Treating Schizophrenia Globally: Training, Medication Access, and Tackling Stigma

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As we celebrate World Schizophrenia Day on May 24th, I reflect on my own recovery from schizophrenia, which has lasted 13 years, thanks to excellent medical care in the United States. I also reflect on the experience and treatment of schizophrenia throughout the world.

The incidence of schizophrenia is about 1% worldwide (1), with males at higher risk of developing schizophrenia (2), the disease affects every country, culture, ethnicity, and people of any socioeconomic status, just like most other medical illnesses.

The stigma of schizophrenia continues to be strong, though it is lesser in developed nations. While the stigma of anxiety, depression, and even bipolar disorder in the past decade seems to be abating, the stigma of schizophrenia strongly lives on. Members of the general public may not understand that schizophrenia is a treatable brain disorder, and many patients recover and resume their lives.

Throughout the world, there is a shortage of mental health workers. The World Health Organization’s Mental Health Atlas 2017 reported that in low-income countries, the rate of mental health workers could be as low as 2 per 100,000 population, compared with more than 70 in high-income countries (3).

During my college years, I spent two months living in a slum area of Nairobi, Kenya, and a week in Lagos, Nigeria. I have developed a love and passion for the people of Africa. During my stay, I do not remember encountering anyone who was obviously affected by mental illness. Today, considering all the resources available to me during my journey to recovery, I feel especially passionate about treating the mentally ill in developing nations.

I am honored to be friends with an American couple who are both psychiatrists trained in Ohio. They spent months working in West Africa as psychiatric physicians and are currently training in Kenya to study the East African culture and learn to practice medicine most effectively in Africa.

While in West Africa, this couple encountered desperately psychotic people who were tied or roped like dogs. These individuals were suffering without any form of mental health treatment. Unfortunately, when medications are offered in this part of the world, the only ones available are often older antipsychotics with harsh side effects. Some medications are totally ineffective due to being outdated or corrupted with various substances.

Psychiatrists practicing in developing parts of the world may be more likely to encounter primitive beliefs, such as believing that psychotic behavior results from demon possession.

Families living in impoverished parts of the world often cannot afford food, or the most basic medical treatment, let alone pay for psychiatric intervention and/or medication. Lack of psychiatric medication is tragic for depression and anxiety, but even worse when the patient is experiencing psychosis.

While living in Kenya, I met a Rwandan man and his family who were on an extended visit to Kenya. He had completed a master’s degree in counseling, and his dream was to return to Rwanda to counsel people who had suffered through the genocide in 1994. What better experience could a struggling Rwandan have than to work with a highly educated man from his own country, speaking his own language, who had fled the genocide himself? Through the passion and drive of individuals like this man, there is hope.

The best scenario for sustained improvement in psychiatric treatment throughout the world is to train professionals in their home countries to become psychiatric nurses, doctors, counselors, and psychiatrists. Having a patient treated by a clinician who speaks the language and knows the culture may be the key to better outcomes.

When my psychiatrist friends were living in West Africa, they spent much of their time training nurses to deal with mental health emergencies and psychosis. But I look forward to a time when more of the best psychiatrists, nurses, and other professionals, many of who train in the United States or other parts of the developed world, decide to return to their home countries to serve and train their own people.

In addition to training clinicians and counselors, a steady supply of antipsychotic medication needs to be available. When I was living in Kenya, an American doctor brought in a supply of antibiotics and administered them to the needy. Bringing antipsychotics into the developing world is much more complicated, as these medications need to be taken regularly, indefinitely.

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It is always important to open our eyes to the needs of people living far away. Mine were opened wide when living in Africa.

I hope to one day live in a world where even the poorest individuals can obtain badly-needed and high-quality treatment for brain disorders, wherever they may reside.