For a number of weeks, we have explored adolescence in various considerations.
Health is a great component to any individual’s life, including adolescents.
I argue that there are certain socio-cultural, economic, genetic, physiological factors that may lead to poor mental health which will create a demand for healthcare on the part of the person whose health in compromised.
This piece explores mental health framework in Botswana, with specific views at interrogating or engaging with the Mental Disorders Act 1969, and the National Policy on Mental Health of 2003.
As a starting point, Botswana is not a signatory to the United Nations Convention on the Rights of Persons with Disabilities. In 1969, however, the Mental Disorders Act came into effect.
The objective of the Act, as is stated in the Act is to “…make provision for the reception, detention, treatment and protection of mentally disordered persons.” In a Cambridge journal on Mental Health Legislation in Botswana, there is an observation that the statute, in fact, is quite procedural, and does not focus on protection of the individual in terms of human rights, nor does it take a patient-centred approach.
It is further noted that the Act does not regulate or prescribe how persons shall be treated or provided with care once they are received or detained.
The Act, in recognising the principle of evolving capacities, on addressing adolescence, provides that persons of 16years and older can request to be received and detained at the Psychiatric hospital, without parental consent. A patient, who has voluntarily had themselves detained, may also make a request to be discharged.
The National Health Policy on Mental Health of 2003 was established to provide a “…framework for the incorporation of the objectives of the mental health care services.”
It purports to upscale resources to expand and convalesce current mental health services and facilities. It notes that, in its introduction, that “mental health is an integral part of health. Every individual has a right to mental health, which can be described as a positive state of mental wellbeing in which the individuals feel basically satisfied with themselves.”
This aligns the policy as well as the country with the Sustainable Development agenda, which prioritises mental health as a critically recognised important component of the global health agenda.
Whether or not the statute and policy are impactful, is debatable. In Botswana, there is one psychiatric hospital, situated in Lobatse. In 2017 Statistics Botswana released a Health Statistics report that indicated that there are 300beds at the Psychiatric clinic in Lobatse. There are five psychiatric units in general hospitals around the country, and a total of 390 beds (including the 300 at the psychiatric hospital). Botswana has taken a community based approach
This has meant there is little integration of this aspect of health, to primary care. The community-based approach is definitely more expensive, while there are limited resources. Seloiwe and Thupayagale-Tsheneagae argue that this approach further has a high relapse rate. There are very few practitioners in comparison to the number of patients.
Cambridge provides that in fact, the country has a ratio of 17.7 mental health practitioners for every 100,000 people. Most of these practitioners are nurses, despite the Policy emphasising the need to identifying trained mental health workers.
Differentiating between health care and health, there is need to note that the strengthening of the community based health approach could very well, better benefit all persons and more specifically, patients.
The approach includes citizen involvement and collaboration. It places the society at the centre of interventions. There are ways in which society can constructively engage with mental health disorders.
This column has engaged with this issue before. This is no different when engaging with mental healthcare for adolescents. Stigma and discrimination against persons living with mental health disorders is still quite prevalent. This may have the effect of affecting healthcare seeking behaviour for adolescents. The narrative on mental health in Botswana is scattered with similar challenges.
UNICEF has proposed that ensuring mental health and wellbeing in an adolescent’s formative years can foster a better shift from childhood to adulthood. It suggests that adolescence, being a transition phase in life, needs great care.
Adolescents should therefore be supported for fostering the growth and laying foundations for a healthy and productive remainder of their lives.
Mental health and disorders, as recognised by UNICEF constitute a great burden for adolescents throughout the world, with an estimated one in five adolescents experiencing mental health challenges, annually.
Depression is a leading mental health disorder cause. Self-harm is the third leading cause of death in adolescents.
The above establishes that not only is there a critical need for reformation of the Act, to ensure that it takes a human rights approach to mental health, centering healing on the client; but further that the community based approach to mental healthcare be more resourced, to complement government’s efforts, as well as to include the community and collaborate with it more extensively.
There is further, a graver need to specifically ensure programming for aiming interventions at adolescents, directly intended to reach and impact them.
Further, a collaboration with society may assist families in ensuring the good mental health of the children therein. Of course this will take a long time. There is need however, to rehabilitate adolescents, beyond what is currently available.