An incongruence between policy, practice, and cultural values: implications for mental health services in Namibia

ABSTRACT

Mental health access, provisions, and utilization of social services in Namibia have seen challenges as well as opportunities for improvement. In this article, the authors 1) discuss Namibia’s antiquated mental health law and policies, 2) discuss the current landscape of social work and mental health in Namibia and similarly situated countries, 3) explore five-to-ten year projections for development, 4) discuss preventative and innovative solutions to address mental health in Namibia in the context of the grand challenge related to eradicate social isolation, and 5) explore opportunities for social work practice and research.

KEYWORDS:

• Mental health or community mental health
• family services
• social work education and training

Introduction

Africa is rich in people, culture, and mineral resources (Chiwara & Lombard, 2022; Izvorksi, 2018), yet it is also the most impoverished low-income continent in the world (Hamadeh et al., 2022). It is also one of the most colonized by European nations (Settles, 1996). Namibia, a former colony of Germany and later apartheid South Africa gained its independence in 1990 (Bartholomew & Gentz, 2019; Chipare et al., 2021). Although classified by the World Bank as lower middle-income country, it is reported as having the highest income inequalities in the world according to the Gini Coefficient, which is the most commonly used measure of inequality (Ananias & Lightfoot, 2012; Hasell, 2023). The country ranks 4th in suicide in Africa (World Health Organization, 2022b) and is characterized as a nation whose mental health is in a poor state due to past European domination and racial oppression (Ministry of Health and Social Services, 2005). As a southwest African country of approximately 2.5 million people, it is reported that per 100,000 persons, the main providers of mental health services in Namibia include psychologists (0.12; n = 3), mental health nurses (0.28; n = 7), other mental health workers (e.g., occupational therapists) (0.16; n = 4), psychiatrists (0.12; n = 3), and social workers (0.16; n = 4) (World Health Organization, 2020). As seen here, social workers are in short supply in this country (Namibia Press Agency, 2019) where mental disorders reportedly present among 12–13% of Namibians (Bartholomew & Gentz, 2019). Overall, the number of mental health professionals in Namibia pale in comparison to those in need of mental health services.

Mental health services in Namibia are governed by legislation put into effect in 1973 and is prescribed and regulated by the government. The Namibian government provides health and social services through the Ministry of Health and Social Services (Ministry of Health and Social Services, 2005, 2022). Mental health services fall under the auspice of this ministry. Namibia’s health care structure, however, views physical health care as separate from mental health care although mental health services are embedded within its healthcare system (Bartholomew & Gentz, 2019; Sibbald, 2006). To further complicate mental health service delivery, social work practitioners in the mental health arena are said to primarily operate from a Western lens, which leaves little room for the integration of traditional cultural approaches to mental health care (Ananias & Lightfoot, 2012; Chipare et al., 2021). As a result, policy, practice, and cultural values in Namibia often clash and result in incongruence.

In this paper, the authors discuss the incongruence between policy, practice and cultural values related to mental health services in Namibia. Specifically, the authors 1) discuss Namibia’s antiquated mental health law and policies, 2) discuss the current landscape of social work and mental health in Namibia and similarly situated countries, 3) explore five-to-ten year projections for development, 4) discuss preventative and innovative solutions to address mental health in Namibia in the context of the grand challenge related to eradicate social isolation, and 5) explore opportunities for social work practice and research.

Mental health law and policies in Namibia

In order to understand mental health challenges in Namibia and their effect on Namibian people, it is critical to examine the complexity from a historical and contemporary lens. Namibia’s National Policy for Mental Health is based on the Mental Health Act (1973)—a time when Namibia was still under rule by brute colonizers. To this day, the laws and policies around mental health care in Namibia are inherited from the apartheid regime that colonized Namibia (Mental Health Act, 1973; Ministry of Health and Social Services, 2005). Therefore, they are outdated and should not inform current practice or professional norms in Namibia where the people now operate as an independent nation – free from tyrannical leadership and European dominance. Namibia’s former apartheid regime was focused on segregation, exclusion, and racism (African Democracy Encyclopaedia Project, 2009; Müeller-Friedman, 2006). For instance, some of the first social workers in Namibia upheld structural inequalities and systemic racism, and as a result, Black Namibians were often denied social services (Ananias & Lightfoot, 2012). Therefore, unpacking these law and policies to understand how Namibians are impacted today becomes imperative when it comes to mental health service provision.

