Self-Assessment Questions (SAQs) for Study Session 9

Answer

A is false – the burden also includes the amount of disability that a person suffers because of their mental illness.

B is true – although some people may describe the woman as lazy, this is not correct. She cannot work because of her mental illness and so this is disability.

C is false – most people do not have any access to specialist mental healthcare and must rely on ways of helping themselves or getting help within the family (self-treatment), using traditional healers (informal community care) or receiving care through the primary healthcare system.

D is true – this is an example of negative behaviour towards a person just because they had a mental illness and not because of their ability to do the job. Therefore it is discrimination.

E is false – self-treatment is what the person does to help themselves to get better, but often people with mental illness also need help from the health system, e.g. medication for people with psychosis.

Answer

If the adult population of a typical kebele is about 2,500 people, we would expect the following number to have a mental illness:

50 adults (2% of 2,500) with severe mental illness (psychosis)

250–375 adults (10–15% of 2,500) with depression

125 adults (5% of 2,500) with anxiety disorders

75–125 adults (3–5% of 2,500) who have a problem with alcohol or khat.

These numbers show that it is likely that many people in your kebele could be affected by mental illness. Some adults may be affected by more than one disorder at the same time, e.g. depression and alcohol abuse.

Answer

Some reasons to bother about mental illness in the local community could include:

• Mental illnesses are common – they affect 1 in 6 people
• People with mental illness are more likely to die young
• Mental illness causes a lot of disability and means that the whole family is more likely to be poor
• Mental illness can be treated with cheap and simple medication, but few people manage to get the treatment
• Mental illness can complicate health conditions such as HIV/AIDS
• People with mental illness (and their families) endure a lot of unnecessary suffering because of stigma, discrimination and abuse.

Answer

• a.Possible biological causes could be (i) inheriting increased risk of psychosis from her mother, and (ii) hormonal changes following childbirth. Stress because of her husband’s joblessness and their resulting poverty could be a social cause of her illness.
• b.An explanatory model is the way that a person understands their illness, including why it happened, what caused it, how serious it is, and what treatments they believe will help.
• c.Tigist understands her illness to be caused by an evil spirit. She believes that the illness is serious and that she could die. She believes the best treatment for her condition is from holy water or a traditional healer.
• d.You could explain to Tigist that you understand she is worried that her condition is caused by an evil spirit. You could then say that, in your experience, such a condition can also be due to changes in hormones that happen after childbirth. You could tell her that you would expect medical treatment to help her, and that she can continue her traditional treatments as well.
• e.You can advise the family that medical treatment is available for Tigist’s condition and encourage them to take her to the nearest health facility that can deliver mental healthcare. This might be the health centre or the nearest psychiatric nurse unit. You can also encourage the family to remove the chains.

Answer

Mental health is relevant to the following Millennium Development Goals:

MDG 1 End poverty and hunger Mental illness leads to poverty because the affected person may be too unwell to work, and sometimes because people with mental illness experience discrimination and don’t have as many opportunities to work.

MDG 2 Universal education Undetected mental illness in children interferes with their ability to benefit from education.

MDG 4 Child health Undetected maternal mental illness can affect child health (diarrhoea episodes), growth and development.

MDG 5 Maternal health Maternal health is compromised by mental illness. Pregnant women with depression and anxiety are more likely to have a prolonged delivery. Also, women who experience a complicated delivery are more likely to develop mental illness.

MDG 6 Combat HIV/AIDS Undetected mental illness can lead to people with HIV/AIDS not taking their medication regularly, resulting in a worse outcome.

Answer

• a.The treatment gap is the gap that exists between the need for treatment for mental illness and the treatment that is actually available. In Ethiopia 9 out of 10 people with mental illness don’t receive the treatment that they need. This is a very high treatment gap.
• b.The Health Extension Service can help to reduce the treatment gap for mental illness by doing the following things:
  • increasing detection of mental illness
  • referring people with mental illness to the health centre
  • supporting people with mental illness and their families
  • encouraging people with mental illness to attend their follow-up appointments and take their medication
  • educating patients, their families and the community
  • challenging stigma, discrimination and abuse.