mental health issues are still uncomfortable topics to accept and understand in most Zimbabwean communities. Thus we need to continue pushing towards awareness. The referral pathway for mental health in Zimbabwe is not solid and, in some cases, quite outdated; as we carried our research, there were gaps in terms of how clients would get comprehensive support care as systems in their communities have changed (some clinics have closed).
In response to all these mental health social problems, one transformative trend or approach is the application of tele counselling in providing mental health services. A key use case is the treatment of depression in rural areas where access to qualified therapists is limited. Telemedicine bridges this gap, demonstrating the power of technology in mental health treatment. There is need for strengthening of the Afrocentric approaches to mental health like the HURUKURO Model from the Institute of Women Social Workers, an approach to mental health care and support, counselling and community development which draws on principles of UBUNTU and an understanding of the African context. Another example is the Nhanga from Rozaria Memorial Trust, where they use the African approach to addressing mental health and women’s education without distracting the community set up.
Mental health and psychosocial care are supposed to be held using Afrocentric approaches to accommodate all the women without infringing their cultural beliefs. Sticking to basic counselling principles will remain key in handling mental health service delivery. There is a need for acceptance by the patient with her physical, psychological, social, economic and cultural conditions so that the clients are free to open up without feeling less or unworthy.
In terms of providing one on one counselling sessions to women from rural marginalised communities, there is a need to truly probe to achieve fruitful sessions. This is because women in these communities believe that opening up and sharing problems is a weakness that can destroy marriages and other family secrets that are not supposed to be shared by anyone. Group therapy works better than one to one when handling women who have gone through a relatable experience, as women from the community commonly find healing when sharing a problem in group settings rather than speaking to a counsellor on a one to one basis.
The best approach to mental health is to prioritise women’s mental health needs and to invest towards a better future where women and girls are able to fully enjoy their rights in the absence of mental violence, with an understanding that mental health is a human right.
Ethel is a qualified Social Worker from the Women's University in Africa. She is the Programmes Manager at a women-led feminist organization called Institute of Women Social Workers (IWSW) - a movement of social workers, development practitioners and psychologists who engage in areas around social justice, women's mental health, sexual reproductive health and Rights. They advocate to challenge norms that perpetuate sexual and gender based violence. Ethel often works with indigenous communities, mostly with survivors of sexual violence and gender-based violence, carrying out research offering meaningful evidence based knowledge around gender, social development and women's mental health. She also occasionally works with the ZTN DSTV channel on a mental health awareness program called "The Drug Haven".