The Namibian Mental Health Act (MHA) stipulates its function as “to provide for the reception, detention and treatment of persons who are mentally ill” (Mental Health Act, 1973, p. 1). It also specifies the grounds in which people with mental illnesses must be detained if they are involuntary with a court order. Furthermore, the Act discusses the conviction of a mentally ill patient whereby the patient is evaluated by two State psychiatrists who is charged with assessing their mental capacity. If found that the individual has a mental condition, they would be detained in a forensic unit (i.e., a facility for convicted patients with a mental disorder). These individuals are then referred to as State President’s Decision Patients and would serve their time in the facility until the President releases them (Mental Health Act, 1973).

Post the Mental Health Act, 1973, the Ministry of Health and Social Services developed a National Policy for Mental Health in 2005. The goal was to achieve and maintain high quality mental health services that reduce stigma through comprehensive community based mental health services that are decentralized and integrated in general health care (Ministry of Health and Social Services, 2005). This policy outlined the role and function of directorates within the Ministry in implementing this policy. Overall, the emphasis of the policy was on developing empirical evidence for mental health service delivery in the country in addition to measures that would be implemented to ensure that mental health services were decentralized and integrated within general health care (Ministry of Health and Social Services, 2005). Both the Act and the National Policy for Mental Health are outdated though (Dipura, 2019; Ministry of Health and Social Services, 2005, 2022) and do not provide evidence-based approaches that mental health providers could use in service delivery. As for its foundation, the Mental Health Act defines mental illness as “any disorder or disability of the mind, and includes any mental disease, any arrested or incomplete development of the mind and any psychopathic disorder” (Mental Health Act, 1973, p. 2). As shown here, the legal language used to define mental illness in Namibia is antiquated and pathological. The 2005 National Policy for Mental Health references mental disorders and mental illness a number of times, but never defines either term even once (Ministry of Health and Social Services, 2005). The World Health Organization states that a mental disorder is, “characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour” (World Health Organization, 2022c, para. on Key Facts). This definition encapsulates identifiable aspects that can be used to measure impairment and to guide diagnosis and treatment.

According to the National Policy for Mental Health, diagnosis and treatment of mental illnesses are to be done at the district hospital level, and referrals to specialized care are to be made when the case is deemed too difficult to further treat (Ministry of Health and Social Services, 2005). Additionally, the Namibia Standard Treatment Guidelines are used by medical officers to diagnose and treat all types of medical conditions in Namibia. These guidelines were developed through a consultative process involving experts in health care in consideration of current treatment policies, prevalent disorders in Namibia, as well as universal evidence-based medicine approaches (Ministry of Health and Social Services, 2021). Since its enactment in 2005, Namibia’s National Policy for Mental Health (NPMH) has been criticized for not being successfully implemented. Ashipala et al. (2016) found that when interviewing 52 nurses and 12 healthcare administrators spread throughout 13 health facilities in the Oshana region in Namibia about the country’s NMHP, it was concluded that mental health services were not fully implemented into primary health care due to budget issues, poor mental health leadership, few available medications, and the lack of preparedness of practitioners to offer mental health services. The study further revealed the limitations of implementation being due to a lack of clear guidelines on diagnosis, treatment, and management of mental disorders, lack of adequate secondary referral systems, a shortage of mental health professionals, and lack of training on the implementation of the policy. While the country continues to waddle in inaction, Namibians with mental disorders wait and suffer in isolation due to the stigma associated with mental disorders.

