Foreword

Childhood Schizophrenia and a word about Mental Health.

​

     There is a dearth of knowledge of the magnitude of psychiatric disorders in sub-Saharan Africa and in Malawi, in particular, due to a lack of robust research. The situation is even worse for childhood psychiatric disorders like schizophrenia. A community study done on the collective prevalence of common mental disorders among children and adolescents in the commercial city of Blantyre found a prevalence of about 7%.  Studies indicate that childhood-onset schizophrenia (COS) is rare, affecting about 0.4% children globally. However, this may not be a true reflection because in clinical practice, even in research, the process of diagnosing COS is characterised by challenges because its symptoms can be confusing with other common childhood mental and developmental disorders like Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

​

          Treatment of COS follows the same biopsychosocial model as in all mental health disorders to ensure that there is a holistic care. Biologically or medically, the main treatment line is the use of medications called anti-psychotics. Psychologically, there are different interventions which aim at challenging negative thoughts, increasing self-confidence, preventing harm, controlling unwanted behaviours associated with the condition like aggression, agitation, and social withdrawal. The common psychological approach used in schizophrenia is called Cognitive Behavioural Therapy (CBT).

           Malawians’ impressions or opinions about mental health until recently, have been negative. These perceptions are among other things, influenced by culture and most importantly, the history of the practice of mental health in Malawi.  Historically, mental health practice in Malawi originated at the Zomba Maximum Prison where a wing called Zomba Lunatic Asylum was established to take care of prisoners who were seen to have developed psychiatric conditions. Psychiatric disorders like schizophrenia were thus, perceived as diseases of prisoners and outcasts of society.  Furthermore, culturally, those suffering from mental disorders were thought to be demon-possessed and thus, were ill-treated and discriminated against. Given that Malawians, especially those in the rural communities, associate mental disorders with spirituality, this affects their health-seeking behaviour and pathway to care.

       To make provision for the care of persons with mental disorders like schizophrenia, Malawi has legislation in the form of an Act called the Malawi Mental Treatment Act. Unfortunately, the Act is way too old as it was enacted in 1959 and got amended in 1968. The implication of having an old Act like this is that some provisions may not resonate well with the way of life in recent times for example, as of 2023, suicide was a criminal offence and any person found to have attempted suicide could be prosecuted. This is contrary to current international practice where suicide is no longer a criminal offence. The good news is that there are plans to replace the archaic legislation with a new one and this process has been initiated with the development of a new Mental Health Policy (2021). However, the process has been too slow because, this new policy, replaces another policy of 2000-04, which failed to see the enactment of a new Mental Health Act.

Dr. Precious Makiyi

Child and Adolescent Mental Health Specialist

MSc CAMH, MBBS

Malawi, April 2023.