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In the wake of the Newtown shooting, talk has been swirling about the need for more extensive background checks for gun buyers and, more importantly, an increased focus on mental health in the United States. The tragedy of the massacre at Sandy Hook Elementary has led me to reflect on the status of mental health in Malawi and, not surprisingly, the situation on this side of the Atlantic isn’t much better. The World Health Organization (WHO) estimates that as much as 40% of individuals attending outpatient clinics in sub-Saharan Africa have problems related to emotional or mental health, and that mental disorders are the fourth most common cause of disability in Malawi after HIV/AIDS, cataracts and malaria (Bowie, 2006 Malawi Med J ). However, the country has only 2.5 psychiatric nurses and less than 1 psychiatrist per 100,000 population (Jacob et al., 2007 The Lancet). The majority of mental health services are provided in primary care settings by medical assistants and/or clinical officers who, during their training, undergo a mere four weeks of psychiatry theory and clinical attachment at the country’s main psychiatric hospital (Kauye, 2011).

With so few options for treatment, those struggling with mental illness are often relegated to the outskirts of their communities and society, facing the same stigmatization that plagued – and continues to plague – those living with HIV/AIDS. The stigma and discrimination that so often accompany mental illness is strongly associated with suffering, disability and poverty. In many sub-Saharan African countries, the general public and medical professionals alike often attribute mental illness to substance abuse, sprit possession, stress, or a lack of willpower rather than recognizing it as a legitimate medical affliction (Crabb et al., 2012 BMC Public Health).

As a result, the mentally ill often suffer in silence. A few months ago, the girlfriend of a Malawian friend of mine was in a car accident. She escaped with only some minor bruises, but for several days after the accident, something still wasn’t right. She had difficulty falling asleep and would wake up suddenly with tremendous pain in her chest, as if someone were squeezing her heart in a vice. She returned to the hospital for more tests, but the doctors could find nothing wrong with her physically. When I suggested to her that perhaps the stress and mental trauma of being in the accident was causing these physical symptoms, she paused. “Yes,” she finally said. “But you have to understand that things are different here than they are in America. You can’t go to a psychiatrist. It’s not accepted.”

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