Social work and mental health services in Namibia

Social workers play an important role in the delivery of mental health services in Namibia. The educational requirements and formal registration of social workers in Namibia fall under the auspice of the 2004 Social Work and Psychology Act (Republic of Namibia, 2004). The first undergraduate social work degree program was first established in 1992 at the University of Namibia (UNAM) where it remains the only institution in Namibia today to offer an undergraduate social work degree and post graduate studies (Ananias & Lightfoot, 2012; Gibson et al., 2022). Together, the UNAM and the Social Work and Psychology Council, have played major roles in developing the social work profession in Namibia under the mandate of the 2004 Social Work and Psychology Act (Ananias & Lightfoot, 2012; Republic of Namibia, 2004). Specific to mental health, social workers are to be properly trained and regulated by the Council. The Council’s charge is:

To regulate the manner in which practices in connection with the diagnosis, treatment or prevention of physical or mental defects, illnesses, diseases or other deficiencies in persons, or the performing of social work, as the case may be, are exercised by any person practising any such profession.

(Republic of Namibia, 2004, p. 9)

Related to clinical practices, the Ministry of Health and Social Services guidelines identify anxiety (including panic disorder and generalized anxiety disorder), delirium or confusion, depression, bipolar disorders, insomnia, and schizophrenia spectrum disorders as most prevalent in Namibia (Ministry of Health and Social Services, 2021). These clinical disorders are all found in the Diagnostic and Statistical Manual of Mental Disorders – a Western text often used in the United States to diagnose mental disorders that include just 10 Cultural Concepts of Distress related to disorders usually diagnosed abroad (American Heart Association News, 2022). Furthermore, the guidelines outline the diagnosis, the causes, signs and symptoms, the management of different phases at different levels of service provision including pharmaceuticals that can be used for treatment, and other alternatives to pharmaceutical treatment. These alternatives include psychotherapy and breathing techniques (Ministry of Health and Social Services, 2021).

Despite social work’s focus on clinical practice, Ananias and Lightfoot (2012) assert that the Namibian government and the University of Namibia reportedly state that they place a premium on social development (macro approaches to problem-solving), but yet their prescriptions for social workers and mental health professionals are micro (clinical in nature) (Republic of Namibia, 2004). Equally disconcerting, when engaging in clinical work, social workers in Namibia tend to prioritize traditional Western micro approaches to social work practice. In a sample of 96 social workers (89.6% female) listed as members of the profession’s National Association of Social Workers in Namibia (NASWA), two researchers found that only 25% of social work respondents were extremely familiar with the country’s social development approach or somewhat-slightly familiar with the approach, respectively. Additionally, when asked about future NASWA training suggestions, only 22 respondents indicated social development and economic development were of interest, respectively (Ananias & Lightfoot, 2012). As seen here, the practices of social work and preferences of social workers are incongruent with the government’s reported charge for the profession. Chiwara and Lombard (2022) argue that social work’s fragmented reputation in delivering services is the result of Namibia’s colonial past and inequitable provisions of services to Black Namibians. In other words, the social work profession in Namibia do not subscribe to a social work policy development framework that challenges the status quo, but instead maintains it. The authors assert that Namibia’s micro approach to social work must become secondary to social development (macro) approaches if socio-economic inequalities are to be addressed in the country and Black Namibians are to benefit from the country’s new found independence.

Another example of Namibia’s clinical approach to social work involves modes of training. Bartholomew and Gentz (2019) found that when seven women mental health practitioners (including two social workers) were interviewed about how they provided clinical mental health services in Northern Namibia, they found that respondents reported Westernized modes of training (e.g., therapy, groupwork, etc.) although they believed that the origins of illnesses and symptoms of some of their Aawambo clients was due to a curse or bewitchment. They were not trained in traditional approaches, however. As a result, many of their clients expressed disdain and devaluation of these practitioners’ non-traditional methods given their own cultural beliefs. In an effort to compromise with what some Namibians prefer when seeking care for psychological distress, Bartholomew (2016) recommends an integrative approach whereby Western trained practitioners and traditional healers find a way to mutually respect one another and work for the good of the people and their cultural values. Hanlon et al. (2014) examined challenges and opportunities around integrated mental health care in Ethiopia, India, Nepal, South Africa, and Uganda. They found no link between primary health care approaches and traditional/religious healers unless the patient was experiencing psychosis. Then the use of traditional/religious healers was high across all five countries. These findings suggest that there is merit in the use of traditional/religious healers in the treatment of some mental disorders in parts of the world.

