Gambia is a country with an approximate area of 11 thousand sq. km. (UNO, 2001). Its population is 1.462 million, and the sex ratio (men per hundred women) is 98 (UNO, 2004). The proportion of population under the age of 15 years is 40% (UNO, 2004), and the proportion of population above the age of 60 years is 6% (WHO, 2004). The literacy rate is 43.7% for men and 29.7% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 6.4%. The per capita total expenditure on health is 78 international $, and the per capita government expenditure on health is 39 international $ (WHO, 2004). The main language(s) used in the country is (are) English. The largest religious group(s) is (are) Muslim, and the other religious group(s) are (is) Christian. The life expectancy at birth is 55.4 years for males and 58.9 years for females (WHO, 2004). The healthy life expectancy at birth is 48 years for males and 50 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Gambia in internationally accessible literature. There are two studies on Sierra Leonean (Fox & Tang, 2000) and Senegalese (Tang & Fox, 2001) refugees living in Gambian refugee camps. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 were used as survey instruments. High prevalence of anxiety, depression and PTSD was found among the exposed population.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is absent. The Department of State for Health and Social Welfare in collaboration with the WHO is in the process of developing a national mental health policy. The draft of the policy document is now ready for a final review by an expert committee, prior to its final submission for approval of the cabinet.
Substance Abuse Policy A substance abuse policy is absent.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1992. The national mental health programme was developed with the technical assistance of the Voluntary Services Overseas (Country Office) through the support of the British Government.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1996.
Mental Health Legislation There is a Mental Health Act. It was last amended in 1964. There is a need for an updated legislation. The latest legislation was enacted in 1924.
Mental Health Financing There are no budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is grants. The country has disability benefits for persons with mental disorders.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. Treatment is available and mental health is being integrated into the primary health system. Regular training of primary care professionals is carried out in the field of mental health. A good number of doctors and nurses were trained on the diagnosis, treatment and management of mental health disorders through WHO support last year. Some traditional healers have also been trained. There are community care facilities for patients with mental disorders. There is a community mental health service that conducts country wide mental health promotional activities.
Psychiatric Beds and Professionals
- Total psychiatric beds per 10 000 population
beds in mental hospitals per 10 000 population
beds in general hospitals per 10 000 population
beds in other settings per 10 000 population
- Number of
psychiatrists per 100 000 population
- Number of
neurosurgeons per 100 000 population
- Number of
psychiatric nurses per 100 000 population
- Number of
neurologists per 100 000 population
- Number of
psychologists per 100 000 population
- Number of social workers per 100 000 population
There are 2 assistant occupational therapists.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in promotion and prevention.
Information Gathering System There is no mental health reporting system in the country. The country has no data collection system or epidemiological study on mental health.
Programmes for Special Population The country has specific programmes for mental health for children.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, biperiden. The essential drug list was formulated in 2001, and it will be reviewed again in 2004-2005. Some of the drugs are not always available at primary level, but these are always available at the secondary and tertiary levels.