Addressing Misconceptions and Eliminating the Stigma: Mental Health in Malawi
Amelia Rutter, Seed Global Health
According to the World Health Organization, one half of all mental illness starts by the age of 14, but most cases remain untreated. World Mental Health Day, marked every year on October 10, provides a moment to pause and recognize the need to prioritize access to mental health care, remove the stigma and raise awareness for the treatment and prevention of mental illness worldwide.
To learn more about misconceptions in mental health, we spoke with former volunteer Amelia Rutter. She served in Malawi from 2016-2017 at St. John of God College of Health Sciences. She spoke of her time in Malawi, and how it has continued to impact her work as a family nurse practitioner now that she’s home in the United States. .
1. How did you initially become involved with Seed Global Health/Global Health Service Partnership (GHSP), and what are you doing now?
I am currently working as a family nurse practitioner at a Federally Qualified Health Center in Yakima, WA -- the same clinic where I worked prior to my time in Malawi. I’d always shared my interest in working internationally with the administration at the clinic, and they were flexible and kind enough to give me a leave of absence for my time to serve with GHSP. In many ways the clinic prepared me well for my time in Malawi, and has been the perfect place to return to.
I initially heard about Seed Global Health and GHSP while I was still in nursing school. I had served as a Peace Corps Volunteer prior to nursing school and always thought I would take my nursing career internationally at some point. It gave me the opportunity to serve in a capacity that I felt contributed to the strengthening of a health care system.
2. What are some common misconceptions about mental health that you've encountered? How do you respond?
I do feel that there is a growing understanding of mental health conditions, as well as a greater appreciation for importance of mental health care in our country. More people now understand that a mental health condition can and must be treated -- it is not something under the control of the individual. That being said, mental health issues are still stigmatized. Stigma is a powerful thing, deeply ingrained in societies and cultures. My students in Malawi often stated that they even felt stigmatized by working in the mental health field.
In my current clinical practice, I try to address misconceptions by openly discussing mental health with all patients that I see. Starting a conversation is the first step with an individual and will hopefully lead to more people addressing the mental health issues they may be dealing with.
I also think increasing access to care will help decrease the stigma and misconceptions surrounding mental health disorders. Access to mental health care is a huge issue here in the US and an even larger issue in many countries. In Malawi for example, there are only .01 psychiatrists working in mental health per 100,000 people compared to 12.4 in the US.
3. Is there an experience that has stuck with you?
I spent a morning on the inpatient psychiatric unit to provide clinical supervision to the mental health-psychiatric nursing students. One student engaged a client who was admitted with a diagnosis of alcohol intoxication – he was brought in by family members who had tied his wrists and ankles together due to his aggressive behavior. I observed as the student collected a patient history in a non-judgmental, empathetic manner. The student spent time answering all the questions the patient had – about his options for addiction treatment, what medications he was on, if there was financial assistance. He addressed this patient as a fellow human being and I felt hope; hope that our daily interactions with people can make the world a kinder place. I observed another student conduct a group therapy session, engaging six clients with a range of different psychiatric disorders in a reflective group discussion – each client was given time to speak and feel valued. Those experiences have stayed with me.
4. How has your time volunteering in Malawi continued to impact your current work?
My time in Malawi taught me flexibility and patience, and showed me on a daily basis how adaptable the human spirit can be. I learned from my Malawian colleagues that just showing up, as well as persevering through whatever the day brings you, has a huge impact on those you work with and the patients you are treating.
As a primary care provider, mental health care is just one element of the comprehensive health care I administer, but having spent a year focused on mental health in Malawi, I now make sure to incorporate mental health best practices into the care that I provide for each patient. My time in Malawi has made me more resourceful and more open to reaching further for treatment modalities. I continue to dream about a more holistic model for mental health treatment in this country.
5. What’s the most important thing about working in mental health that you would want the world to know?
My students often repeated, “there is no health without mental health.” If the world starts talking more about mental health, and it’s integrality to total wellbeing, we will be taking the first step towards eliminating the stigma that is still so prevalent.