Similarly situated countries and mental health care challenges

Namibia’s mental health service provision challenges are not atypical. Other Sub-Saharan countries continue to have challenges too. According to Van Breda and Addinall (2021), South Africa has five universities that offer clinical social work or closely related degrees, but only two of them substantively address mental illness or DSM-5 diagnoses. When it comes to practice models, the 108 social workers surveyed in Van Breda and Addinall’s (2021) study reported a heavy reliance on Western pedagogy, which is suitable for the medical model espoused by the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM) of Mental Disorders (American Psychiatric Association, 2022). Specifically, the social workers heavily relied on grief counseling (n = 52; 48%), cognitive behavioral therapy (n = 50; 46%); crisis intervention (n = 50; 4 6%), psychodynamic therapy (n = 50; 46%), and person-centered counseling (n = 45; 41%), while excluding traditional healing methods. Unfortunately, these Western modalities are not indigenous to Namibia and fail to integrate traditional ways of understanding mental health in Namibia, especially in rural communities.

Malawi, Namibia, and Sudan were examined for their adherence to core concepts of human rights and inclusion of vulnerable groups in their mental health polices using EquiFrame. EquiFrame is an innovative policy analysis framework that measures 1) coverage of 21 predefined core concepts – Core Concept Coverage [CCC] (e.g., nondiscrimination, coordination of services, integration of mainstream services, cultural responsiveness, family support, etc., 2) a policy’s commitment to said core concepts – Core Concept Quality [CCQ], and 3) their inclusion of Coverage of 12 identified Vulnerable Groups [VGC] (e.g., older people, children with special needs, ethnic minorities, persons with disabilities, impoverished persons, people who live great distances from health services, etc.) (Mannan et al., 2013). Each policy was then assigned an overall summary score. Malawi, Sudan, and Namibia were assigned low, moderate, and high summary scores, respectively. Namibia’s “high” summary score (>50% in each of the three areas) was based on its CCC (71%), CCQ (57%) and VCG (58%). That is, Namibia’s National Mental Health Policy was favorably ranked in comparison to its counterparts due to its written policy’s goal of achieving and maintaining good mental health in Namibia, reducing mental health stigma, plans to decentralize community-based mental health services, and the integration of mental health care into general health services (Mannan et al., 2013). Despite this high EquiFrame ranking, quality and accessible mental health care is said to not be one of Namibia’s priorities (Chipare et al., 2021).

In their study on integrated mental health care in Ethiopia, India, Nepal, South Africa, and Uganda, Hanlon et al. (2014) found that only India and South Africa had implemented a formal mental health plan of some type, that South Africa was the only country with a training manual for mental health at the time, and that stigma was high across 80% of the countries and significant in 20% of the countries. Last, only one NGO in India had mental health social workers while South Africa reportedly only had 2 or 3 mental health social workers in their respective PRIME districts.

A social work grand challenge: eradicate social isolation (in mental health)

In 2013, twelve Grand Challenges for Social Work were proposed by the American Academy of Social Work and Social Welfare (AASWSW) and eliminating racism was added seven years later as the last grand challenge (American Academy of Social Work & Social Welfare, 2022a; S. Rao et al., 2021). Social work grand challenges center on individual and family well-being, a just society, and a stronger social fabric (American Academy of Social Work & Social Welfare, 2022b; Lee et al., 2022; Meshelemiah et al., 2024; Teixeira et al., 2021). Eradicate social isolation falls under stronger social fabric and is described as a silent killer (Lubben et al., 2015). Social isolation is defined as a lack of social contacts and infrequent interactions with others (National Institute on Aging, 2021) and is linked to depressive symptoms, suicide attempts and low self-esteem in younger populations and cognitive impairments and dementia in older populations (Lubben et al., 2015). It is also linked to higher mortality (E. Harris, 2023) and poor heart and brain health (American Heart Association News, 2022).

