In developing countries, mental health care is very limited.

Due to stigma towards mental illnesses, mental health care is often drastically under funded. This means that psychiatric services cannot be offered throughout the country.

In most countries the psychiatric services are just located in the capital city. These services are inadequate to cope with the demand.

In many countries, there are very few psychiatrists working in the public sector. In Tanzania, there are only six psychiatrists. In Ghana there are only four. In Laos PDR, there are only two. Often, there is only one psychiatrist for a million people. Quite regularly, the figure is much worse than that.

The stigma towards mental illness even extends to the psychiatric profession itself. People believe that psychiatrists and mental health staff become mentally ill through working with mentally ill people.

Their medical colleagues even stigmatise them. For example, in Accra (the capital of Ghana), community psychiatric nurses at one local clinic are forced to use a small office in a little hut located around the corner from the main building.

Psychiatric treatment is usually focused around admission into a psychiatric hospital. Community-based treatment available locally is not considered as an option. These hospitals can be very bad with mentally ill people sometimes being chained and beaten.

The Indian Human Rights Commission described Indian Psychiatric hospitals as being:

“…dumping grounds for families to abandon their mentally ill member…The living conditions in many of these settings are deplorable and they violate an individual’s right to be treated humanely and live a life of dignity. Despite all the advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration…Their role is predominantly custodial…Medical treatment is used to keep patients manageable…” (Human Rights Commission (1999) Quality Assurance in Mental Health. New Delhi.)

In Accra Psychiatric Hospital (one of only three psychiatric hospitals in Ghana), there is a lot of overcrowding, with a skeleton staff only able to monitor patients rather than treat them. Overcrowding leads to patients sleeping on the floor and outside.

Along with a lack of treatment and mental health services, mentally ill people are also struggling to get effective medication.

Governments often have lists of essential drugs that are free or very cheap. Unfortunately, due to stigma towards mental illnesses, the cost of the drugs and the chronic nature of the illness, the medication that mentally ill people need is usually not on these lists.

Any medication that is on the list is often very old, meaning that they often have a large amount of adverse side effects. These side effects make it very difficult for medication compliance; mentally ill people often feel worse taking the medication than they do if they didn’t take it. This can lead to their families and communities getting angry and disheartened with the mentally ill person; they feel that the mentally ill person doesn’t want to get better.

Mentally ill people are forced to get the medication they need on the open market and this is very expensive – far too expensive for the many desperately poor mentally ill people we work with.

Many mental illnesses are easily treatable and once the right medication is administered, the change in behaviour and the relief bought to the sufferer is remarkable.

Such a simple step, like getting the right medication, can have a massive effect on a life, bringing irrevocable change. Unfortunately, for most mentally ill people, this hurdle is too big for them to overcome.