While at home one day, Stephen* heard voices from what he thought was the Army. They were telling him he must take his family and leave his home. These voices told him 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 were now telling him that if he and his family didn’t leave, he must 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.
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 with just 20 registered clinical psychologists and nine public Mental Health Institutions, for a country with a population of over 14 million people. This means that for many Zimbabweans, mental health support is out of reach, either physically or financially.
"Stephen’s psychosis had subsided and he couldn’t remember anything from the previous three weeks ... upon realising what he’d done, Stephen was inconsolable'
The next thing Stephen remembers if finding himself at Chikurubi Maximum Security Prison Psychiatric Unit in Harare, Zimbabwe, where Médecins Sans Frontières has been running a mental health program since 2012. As a new inmate, imprisoned in the mental health wing, Stephen was assigned to Emmerson Gono, a Médecins Sans Frontières clinical psychologist. 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.
Stephen is one of about 300 inmates at the Chikurubi Maximum Security Prison Psychiatric unit. Emmerson says, his story, while extreme, explains the situation many patients find themselves in, when their illness is left undiagnosed and untreated. “When you are professional, you realize 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. “My wish is to see a shift from institutionalized mental health services to community mental health services. I want to see patients getting services closer to home in their community rather than being institutionalized. 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.
In October 2015, MSF launched a mental health project at the Harare Central Hospital 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. MSF has also been supporting eight other selected prisons in the Mashonaland Provinces with mental health training programs.