Related to social isolation in Namibia, it is important to discuss context. When people decide to seek mental health services, there are a number of factors that influence their decision-making (New Era, 2016; D. Rao et al., 2007). For instance, Namibia is considered one of the most sparsely populated countries in the world because of is population density of just 2.8 people per square kilometer and only 6.4% of households own a personal vehicle; 56.2% of families live more than 3 miles from a health facility, and approximately 5% of households must travel more than 24.85 miles to reach healthcare facilities (Katirayi et al., 2022). These are all potential barriers to seeking mental health services and may result in social isolation for persons with mental disorders as well as their families. Additionally, stigma exacerbates social isolation, as people with mental health challenges are marginalized and are often discriminated against (The Namibian, 2012; Overton & Medina, 2008; Shifiona et al., 2019).

Promoting good mental health and ensuring that people receive quality mental health services are noted as critical by both the World Health Organization and the National Institutes of Health (Lubben et al., 2015). Lubben et al. (2015) asserts that it is important to address social isolation and its intersection with mental health. Bartholomew’s (2020) findings concur. He utilized a multiple case study design to explore the experiences of four individuals with mental illnesses (labeled as the mad one or Omunanamwengu) and their families among the Northern Aawambo people. Participants in the study described marginalization and isolation (100%), omunananwengu or psychosis (75%), fire setting (75%), and belief in traditional healers when curses or bewitchment was the believed origin of the psychological distress (100%). Shifiona et al. (2019) also found that some Oshiwambo speaking people in northern Namibia believed in curses and bewitchment as the source of their mental illnesses, and therefore preferred traditional healers as well. Thus, it is important to consider cultural context in Namibia when delivering mental health services.

Ayano (2018) argues that all people with mental health concerns should be provided quality treatment that enhances human dignity in a humane manner. When structures result in social isolation through a legal framework that is limiting or outdated and do not meet the current need of the people, this could increase mental health issues. Even though a written provision has been made through the National Policy for Mental Health for community mental health services in Namibia in order to enhance social connection and reduce stigma, this provision has not been implemented in Namibia (Ministry of Health and Social Services, 2022). This is problematic on many levels and needs to be addressed.

Social workers can play a key role in significantly decreasing the danger and effects of social isolation by collaborating with other related professions (Lubben et al., 2015). Beyond counselors, psychiatrists, nurses, and social workers, Kalomo et al. (2022) recommends the use of friends and spirituality/religiosity as a means to reduce depressive symptoms in older caregivers. Bartholomew (2016) echoes similar sentiments and asserts that traditional healing practices must be made congruent with Westernized practices.

Five-to-ten year projections for development | a grand challenge for the profession

As previously stated, the vastness of Namibia has had a detrimental effect on its mental health services. Nearly 70% of Namibians live in rural areas (Chipare et al., 2021), and Namibia has only two hospital-based mental health units for the whole country and only one of them has a full multidisciplinary team (Dipura, 2019; World Health Organization, 2020). When patients need specialized mental health services, they must travel long distances and endure overcrowded hospitals (Namene & Jamu, 2021). This could be a contributing factor to social isolation in Namibia as reported by Kaulinge (2022). During the pandemic, an international public health crisis ensued, and the health care services system witnessed a drastic increase in service needs that they were unable to handle. A lack of access to mental health services results in an individual having to deal with their untreated condition. This can result in social isolation (Shifiona et al., 2019).

Mental health is a topic that is not openly talked about due to stigma and discrimination in many societies. Many families and individuals with mental disorders choose to self- isolate rather than be stigmatized (New Era, 2016; Pescosolido & Martin, 2015; Subu et al., 2021). Brown et al. (2021) states that isolation is a symptom of anxiety and depression because some people use it as a self-inflicted coping method to deal with overwhelming feelings and emotions in social interactions. To eradicate social isolation, targeted approaches need to be employed that focus on social connections. Specific to Namibia, there is a great need to invest in mental health services and investigate what the country’s distinct mental health needs are (Chipare et al., 2021; Mudumbi, 2019). Related to isolation, social workers can help to eradicate it by the adoption of evidence-based practices, advocacy, and community engagement (Coyle, 2022).

