Mental Health has been said to constitute a large and increasing part of the burden of disease worldwide. In fact, apparently a quarter of the world's population will develop a mental or behavioural disorder at some point in their lives. You could say it's the elephant in the room.
Essentially, it is a public health issue. Particularly, the World Health Organisation has found that depression is a leading cause of both injury and disease for people around the world. Further, depression is ostensibly the leading contributor to suicide. In 2014 suicide deaths in Botswana were 64. That means 0.43% of deaths in the country, in that year were attributable to suicide.
This placed Botswana at the 142nd ranking in cases of suicide, worldwide. Three years later, in 2017, 220 suicides occurred. This placed the country at the 57th position in the world ranking. This tripled the earlier statistics. Despite these statistics, mental health is the often bastardised and neglectfully forgotten arm of the health sector.
Each day, our world seems to spin faster on its axis, continuously picking up momentum. Demands escalate rapidly.
There is so much we need to know, and we constantly live with the threats of terror to our very existence.
This urgency is cross-cutting. It is in any number of things, from the politics we observe or take part in, to trying to find employment; from trying to keep employment, by remaining relevant, to things that seem so inconsequential but add up to affect us completely, like the currency, world turmoil, water, electricity and our social lives.
One writer says, “the immediacy of real–time communications through various mediums such as text messages, snaps and whatsapp group chats has already created a new normalcy where any person, regardless of their hierarchy of importance in our lives, has the power to place immediate demand on our time and possibly distract and even derail us from our plans. [This makes it] easy to see why so many people are experiencing stress, worry, and anxiety attacks. Unfortunately, these are not simply innocent states of emotion – they can insidiously develop into chronic depression…and even suicidal tendencies.”
It is important to note, as the Court of Appeal did, in AG and Others v Tapela and Others, that caution must be employed when considering socio-economic rights, including the right to health. These rights cannot, as the Court stated be assumed to exist in the context of the Constitution, where they are not explicitly stated.
This notwithstanding, the Botswana government has largely taken a Human Rights approach to dealing with health related matters, prioritising health for most persons in various regards, equally. This arguably creates a legal obligation on the country to provide the highest attainable standard of health as a fundamental human right, thereby ensuring access
A rights-based approach to health requires that health policy and programmes must prioritise the needs of those furthest behind first. We have heard it said many times that, the human right to health means that everyone has the right to the highest attainable standard of physical and mental health.
One of our greatest shortcomings however, has been in the area of addressing mental health. This is perhaps the reason why mental health related suicides have been on a consistent rise. Government’s interventions appear to be at a secondary response level, providing institutionalisation and medication. There is a missing link though. If health is a human right, and mental health is a component of health, how do we account for the lives we are losing?
Stigma remains one of the greatest challenges in addressing mental health in Botswana. Young people appear to be the worst affected by this with the largest number of suicides recorded being of people aged between 18-40 years.
When one looks at our timelines on social media, it is so easy to pick up that our lives are literally going at a fast forward pace, and we are struggling to catch up. Many of us are able to understand when our peer shares a post about just not feeling like waking up in the morning.
We are, by and large able to articulate our struggles, and daily challenges. The problem is that many of us do not know how to respond. We are the “go tlaa siama” generation. Often, our own impending grief and unresolved trauma incapacitates and paralyses us from adequately responding to those who are most vulnerable amongst us. Reaching out is often viewed as emotional and needy. We say, “o a bo a tsogetswe” to speak away the challenges our associates face. Suicide is literally a national crisis.
But it usually doesn’t start with death. And in very many instances, if we were to retrace, we would find the roots are mental health related. There is a need to be kinder to each other, in the ways of genuinely prioritising our lives.
We are half way through 2018. With the reports that have been published of recent suicides, almost each of us know of those suffering amongst us. Compassion costs nothing. Existing in a space that is almost a vacuum where mental health is not addressed at inception, it is our duty, as individuals to just be considerate.