Bridging Gaps in Access to Mental Health Care in Malawi

The citizens of Malawi and other countries in Sub-Saharan Africa have a critical need for mental health services that has been compounded by the COVID-19 pandemic. Other factors such as widespread poverty, lack of transportation, inadequate human resources, and the stigmas and customary beliefs associated with seeking care present ongoing challenges to providing treatment for those in need.

Studies conducted by the World Health Organization have shown that 70% of African countries spend less than 1% of their budgets on mental health. Half of Malawi’s population lives below the poverty line, and the country’s current health care efforts are more focused on treating communicable diseases and issues related to hunger. Because mental health is health, the people of Malawi are especially vulnerable in that regard.

In an effort to address this urgent need for care, the Guidance and Counseling Association of Malawi (GCAM) advocates for mental health, educates and trains workers who provide care, mobilizes them, and works to expand access to telehealth services, among other measures.

GCAM President Gibozi Mphanzi and its co-founder, Diana Nyirenda, a project coordinator at the United Nations, recently shared some insights into Malawi’s mental health realities and how GCAM is working to bridge the country’s gap in access to care and promoting equity.

In what ways has the COVID-19 pandemic impacted mental health in Malawi?

Malawi has registered over 61,834 COVID-19 cases cumulatively with more than 2,301 registered deaths. COVID-19 brought fear in the lives of many Malawians. Almost everyone was scared to move about and be physically available for people, especially those in need. We are a very communal and physically engaging people in terms of our ceremonies, and all of that was banned and it almost became a criminal offense. This isolation brought along loneliness, which brought stress and then depression in some cases. 

For those that came too close to COVID-19 either by way of being sick or watching a relative die of the virus, there was trauma that was caused. Most of the victims of the virus would be talking in the previous two hours and then dead in the next two or so hours. That brought in so much trauma, because the deaths were as if they resulted from a fatal accident.

For those left behind as orphans, widows, and widowers, the gap that the deceased leaves behind is too huge so that no one is able to fill it. As a result, there is emptiness and lack of emotional support that is affecting their mental health.

What efforts have you made to address these challenges?

It is important to admit that this virus is pretty new to many people including most Malawians. The first thing was that GCAM mobilized its members to come together and do something. This did not even originate with the top leadership; it came from members. When members met, the first thing was to isolate myths from facts so that we worked from an informed stance. Thereafter the team provided refresher trainings for members to manage counseling sessions in which a client presents with stress, trauma, or grief. Members then formed a team that was on standby to be deployed with a short notice.  A list of these members that included contact details was generated and shared with the Ministry of Health and the Ministry of Education. An introductory session was held with Ministry of Health top management. In addition, individual counselors were practicing in their backyards to ensure social distancing. A consolidated total of 204 individual clients, (122 women and 82 men) have been supported by at least 20 mental health and psychosocial counselors who are GCAM members within their workplaces or at their private or voluntary place of practice during the surge.

How do you see the adaptations that you have made affecting mental health care in Malawi long-term?

The adaptations are very useful long-term. For instance, telehealth or Zoom counseling has made it possible for a counselor to provide care to a client who for one reason or another cannot manage to attend a physical session. We see this continuing to help bridge the gaps that are there sometimes. Of course, we must hasten to say that counseling a client remotely is challenging because in some cases the counselor is not able to use nonverbal or body language to express some emotions to the client. 

What feedback have you gotten from those who have received care, if any?

Mostly the clients have expressed so much appreciation for the care that was provided. The reassurance that was provided helped my personal clients to recover. Many of them tasted counseling for the very first time and were able to appreciate how the counselors were able to touch the lives of the clients deeply. 

What are your hopes for the future of Malawi’s citizens regarding mental health care?

Our hope is to see the counseling profession grow and become more acceptable and accessible in Malawi. This has already started to happen; two of our colleagues have been hired by government health institutions. This means that Malawians will manage to access the services with ease.

Is there anything else about your work, or mental health care in Malawi, that you would like to highlight?

The volunteering spirit that has been—there have been so many phenomenal counselors willing to step up just like the medical practitioners in order to care for those in need.

Secondly, the career is just in its infancy stage. There is a lot that needs to happen. For instance, the institutions need to have their curriculum vetted by the Medical Council of Malawi. This process was not properly done by some institutions that were training counselors in the past. These processes need to be done in order to have all counselors registered. Efforts are under way to have this sorted out.

Partnerships that have been there between the Guidance and Counseling Association of Malawi (GCAM) and NBCC have been very crucial in the development of counseling as a profession in Malawi. The moral support as well as the technical and financial support have all been priceless. Just as a baby needs a mother and other adults to thrive, so does GCAM, and I am also sure there are ripple benefits that apply to NBCC in partnering with upcoming associations like GCAM.