Looking ahead, five-to-ten-year projections for development in Namibia should include a comprehensive mental health approach. Specifically, it is important for Namibia to do the following:

• Enact a new National Mental Health Act. The current Act is 51 years old.

• Develop a current National Policy for Mental Health in Namibia. The current 2005 national policy is antiquated.

• Prioritize mental health services in the country’s budget. Windhoek and Oshakati are the two primary areas of service accessibility while other areas remain underserved (Shifiona et al., 2019).

• Implement a community mental health approach to reduce social isolation given the sparse landscape of Namibia (e.g., 2.8 people per square kilometer) (Katirayi et al., 2022). The WHO recommends a comprehensive and integrated approach to mental health treatment within communities throughout the country (Matsea et al., 2022).

• Train and register more social workers and other practitioners who can competently provide mental health services in a variety of settings.

• Integrate traditional healing practices with Western practice modalities so that Namibian cultural values are acknowledged and incorporated into treatment, and

• Utilize empirical evidence in the development of policies and practices around mental health in Namibia.

Preventative and innovative solutions to address mental health in Namibia

As discussed in this article, many of the mental health challenges experienced in Namibia are closely related to issues of access, lack of mental health providers (especially social workers), antiquated laws, Western pedagogies, and limited community resources (Dipura, 2019; Mudumbi, 2019; Shifiona et al., 2019). As a result, approaches for prevention and innovative solutions must be diverse in nature (Bartholomew, 2016; Mudumbi, 2019). On the micro-level, Namibia must invest in training more mental health professionals (Dipura, 2019; Ministry of Health and Social Services, 2022). Regarding the scope of practice of clinicians, the training of social workers must include the integration of cultural values (e.g., traditional healing practices) and a robust understanding of mental disorders in a Namibian context. On the macro-level, social development approaches to reduce incongruence between policy, practice and cultural values must be prioritized. Preventative and innovative solutions require flexibility and action on a large scale. A first step should include investigating innovative and culturally inclusive alternatives to mental health access and provision of mental health services, especially in remote areas. An example includes community involvement (Ministry of Health and Social Services, 2022; Mudumbi, 2019). This would entail organizing community establishments to provide first aid mental health services. Currently, Namibia does not have community mental facilities, even though the National Policy for Mental Health makes provisions, on paper, for such (Ministry of Health and Social Services, 2005; World Health Organization, 2020). Investments in community mental health centers include alternatively existing structures such as schools, churches and workplaces to be used to advance mental health education and service provisions (Ministry of Health and Social Services, 2022; Mudumbi, 2019). Secondly, Namibia must move past colonized practices and start to develop indigenous ways of addressing mental health in the country.

Opportunities for social work

The changing of the legal framework is a lengthy process in Namibia due to limited resources, lengthy consultative processes, and other priorities of the National Government (Ministry of Health and Social Services, 2005). Therefore, social workers must look for alternative ways to address mental health challenges in the country. The scope of practice of social workers in Namibia is guided and regulated by the 2004 Social Work and Psychology Act (Republic of Namibia, 2004). These regulations clearly outline the functions of the social work profession and as a multidisciplinary team member who could contribute to mental health care (Ministry of Health and Social Services, 2011). In geographical areas, however, where social workers do not work in hospital settings, the primary role include making referrals for diagnoses to a different level of service provision (Ministry of Health and Social Services, 2011). Arming social workers with the authority and capacity to offer evidence-based assessments, use diagnostic tools, and directly provide clinical interventions could reduce some mental health access issues. Currently, social workers primarily make referrals for services.

