First person: Supporting mental health in Madagascar, one consultation at a time

Henrielle Emasignavy works for the WHO in Ambovombe, where the Androy Regional Referral Hospital is based. She spoke about the care given to people struggling with mental health crises.

“In Ambovombe town we are seeing a number of mental health issues including psychotic episodes, schizophrenia and depression.

There has been an increase in young people suffering from mental health episodes. We think that among young men it may be related to cannabis use, and among young women between 13 and 18 years old, it could be the breakup of a relationship or depression after the birth of a child.

One of the contributing causes for both men and women is the anxiety of constantly living in stressful conditions caused by the ongoing humanitarian crises in southern Madagascar.

We have recently experienced droughts and cyclones in different southern regions that have aggravated the effects of climate change and deeply rooted underdevelopment. This has left many vulnerable people living across the south struggling to survive. When crops fail, they have no safety net and often go hungry. Access to health and other social protection services can also be problematic.

'Victims of witchcraft'

I met a woman called Elodie who suffered postpartum psychosis after giving birth at age 20 and losing her child six months later.

When I met her, I noticed that a chain had been tied to her ankle.

Her mother told me it was for her own safety since her daughter was still trying to escape. There is a lot of stigma associated with people who suffer from mental health disorders. They are said to be “possessed” and victims of witchcraft.

Mental health problems are medically curable, but increasing ignorance and poverty force people to resort to drastic measures such as restraints, which aggravates the mental illnesses they suffer from.

Elodie's (right) mother (centre) says she has responded well to the medication.

Access to care

Accessing treatment is a huge challenge for patients. The nearest specialized hospital for mental health treatment is about 600 kilometers away, so to meet the growing need for services, WHO has brought in medical teams for regular outpatient care.

Over a three-day period, there were a total of 93 free consultations; 67 percent of those patients were women, including Elodie, who was seen by a neurologist. As a result of this consultation, she was administered medication that, according to her mother, is improving her mental health status. Elodie takes better care of her; for example, she takes care of her personal hygiene.

The WHO would like to see more services available for people like Elodie, and while it is clear that a visiting psychiatrist can only do so much, I am glad that we can help some patients on the road to recovery.

Elodie has the support of her mother and sister, but unfortunately the rest of the family rejected her and that is why she and her mother were forced to leave the family home.

Her mother hopes to make a full recovery soon so Elodie can return to living a normal life and earn some money and contribute to the family of three women.”