Mental Health in The Gambia

In 2003, mental health advocates bought complaints on behalf of patients detained at Campama, the only psychiatric inpatient facility in the Republic of The Gambia, to the African Commission on Human and People’s Rights. These complaints painted a bleak picture of the treatment of those with mental illness.

The case argued that the governing mental health law, known as The Lunatics Detention Act, was archaic and ineffective. Within the act there was no legal definition of ‘lunatic’ and no safeguards or provisions to protect those who would be diagnosed and detained under the act. Patients detained under the act had no right to vote or seek compensation if their rights had been violated.

Furthermore, the case highlighted the poor conditions at the Campama facility. Overcrowding was rampant and there was no process to independently examine the administration, management and living conditions within the facility.

Sadly, this case is simply a reflection of the social and political attitude towards mental health in  Gambia.

Despite the fact that a significant number of people in Gambia are affected by mental illness (some estimates are as high as 13%), almost 90% of people with a severe mental illness do not have access to treatment. Mental health services in Gambia were not integrated into general health services. There was a clear lack of investment within mental health services. The government budget had no specific allocation for mental health, and the majority of the financing towards mental health comes from grants. Most of the funding available was redirected towards the upkeep of the Campama unit. Furthermore, lack of trained staff was also a major issue. None of the major health centres in the nation had specifically trained mental health workers, and a few providers in minor healthcare facilities had the knowledge and skills to provide adequate care.

The African Commission on Human and People’s Rights found The Gambia to be in violation of multiple articles of the African Charter.

Seventeen years have since passed. Has The Gambia changed its approach to mental illness?

In 2004, the Department of State for Health and Social Welfare in The Gambia, in conjunction with the World Health Organisation (WHO), detailed a plan aimed at ensuring effective and humane mental health treatment and care for the nation’s citizens. It aimed to do so by;

  • Increasing awareness of mental illness
  • Better mental health services
  • Creating a supportive environment through engaging community leaders, traditional healers etc.
  • Developing modern legislation to protect and promote the human rights of people with mental illness.
  • Developing a mental health policy

Since then, some progress has been made.

In 2005, the WHO collaborated with the Department of State for Health and Social Welfare to arrange a technical workshop on mental health policy. This workshop included reviewing the mental health policy that was being drafted and commentary from WHO-trained technical workers was incorporated. The Gambia Mental Health Strategic Plan was implemented in January 2007 and planned to run until 2012.

As part of this plan, the Campama Unit was closed, and a new psychiatric facility opened in 2009. The Tanka-Tanka Psychiatric hospital has dedicated staff trained in providing cognitive behaviour therapy, psychotherapy, psycho education and individual counselling. On the occasion of World Mental Health Day, the hospital arranges workshops to train healthcare workers on how to psychosocial support. These workshops have been consistently held with the last workshop taking place in November 2020 with 500 attendees.

However, key recommendations by the African Commission have not been implemented.

Legal experts in The Gambia are frustrated that the Lunatic Detentions Act has not yet been repealed or amended. The draft Mental Health Bill that had been recommended by the Commission is still on hiatus at the National Assembly.

In 2012, the WHO summary Report on Mental Health in The Gambia stated:

…Mental health services are very limited in the Gambia; there are significant gaps in capacity, human resources, materials, medication and outreach services, most of which stem from very limited budget allocation (about 0.5% of the national health budget is spent on mental health services)”

Though the opening of the Tanka-Tanka hospital was a significant milestone, no further psychiatric units or hospitals have been opened since.

The mental health crisis is predicted by some to be the next pandemic. Historically, infectious disease and maternal health were considered to be the major healthcare issues in low- and middle-income countries (LAMIC)s. However, the WHO have identified that ‘there is no health without mental health’ and that mental health is becoming a large proportion of the disease burden in LAMIC. Though the pandemic has necessitated diverging the budget towards controlling the spread of COVID-19, mental health must not be forgotten. Further investment is needed to ensure that the 118,000 people with mental illness receive adequate treatment and care.

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