Mental health in the Republic of The Gambia

Abstract

The Republic of The Gambia, on the west coast of Africa, is a narrow enclave into Senegal (which surrounds the nation on three sides), with a coastline on the Atlantic Ocean, enclosing the mouth of the River Gambia. The smallest country on mainland Africa, The Gambia covers 11 295 km2 and has a population of 1705 000. There are five major ethnic groups: Mandinka, Fula, Wolof, Jola and Sarahuleh. Muslims represent 95% of the population. English is the official language but a miscellany of minor languages are also spoken (Serere, Aku, Mandjago, etc.). The Gambia has a history steeped in trade, with records of Arab traders dating back to the ninth century, its river serving as an artery into the continent, reaching as far as Mauritania. Indeed, as many as 3 million slaves were sold from the region during the trans-Atlantic slave trade. The Gambia gained independence from the UK in 1965 and joined the Commonwealth of Nations.

Barriers to accessing mental health services in The Gambia: patients’/family members’ perspectives

“… 9 Family decision-making about the perceived cause of mental illness is problematic as it can either delay care seeking or lead to no care being provided at all, because of an assumption that the condition will go away spontaneously. The scarcity of mental health services in the Gambia 8 hinders individuals from accessing services, as they would either have to travel to the city or use alternative services that are traditional in character. This finding is consistent with findings reported from Nigeria and Ghana, 10 , 11 where mental health services are also significantly skewed in favour of urban populations.…”

Quality of care and respect of human rights in mental health services in four West African countries: collaboration between the mental health leadership and advocacy programme and the World Health Organization QualityRights initiative

“…These findings reflect those of previous studies in West Africa. [3][4][5][6][7][8] More resources need to be allocated by the governments to improve the facilities' environment and make the buildings disability-friendly (e.g. ensuring that the entrances do not have stairs, the doors are wide enough to accommodate wheelchairs, there are hand-bars near toilets and bathtubs).…”

“…2 Countries in West Africa face similar challenges. [3][4][5][6][7][8] In these countries, the mental health budget ranges from 0.5% (The Gambia) to 1.3% (Ghana) of the total health budget. 7 Community-based models of care are not present in many places, and the main providers of mental health services are psychiatric hospitals.…”

Burden on Caregivers of Schizophrenic Patients at Polyclinic Outpatient Psychiatric Department, Edward Francis Small Teaching Hospital, the Gambia

“…Schizophrenia is the second highest recording number of patients seen in this clinic, thus, raising concern among the hospital authorities (Tanka-Tanka, annual reports from 2014 to 2020). A study conducted in The Gambia, the commonest disorders leading to admission are substance misuse (most frequently cannabis misuse), schizophrenia, organic psychoses and affective disorders [14]. Similarly, the community data revealed that 48% of the mental health burden is accounted for by schizophrenia, 23% by epilepsy, 16% substance misuse, 3.4% depressive disorders, 4.9% anxiety disorders, 1.6% dementias and 0.4% post-malaria neurological symptoms [13].Although there is limited information on the burden of caregivers of schizophrenic patients in The Gambia, clinical observation has shown that the caregivers frequently have psychological breakdowns, societal discrimination and stigmatization and nancial problems (buying medication and other needs) as a result of caring for their patients.…”

“…Schizophrenia is the second highest recording number of patients seen in this clinic, thus, raising concern among the hospital authorities (Tanka-Tanka, annual reports from 2014 to 2020). A study conducted in The Gambia, the commonest disorders leading to admission are substance misuse (most frequently cannabis misuse), schizophrenia, organic psychoses and affective disorders [14]. Similarly, the community data revealed that 48% of the mental health burden is accounted for by schizophrenia, 23% by epilepsy, 16% substance misuse, 3.4% depressive disorders, 4.9% anxiety disorders, 1.6% dementias and 0.4% post-malaria neurological symptoms [13].…”