*Stephen is a 30-year-old psychiatric inmate in the psychiatric wing of Chikurubi Maximum Security Prison, on the outskirts of Harare, Zimbabwe. His name has been changed to protect his identity.
While at home one day, Stephen heard voices from what he thought was the army. They were telling him he must take his family and leave his home. These voices told him that if he did not do this, the army would come and kill them all.
Stephen told his family, but they ignored what he said and the voices in his head grew louder. They were now telling him that if he and his family didn’t leave, he must kill his wife and children before the army arrived. His family, confused by Stephen’s ideas, again refused to leave their home.
By the next morning, Stephen had murdered his wife and three children.
Imprisonment and Aid
The next thing Stephen remembers is finding himself at Chikurubi Maximum Security Prison’s psychiatric unit in Harare, Zimbabwe, where Doctors Without Borders/Médecins Sans Frontières (MSF) has run a mental health program since 2012.
As a new inmate in the mental health wing, Stephen was assigned to Emmerson Gono, a clinical psychologist who has been working at the with MSF for four and a half years. When Stephen first arrived, Gono asked him if he knew why he had been imprisoned. But Stephen’s psychosis had subsided and he couldn’t remember anything from the previous three weeks. After Gono’s careful explanation, and upon realizing what he’d done, Stephen was inconsolable.
According to Zimbabwe’s Ministry of Health and Child Care, there are at least 1.3 million people living with mental illness in Zimbabwe. Despite the growing numbers, there are dire shortages of mental health resources like staff and drugs. There are just 20 registered clinical psychologists and nine public mental health institutions in Zimbabwe, a country with a population of over 14 million people. This means that for many Zimbabweans, mental health support is out of reach.
Understanding Psychiatric Care
Stephen is one of about 300 inmates at the Chikurubi Maximum Security Prison’s psychiatric unit. According to Gono, Stephen's story, while extreme, illustrates the situation many patients find themselves in when their illness is left undiagnosed and untreated. "When you are a professional, you realize that the patient committed a crime because of mental illness and they need help," he says. "No matter how heinous their offences are, they still need help, they are still human beings."
The lack of mental health care resources isn’t the only challenge patients face—for many, the stigma associated with mental illness can be even more debilitating. Gono has seen it first hand. "If you work and play with kindergarten children for a long time you end up behaving like them," his friends tell him. "If you spend time with mental patients, you also end up being like them." Words like these remind Gono just how misunderstood mental illness still is. But he's not discouraged. "If I don’t go into prison to help mental patients, who will?" he says. "My wish is to see a shift from institutionalized mental health services to community mental health services. I want to see patients getting services closer to home in their community rather than being institutionalized. The best form of treatment for mental patients is not coming from us professionals in a jail or a hospital—it’s in their homes, and with the support of their family."
MSF has supported the Zimbabwe Prisons and Correctional Services (ZPCS) to provide diagnosis, treatment, care, and support to inmates with psychiatric disorders, HIV, and tuberculosis at Chikurubi Maximum Security prison's male and female psychiatric units since May 2012. MSF also supports eight other selected prisons in the Mashonaland provinces with mental health training programs.
In October 2015, MSF launched a mental health project at Harare Central Hospital's psychiatric unit. The organization has since constructed an outpatient department (OPD) and renovated the male and female acute and sub-acute admission wards with 100 beds. MSF also provides community mental health services through the discharge team, which follows up discharged patients to review them at their nearest clinic in Harare.
"My wish is to see a shift from institutionalized mental health services to community mental health services. I want to see patients getting services closer to home in their community rather than being institutionalized. The best form of treatment for mental patients is not coming from us professionals in a jail or a hospital—it’s in their homes, and with the support of their family."
Emmerson Gono
