Since 2012, Médecins Sans Frontières (MSF) has run mental health programmes in Zimbabwe with the Ministry of Health and Child Care and the Zimbabwe Prisons and Correctional Services. Diagnosis, treatment and the supply of psychiatric drugs are an important part of these programmes in a country that severely lacks mental health staff and drugs. The story of Stephen* is an extreme example of what can happen when mental illness is left undiagnosed and untreated.

Stephen was at home one day when he heard voices from what he thought was the army. They were telling him he must take his family and leave his home. These voices told him that if he did not do this, the army would come and kill them all.

Stephen told his family but they ignored what he said and the voices in his head grew louder. They were now telling him that if he and his family didn’t leave, he must kill his wife and children before the army arrived. His family, confused by Stephen’s ideas, again refused to leave their home.

By the next morning, Stephen had murdered his wife and three children.

The next thing Stephen remembers is finding himself at Chikurubi Maximum Security Prison’s psychiatric unit in Harare, Zimbabwe. MSF has run a mental health programme there since 2012.

As a new inmate, imprisoned in the mental health wing, Stephen was assigned a clinical psychologist: MSF’s Emmerson Gono, who had been working at the prison for nearly five years.

He asked Stephen if he knew why he had been imprisoned. But Stephen’s psychosis had subsided and he couldn’t remember anything from the previous three weeks. After Emmerson’s careful explanation and on realising what he’d done, Stephen was inconsolable.

More than a million people with mental illness

According to Zimbabwe’s Ministry of Health and Child Care, there are at least 1.3 million people living with mental illness in Zimbabwe. Despite the growing numbers, mental health services, including staff and drugs, remain in dire shortage across the country. There are just 20 registered clinical psychologists and nine public mental health institutions for a country with a population of more than 14 million.

This means that for many Zimbabweans, mental health support is out of reach, either physically or financially.

Stephen is one of about 300 inmates at the Chikurubi Maximum Security Prison psychiatric unit. Emmerson says his story, while extreme, explains the situation many patients find themselves in when their illness is left undiagnosed and untreated.

“When you are professional, you realise that the patient committed a crime because of mental illness and needs help. No matter how heinous their offences are, they still need help – they are still human beings,” Emmerson says.

The gap in resources isn’t the only challenge patients face: for many, the stigma can be even more debilitating. Emmerson’s friends sometimes tease him, saying: “If you work and play with kindergarten children for a long time you end up behaving like them. If you spend time with mental patients, you also end up being like them.”

For Emmerson, it’s words like this that remind him just how misunderstood mental illness is. He says it would be easy for him to think he deserves better than to work in a prison with people with mental health issues, but he asks himself: “If I don’t go into the prison to help mental health patients, who will?”

Emmerson wants to see a shift from institutionalised mental health services to community mental health services.

“I want to see patients getting services closer to home in their community rather than being institutionalised. The best form of treatment for mental patients is not coming from us professionals in a jail or hospital – it’s in their homes and with the support of their family.”