Increasing Resource for the Mental Health of Prisoners in Ethiopia

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  Mental, neurological, and substance use disorders are ubiquitous worldwide, affecting every community and age group across all income countries. About 14% of the global burden of disease is attributed to these disorders and most (75%) of the people affected in low income countries have no access to treatment Furthermore, prisons are a particular area where treatment is scarce despite the dense prevalence of mental health issues among detainees. According to the WHO, at least half of detainees have a personality disorder and one of nine detainees has a serious mental disorder (i.e. psychosis, depression).

     In 2006, with the collaboration of the WHO-AIMS, a program created to collect mental health system information specific to each country, Ethiopia published a report highlighting the lack of mental health care in the country.  The country was found to have 53 outpatient facilities, 6 inpatient facilities and one mental health hospital. None of these facilities catered to special populations, including prisoners.

    In 2012, the ministry of health and Ethiopia worked with WHO to incorporate the mental health Gap Action Programme into their country cooperation strategy. Since then they have made considerable efforts and some  headway into scaling up mental health treatment.

    While there is a general awareness of the need to improve mental health treatment in Ethiopia, there is still a limited focus on prisoners. There is no accurate count of persons with mental disorder who are incarcerated in Ethiopia. In order to necessary information about this vulnerable population, the University of Gondar did a study that found the prevalence of psychological distress among prisoners was found to be 83.4 % (95 % CI 80.6, 86.0 %).  

     Because of the challenging environment, though stakeholders are aware of the issue, their resources are not adequately allocated to this vulnerable population. The National Mental Health Strategy mentions that mental health in prisons is an important issue but fails to establish a specific plan to improve the care in prisons.

     Very little progress has been made and was last noted in 2014 when a seminar trained 17 health professionals about mental health in prisons.

     As a physician who works in LMICs, there is a notable impact of mental health on a population and in turn the economy. Mental health needs to be addressed appropriately and resources need to be designated where subpopulations are more vulnerable. There should be a stronger emphasis and resources should be directed towards detainees in mental illness in the National Mental Health Strategy with specifics numbers for funding and dedicated health care professionals.

Ethiopian-refugees-rounded-up-in-Kenya-Aug2010

from ethiopiareview.com

 

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3 Responses to “Increasing Resource for the Mental Health of Prisoners in Ethiopia”

  1. agulamhusein Says:

    Interesting post, thanks for sharing. I agree that mental health is an important component of individual and population health and that resources need to be targeted to treating these illnesses. I like the idea of identifying a vulnerable subgroup to focus on. Particularly when dealing with mental and psychological illness where diagnostic criteria can be somewhat subjective, quantifying the burden of disease can be challenging. I imagine this would be even harder in developing countries and maybe focusing on a smaller population would make data collection easier and more robust.

    The prison population poses its own challenges – it can be hard to obtain enough political will to focus on this marginalized group. One strategy might be to focus on the need for these resources to improve chances as re-integration into the community after release. There has to be a means to give these people a chance at becoming productive members of society and improving the status of the communities within which they live but that takes resources. I know there have been some efforts in North America to institute formal discharge planning programs from prison particularly for young offenders to improve their chance at integration and decrease the risk of recrudescence.

    Who would be in charge of allocating these resources to this program?

  2. raymondbelarmino Says:

    Thank you for the interesting discussion about mental health among prisoners in Ethiopia. The complexity is evident. It is encouraging to read about the WHO’s partnership with the Ethiopian government to enhanced the mental health system. When I was working with an HIV/AIDS program in Ethiopia several years back, one thing I continually observed is the burden carried by so many with mental health challenges. When these challenges are compounded by other health conditions and determinants, the situation is particularly dire. Strengthening the mental health system is certainly a worthwhile public health endeavor.

    As you discuss, reaching prisoners in Ethiopia with mental health services is incredibly complex. As part of the World Health Organization (WHO) MIND Project, the WHO published a fact sheet in 2007 regarding mental health in prisons. (http://www.who.int/mental_health/policy/development/MH&PrisonsFactsheet.pdf)
    The WHO argues that access to mental health assessment, treatment, and referral services should be a fundamental part of health services provided to prisoners. The WHO states, “This may be achieved by providing mental health training to prison health workers, establishing regular visits of a community mental health team to prisons, or enabling prisoners to access health services outside the prison setting.”

    I would be interested in whether mental health teams developed through the collaboration between Ethiopia and the WHO in the Gap Action Programme could be deployed to prisons to offer mental health services. If not, this would be an important objective to establish in developing a functional mental health system in Ethiopia.

  3. yamimbilizi Says:

    This is a great article, and it just brings to light the realities of mental illness in Africa. In Ethiopia and many other African countries, mental health goes undetected or ignored amidst the burden of other serious and life threatening conditions. Mental health needs to recognized as a priority in the health care system, and screening and treatment measures should be in place.Government should allocate resources to train prison guards and wardens, and implement routine mental health screening in all prisons in country settings.

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