Rising rates of mental and emotional illness in Zambia are being met with growing levels of stigma and discrimination, with sufferers often isolated by their communities.
Nora Mweemba, a health information promotion officer for the World Health Organisation (WHO) in Zambia, told IRIN, "Mental health problems are on the increase among the population in Zambia, mostly because of the socio-economic difficulties that exist in this country - HIV/AIDS, poverty, joblessness - they all precipitate mental problems."
Zambia has about 10 million people, an HIV prevalence of 17 percent and only about 400,000 formal jobs; over 68 percent of the population live on US$1 or less a day, according to the government's Central Statistical Office.
Bwalya Mubanga, 31, has lived in seclusion in the capital, Lusaka, for nearly five years since he was discharged from Chainama hospital, the country's biggest treatment facility for mental health problems.
"It is a very depressing situation; many people shun me, some say I am a mad person and that I can become violent anytime - I am not even invited for community programmes or public meetings in my area," Mubanga told IRIN.
"Before I started suffering from the problem I worked as a cashier in a supermarket. I became very depressed when I was abruptly retired and, after coming out of the hospital, I have been looking for another job. Everyone is refusing to give me a job around here; they say they can't employ a mad person."
The WHO estimates that about 14 percent of the total global disease burden could be attributed to mental health, and as much as 40 percent of people attending outpatient clinics in sub-Saharan Africa have problems related to emotional or mental health.
Punishment by God
"Unfortunately, while mental health problems could be on the increase, stigma and discrimination seems to also be growing. People who suffer from mental health problems are highly stigmatised; most of them don't even come out in the open to receive treatment because communities still regard mental health as a misfortune in the family, or some form of punishment [from God]," the WHO's Mweemba said.
Sylvester Katontoka, president of the Mental Health Users Network of Zambia, a civic organisation of people who have experienced emotional difficulties, told IRIN: "As many as one million people could be affected by mental health problems in Zambia, and we need to undertake powerful awareness campaigns against stigma, discrimination, marginalisation and exclusion.
"Most of our members are sidelined from developmental projects after undergoing treatment in the communities where they live. This makes them to continuously live in poverty, and we have high numbers of our people having relapses as a result. It is a cost to the country because our members, who are just languishing in destitution, are still capable of contributing to national development but they are not being given a chance."
Although the government and the WHO have yet to publish statistics on the number of people with mental illnesses, John Mayeya, a mental health specialist with the Ministry of Health, said the Zambian government was prioritising mental health issues.
"We intend to roll out mental health services in the communities. We shall do this by empowering some NGOs [non-governmental organisations] with funds to trace and track all the [treated] former mental health patients in the country. We shall be giving these former mental patients some form of seed money, so that they do not have to over-depend on scarce formal jobs alone," Mayeya said.
Last year the government developed a four-year mental health strategic plan, identifying key areas of intervention such as human resources, mental health service delivery, monitoring and evaluation.
Government is also reviewing the Mental Health Act's language, promulgated in 1951, and is routinely criticised for perpetuating stereotypes through the act's use of pejorative language, such as 'imbecile', 'idiot', 'stupid' and 'mentally-invalid person', when referring to mentally challenged people, or anyone who has undergone treatment.