Following many decades of sustained conflict, South Sudan is a country disproportionately afflicted with mental illness. The civil war threatens to make matters even worse.
The implications for our society are alarming. So, here is what you should know about mental health in South Sudan.
Just how bad is the situation?
A study from Juba found that 36% of respondents met the criteria for post-traumatic stress disorder (PTSD) and 50% for depression. These figures are significantly higher than global averages of 15% for PTSD and 17% for depression. Just take a moment to think about that.
- 2 out of 5 – South Sudanese suffer from post-traumatic stress disorder
- 1 in 2 – South Sudanese suffer from depression
Untreated depression often results in neglect of personal and professional responsibilities and significantly impacts daily life. It also negatively affects the lives of families. Severe depression may lead to suicide.
A study of ex-combatants found that 15% reported wishing they were dead or had thoughts of self harm, and 36% suffered for PTSD. PTSD prevents ex-combatants from re-integrating into civilian life. They often suffer from anxiety, depression, hostility and social withdrawal. Violence commitment by ex-combatants, be they fully demobilised or still in active duty, on the civilian population is a major problem. This has led some to suggest that military barracks are kept away from population centres.
Economic hardship and the change in living conditions for internally displaced persons or for the women of households whose main bread winner has left to become a combatant, often causes substantial psychological and social suffering in the short term. If not addressed, this suffering can lead to long-term mental health and psychosocial problems.
Depression and PTSD both lead to high instances of substance abuse, including alcoholism and drug taking. Both of these have a disruptive influence on family life and on society in general.
What services are being provided?
Virtually no services at all.
Like other low income countries, mental illness takes a back seat and priority is given to physical illness.
Juba Teaching Hospital is the only public medical facility in the country that treats mental illness—with only 12 beds. Hospital records show that treatment for patients is sporadic and rudimental. Patients are given regular doses of diazepam, a sedative and anti-anxiety drug.
Limited services are available in Wau and, before the civil war, had also been available in Malakal. Despite having better facilities than other hospitals, the military hospital in Juba only has a few staff members trained in psychology who carry out basic counseling.
Those at Juba Teaching Hospital are the lucky few. The vast number of mental illness sufferers are locked up in prisons so as to keep them from harming themselves and others. They are almost permanently shackled to the floor and are largely forgotten.
What’s the outlook for the future?
It’s difficult to be optimistic about the future.
The current conflict will only lead to an increase in psychiatric disease as more combatants and civilians are exposed to war time trauma. The economic crisis compounds the problem of under-investment by our government in services to address mental illness which will mean our capability to treat mental illness will decrease just as the number of cases increases.
The effects on our society will be felt for a long time to come. Besides the human suffering, we are facing increased violence both at home and in the community, committed by civilians and security personnel. We are likely to see more substance abuse, especially alcoholism. And we are like to see more apathy and neglect of work by able bodied members of society.
A collective NGO proposal suggests that our government should:
- Support the implementation of basic mental health services as part of the Basic Package of Health & Nutrition Services
- Make finance available for specialised training, equipment, drugs and personal to improve access to mental health services
- Implement findings from the 2001 WHO20 World Health Report on mental health in South Sudan
Assistance from Non-Governmental Organizations, international donors and the World Health Organization will be critical in the years to come. Otherwise we risk being overwhelmed.