From prison to hospital: The evolution of Mental Health care in Malawi

Did you know that in-patient psychiatric services in Malawi started in a prison? That’s right, Zomba Mental Hospital – the main public in-patient psychiatric hospital in Malawi, – started out of Zomba Central Prison in 1910. It all started when wardens and other prisoners noted that some in-mates had poor mental well-being. These inmates afflicted with mental illnesses were kept in a separate area called the Zomba Lunatic Asylum. Though it may be a stretch to call it the first in-patient psychiatric services given the limited services provided for them, the Zomba Lunatic Asylum eventually evolved into the Zomba Mental Hospital, which opened in 1953. At this stage, Zomba Mental Hospital’s management was transferred from Zomba Central Prison to Zomba mental hospital under the Department of Health, thus marking the start of formal, in-patient psychiatric services for Malawians.

The first psychiatrist was appointed in 1955 to Zomba Mental Hospital.  Since then, individuals deemed to have mental aberration have been admitted there. These include individuals with various serious psychiatric illnesses (substance abuse, schizophrenia and related psychoses, bipolar disorders, severe major depressive disorder), intellectual disabilities, and uncontrolled epileptic disorders, among others. In the early 2000s, the Hospital was rebuilt and refurbished to improve the quality of the wards. Today, Zomba Mental Hospital is the main public in-patient psychiatric referral hospital in Malawi, with a bed capacity of 330.  The hospital is staffed with nurse technicians, psychiatric nurse practitioners, psychiatric clinical officers, occupation therapist, psychiatrists and psychiatric registrars (psychiatrists in training). It primarily serves the population of the Southern Region of Malawi, but also receives patients from other parts of the country.

This historical development of mental health care in Malawi is not different from most countries in the Sub-Saharan Africa region. Most patients were isolated in asylums in the 1900s, and later moved to large mental hospitals in the 1950s. These hospitals remained isolated and far from most communities, which resulted in limiting access to care and the development of stigma against people with mental illnesses.

Zomba Mental Hospital was not immune to this stigma, with stigma continuing to surround the hospital today. This stigma is generated by various causes. The first is the limited resources invested in the hospital, which contribute to an unpleasant hospital environment that seems unwelcoming to people. The second is the limited public understanding of the services available at the hospital, limited knowledge on the treatment that occurs once a patient is admitted to Zomba Mental Hospital and lastly, the limited understanding of different types of mental illnesses and that a patient with mental illness can recover with appropriate treatment and support they can get.

So, while I have little control to influence resource allocation to Zomba Mental Hospital, I will contribute to reducing the stigma caused by limited understanding of the mental health services available and the treatment that occurs once a patient is admitted.

Services and treatments at the hospital include in-patient admissions to enable appropriate evaluation and respite care, treatment with medication (pharmacotherapy), shock treatment (electroconvulsive therapy), occupation therapy, and forensic assessments among others. Teaching of various health professionals including doctors, psychiatrists, nurses, clinical officers and medical assistants, also take place at Zomba Mental Hospital.

There you go, this was a bit of history of Zomba Mental Hospital and psychiatric services in Malawi . We hope you enjoyed it, please share with us your thoughts by commenting on this post or via tlk.io on this site.

Reference

  1. Wilkinson MG. Malawi’s mental health service. Malawi Medical Journal. 1992;8(1):10-6.

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