‘Let’s talk about mental health’

They were old, frail and defenceless women from Ha-Kholoko village in Roma, who were stabbed to death with a spear during a deadly night. Their crime? They were accused of being witches. Three suspects, all from Ha-Kholoko village, have since appeared before a High Court judge to answer a charge of murder.

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They accused the women of bewitching one of their relatives who had died.
In Sesotho culture, no one just dies. Someone causes their death. And in this case, the blame was put on the three elderly women.

They were, however not given a chance to defend themselves; they were just bludgeoned to death. Even if they screamed, no one was there to help them.
Stories of this nature are all too common in Lesotho where belief in witchcraft is rife.

’Makamohelo Malimabe, who is leading a Mental Health for Public Health project in Lesotho, says such issues are a reflection of the huge challenges facing Basotho.

“Mental health symptoms are largely misunderstood,” she says. “And so when you have nkhono (grandmother) in the community, facing early signs of cognitive decline, when they are less aware of themselves and their environment, our default position as Basotho is to say they are witches.”

She says some of the old women have been beaten and violated for things that can be clearly explained as early signs of cognitive decline and the early onset of dementia.

“One day this person knew who they were, but now that they are 70, they don’t know who they are and what’s happening to them mentally; we as Basotho resort to calling them witches,” she says.

Malimabe, together with two other colleagues Grace Sello and Sello Ramokanate, are spearheading the Mental Health for Public Health project which seeks to fight these misconceptions about mental health.

She says the project will also seek to address some of these challenges by proving a platform to Basotho to talk about these issues.
The project will also seek to improve mental health services in Lesotho.

Malimabe says the project will carry out training programmes in all districts of Lesotho. It will also seek to raise awareness on issues of mental health and promote dialogue among Basotho who work in mental health services.

She says there is a lot of stigma surrounding issues of mental health in Lesotho. The project will seek to destigmatise the illness by sharing information on mental health.
“There is a lot of resistance, which can be attributed to compromised information about what mental health is,” she says.

“We will share critical information on mental health in an effort to improve mental health services and scale up mental health care in Lesotho.”
Malimabe says Lesotho is dealing with a serious mental health crisis.

Dr Daniel Vigo, a Harvard University researcher, says a fifth of Lesotho’s 2.2 million people, about 440 000 people, are suffering from some kind of mental illness.
“That’s a high number,” she says. “We may not be aware of who does because of our inability to immediately identify mental health symptoms as per how they present in Lesotho. They can be attributed to witchcraft, or bad spirits or other things.”

“So we end up missing cases of mental illness. But based on research and WHO (World Health Organization) numbers, mental health issues are high and very prevalent in our country,” she says.

She says their project will seek to raise awareness on mental health challenges.
“We want them to have sufficient information to be able to identify when they are being presented with mental health symptoms, mental illnesses and mental disorders,” she says.
“What we are hoping to achieve at the end of the day, is to optimise care where mental health is not a neglected problem.”

She argues that at present, issues of mental health are at the bottom rung of the ladder as compared to other health issues such as HIV/AIDS.

“We are seeing heightened programmes in HIV, but when you look at mental health, we are not seeing as much work being done in that area.”

She says they want to “scale up mental health services in Lesotho to respond to global targets”.

At the end of the project, Malimabe says they hope to have disseminated sufficient information to villagers across the country so that they are able to identify mental health issues.

“We are going to work with clinicians, psychiatry nurses, counsellors, psychologists and social workers. With the information they will have, we are hoping there will be some kind of information cascade. Now that I have been trained to identify what psychosis looks likes, I think this is what you need to do,” she says.

“We are hoping to have some sort of intervention that is specific to our context, that will say we have done this, and we think this works. We are hoping to normalise mental illnesses in our context so that they are not as taboo as they are now.”

She says they “want people to talk openly about their challenges”.

“We are hoping that through such training, the mental health champions will be improved in communities.”

She says what inspired the project was a realisation that Basotho had their own ways of healing that worked perfectly before the advent of colonialism.
Malimabe says they want to explore some of those methods as part of community engagement.

“The interventions that have been tried in the past are actually what is guiding our project. We figured out that Basotho had their own ways of healing; they have always had them. When they are burdened with suffering, they go to traditional healers, they go to spiritual healers.

“They go to church leaders and share their challenges and burdens with pastors. This was central to our approach in dealing with mental health issues.”
She says while most Basotho go to hospitals and clinics, including Mohlomi Mental Hospital when they have symptoms of depression and mental health challenges, they had realised that is not the only place they go to when they have challenges.

“We thought since these practices, were used by Basotho in the past, and have always been there in the past, why can’t we uplift these again and ensure they are trusted again? We want to optimise what has already been there by bringing back trust in these services.”

She says there is secondary data from research that shows that traditional healing methods and spiritual healing practices, herbal treatment interventions have been found to be helpful.

“Clinical models have been tested and trials have been done, showing that they work,” she says.
“So it is on this basis that we think they work. We have a strong belief that they actually work when they are done right and they are channelled right.”
The project is being funded by the US Embassy Maseru of the US Department of State.

Participants can reach out to the project team on the following details : Tel +266 57975598 (WhatsApp available)
Email: mentalhealth4publichealth@gmail.com

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