Mental health is just an Addendum: Assessing stakeholder's perceptions on COVID-19 and mental health services provision in Malawi.

INTRODUCTION: The World Health Organization declared COVID-19 as a pandemic in March 2020. COVID-19 has since caused a significant increase in mental health problems at national and global levels. This study assessed the views of key mental health stakeholders regarding the state of mental health service provision in Malawi and the pandemic's impact on the sector. METHODS: The study utilised a qualitative approach through key informant interviews (KIIs) conducted using a semi-structured interview guide. The interviews were audio recorded in English language and were manually transcribed for thematic analysis by generating codes re-classified into themes, sub-themes and quotes. RESULTS: The results are categorised into five themes. Firstly, the availability of mental health services. All experts confirmed the lack of availability of the mental health services especially at the lower levels of care. Currently, only 0.3% of facilities offer mental health services in Malawi. Moreover, although mental health services are part of the essential health care package and, therefore, are supposed to be provided for free in public facilities at all levels, the services are centralised and only functional at a tertiary level of care in public facilities. Secondly, funding sources for mental health in public and private facilities. We learnt that public facilities depend on donor sources and there is lack of prioritisation in budget allocation for mental health services. Whereas private facilities, their major source of funding is user fees. Thirdly, government's response in the provision of mental health services during COVID-19. Almost all experts echoed that government took a proactive approach to address the mental health needs of its population during the pandemic. There was increased collaboration between the government and the private sector to provide psychosocial and counselling services to health workers working directly with COVID-19 patients in isolation centres. Furthermore, to increase awareness of the general population on where to seek counselling services. Lastly, challenges in the provision of mental health services were highlighted and how the pandemic acerbated the challenges including shortage in human resources for health and inadequate funding. CONCLUSION: This study underscores the urgency of addressing mental health challenges in Malawi. Policymakers must prioritize the decentralization of mental health services, explore funding opportunities, and build on the successful collaboration with the private sector. These measures will not only enhance the accessibility and quality of mental health services but also ensure that mental well-being is a central component of public health efforts in Malawi.

Umunthu, Covid-19 and mental health in Malawi.

This paper investigates the centrality of Umunthu in mental health conception and treatment in Malawi. Umunthu is an African philosophical worldview which stresses that an individual is human as they relate to others, as in the saying I am because we are. Its communitarian approach contrasts with a predominantly western individualistic worldview; I think therefore I am. There are spelling variations of the word across Bantu languages, including bomoto (Congo), gimuntu (Angola); umunthu (Malawi); vumutu (Mozambique); vumuntu, vhutu (South Africa); humhunu/ubuthosi (Zimbabwe); bumuntu (Tanzania); and umuntu (Uganda). Literature shows that if embraced and advocated for, Umunthu plays a positive and influential role in mainstreaming and dealing with mental health issues in communitarian societies where the Umunthu ideals are part of the social fabric. However, in the case of Covid-19 and mental health in Malawi, the paper argues that Covid-19 preventive measures, particularly self-isolation when Covid-19 positive; maintaining social distance at all times; and reducing the number of people gathered at funerals, challenge Umunthu ideals, which have in the past been crucial in reducing stress, trauma and anxiety. This original paper bases its arguments on empirical data collected in a study conducted in Mangochi, Blantyre, Karonga and Lilongwe. Based on the study's findings, the paper highlights that although Covid-19 preventative measures have been globally embraced, it is also a limiting factor in the quest for mental health in societies with communitarian value systems.