Related to empirical evidence, Chipare et al. (2021) conducted a scoping review of the literature on pre- and post-independent Namibia and found only 14 studies that examined mental disorders in sample populations including 7 to 639 respondents. The authors conclude that high income countries clearly serve as the exemplar for mental health services on the global stage – even in low-income countries. Therefore, Chipare et al. (2021) recommends that social workers engage in mental health research as a priority in Namibia. The findings must then be translated into practice so that social work practice is based on Namibian cultural norms and the West’s. Training based on evidence-based interventions should be at the core of social work practice (Dipura, 2019; Mudumbi, 2019), and social workers must be innovative in how they integrate research into their practice. To some extent, Western-based psychological practices may be useful in Namibia, but implementing this Western modality of treatment intrinsically disregards culturally derived understandings of healing (Bartholomew, 2016). Western-based social work research must be cautiously embraced and Namibian social workers must always be cognizant of the potential incongruence between that research and their cultural norms.

It is clear that social workers in Namibia have great potential to be a major part of the efforts to comprehensively and sensitively address mental health service delivery. It will require creativity, flexibility, and thinking outside the box though. That is, adopting mental health approaches that promote social justice must take into account the differences and uniqueness of the principal groups of people in Namibia. It also includes giving social workers the authority to offer direct services using integrated methods (i.e., Western traditions). Therefore, it is critical that diverse social workers engage in this work so that language and cultural barriers can be traversed without ongoing challenges. Interventions must also be community-based and extend throughout the country, including very remote areas. Social workers must also think practically and focus on inclusion, equity, diversity, and justice from a contemporary lens. Moreover, the profession must center its efforts on social work values and the grand challenges for the social work profession.

Conclusion

The growing need for mental health services in Namibia must serve as a gateway for mental health professionals to review outdated legal frameworks and to advocate for evidence-based interventions to inform policy. The practice and policy needs related to mental health service provision appears to be similar across Africa. For instance, the World Health Organization (2022a) indicated that 76% of the African-region member states reported mental health policies and strategic plans, and 49% had mental health legislation. These documented mental health policies, legislation and strategic plans suggest progress has been made in addressing mental health – at least on paper. These critical documents, however, lack actual implementation of mental health services in many regards, as in the case in Namibia. These challenges are not unique to Namibia as can be seen in other parts of Africa and other similarly situated countries. Aderinto et al. (2022) discuss various challenges experienced in Sub-Saharan Africa relating to mental health service provision and utilization. Their discussion highlights infrastructural, financial, and human resources as major challenges. This is consistent with the World Health Organization (2022a) report that state government expenditure for Africa on mental health as USD 0.46 per capita, which is much lower than the recommended USD 2.0 per capita. Furthermore, the global mental health provider has seen an increase from 9 to 13 per 100,000 population, however the African region reports 1.6 mental health providers per 100,000 population. This indicates that access to mental health services is a major problem across the Africa continent. Additionally, mental health providers are mainly situated in urban areas in many parts of Africa, thus limiting access for service users outside of these areas, and potentially exacerbating access challenges (Aderinto et al., 2022; D. Harris et al., 2020).

In closing, it is notable that Namibia has made efforts to enhance mental health services through an existing legal framework and the development of the Namibia Standard Treatment Guidelines that make provisions for all prevalent illnesses and treatment regiments for health professionals to utilize. There are still gaps, however, that are identified despite the efforts made in Namibia, such as the total number of mental health professionals; access to specialized mental health care services – especially in rural areas; the devaluation of cultural values (e.g., traditional healing practices), and a need for more research to inform practice and policy (Chipare et al., 2021; Dipura, 2019). The lack of access to essential services like mental health services in Namibia is a social justice issue. This directly presents a problem around access – the further one lives from specialized mental health care, the less access they have. This can and often results in social isolation, which is a priority to address in a bid to eradicate isolation as espoused in social work’s grand challenges. Namibia has come a long way since its independence in 1990, but it still has a long way to go in addressing comprehensive, culturally inclusive mental health issues from a social justice lens.

Disclosure statement

No potential conflict of interest was reported by the author(s).