Suicide Prevention

Risk of suicide

Thoughts or behaviours of suicide are both damaging and dangerous and are considered a psychiatric emergency. Someone experiencing thoughts of suicide should get immediate assistance from a health or mental health professional. Those experiencing suicidal thoughts should not be considered as weak or flawed, they can be as a result of a mental health illness. We should be aware that they can occur to anyone.

Warning signs of suicide

• Threats or comments about killing themselves, also known as suicidal ideation, can begin with seemingly harmless thoughts like “I wish I wasn’t here” but can become more overt and dangerous
• Increased alcohol and drug use
• Aggressive behavior
• Social withdrawal from friends, family and the community
• Dramatic mood swings
• Talking, writing or thinking about death
• Impulsive or reckless Suicide

Signs of impending danger

Any person exhibiting these behaviors should get care immediately:

• Putting their affairs in order and giving away their possessions
• Saying goodbye to friends and family
• Mood shifts from despair to calm
• Planning, possibly by looking around to buy, steal or borrow the tools they need to complete suicide, such as a firearm or prescription medication

If you are unsure, a licensed mental health professional can help assess risk.

Suicide risk factors

Research has found that more than half of people (54%) who died by suicide did not have a known mental health condition. A number of other things may put a person at risk of suicide, including:

• A family history of suicide.
• Substance abuse. Drugs and alcohol can result in mental highs and lows that exacerbate suicidal thoughts.
• Intoxication. More than one in three people who die from suicide are found to be currently under the influence.
• Access to firearms. 
• A serious or chronic medical illness.
• Gender. Although more women than men attempt suicide, men are four times more likely to die by suicide.
• A history of trauma or abuse. 
• Prolonged stress.
• Isolation.
• Age. People under age 24 or above age 65 are at a higher risk for suicide.
• A recent tragedy or loss.
• Agitation and sleep deprivation.

Can thoughts of suicide be prevented?

Mental health professionals are trained to help a person understand their feelings and can improve mental wellness and resiliency. Depending on their training they can provide effective ways to help.

Psychotherapy such as cognitive behavioral therapy and dialectical behavior therapy, can help a person with thoughts of suicide recognize unhealthy patterns of thinking and behavior, validate troubling feelings, and learn coping skills.

Medication can be used if necessary to treat underlying depression and anxiety and can lower a person’s risk of hurting themselves. Depending on the person’s mental health diagnosis, other medications can be used to alleviate symptoms.

 

If you or someone you know is in an emergency, please contact a mental health professional as soon as possible. You can also call 0992717232/0880234250 (Queen Elizabeth Central Hospital, Blantyre, Malawi) to speak to a mental health professional between 8am and 4pm.

 

Reference

1. https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Risk-of-Suicide

 

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.

Where to find Psychiatrists and Psychologists in Malawi

Malawi has a limited number of psychiatrists and psychologists, it can be hard to find one. You do not have to struggle alone with stress and any other mental health issues. You can contact them wherever you are.

In Blantyre, there is a psychiatrist at Queen Elizabeth Central Hospital alongside a competent and dedicated team of mental health practitioners. The team has special expertise in problem solving therapy. At Mwaiwathu Private Hospital there is a part-time psyiatrist and psychologist. At College of Medicine Private Clinic there is a team of psychiatrists and psychologists.

In Zomba, there are psychiatrists at Zomba Mental Hospital.

In Lilongwe, there is a psychiatrist at Kamuzu Central Hospital.

If you are in need, please do not hesitate to reach out and get the support available to you now.