Self-Assessment Questions (SAQs) for Study Session 9

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 9.1 (tests Learning Outcomes 9.1 and 9.5)

Which of the following statements are false? In each case explain why it is incorrect.

A  The burden of mental illness is measured only in terms of the increased mortality that it causes.

B  A woman who has severe depression can’t get out of bed to complete her housework – this is an example of disability.

C  In the health system, most mental healthcare is provided by psychiatrists and psychiatric nurses.

D  A man had psychosis and recovered well after receiving treatment, but he is refused work because he was once mentally ill. This is an example of discrimination.

E  Self-care means that a person with mental illness doesn’t need any help from health services.


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.

SAQ 9.2 (tests Learning Outcome 9.2)

For an average kebele of 5,000 people, can you calculate how many adults might be suffering from mental disorders?

Use the percentages listed in Table 9.1. For example, in a kebele you would expect half the population to be of adult age (2,500 people) and 2% of these adults (0.02 × 2,500 = 50) to have psychosis.


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.

SAQ 9.3 (tests Learning Outcome 9.3)

A community leader comes to tell you that you shouldn’t waste your time on people with mental illness. Write down 5 things you can tell him to try to convince him that mental health is important in his community.


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.

Read Case Study 9.2 and then answer the questions that follow it.

Case Study 9.2  Mrs Tigist the postnatal woman

Mrs Tigist is a 28-year-old woman who developed the mental illness called psychosis soon after giving birth to her second child. While she was pregnant her husband lost his job and the family had to sell a cow so that they had enough money. Now Mrs Tigist can’t understand what is happening to her and is frightened that an evil spirit has possessed her mind. She believes she might die. The family take her to holy water but she doesn’t get better. They then spend a lot of money consulting the witch doctor (tanquaye), but again she doesn’t get better. The family cannot cope with Mrs Tigist’s disturbed behaviour and chain her up in the home.

SAQ 9.4 (tests Learning Outcomes 9.1, 9.4 and 9.5)

  • a.Using the biopsychosocial model, can you identify possible causes for Mrs Tigist’s illness?
  • b.What is an explanatory model?
  • c.What explanatory model does Mrs Tigist have about her illness?
  • d.How would you speak to Mrs Tigist about her illness?
  • e.What would you advise the family about the levels of healthcare available for Mrs Tigist?


  • 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.

SAQ 9.5 (tests Learning Outcomes 9.1 and 9.3)

Describe how mental health is important to the Millennium Development Goals.


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.

SAQ 9.6 (tests Learning Outcomes 9.1 and 9.6)

  • a.What is meant by the treatment gap for mental illness?
  • b.How can the Health Extension Service help to reduce the treatment gap?


  • 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.

Summary of Study Session 9