By Sariba Manneh
Cannabis and Ecstasy are common causes of mental illness in The Gambia and 88% of total patients admitted to the Government-run Tanka Tanka Psychiatry facility as a result of substance abuse are male. That’s according to health expert Mam Jarra Marega, a Psychiatric-Mental Health Nurse Programme Manager at the National Mental Health Programme under the Ministry of Health.
“Majority of the cases are between 18 and 35, and many of them have a history of multiple substance use, cannabis, ecstasy, alcohol,” Marega said.
These patients are often first taken to outpatient clinics for assessment at the Edward Francis Small Teaching Hospital (EFSTH) and Kanifing General Hospital; and if required, they are referred for admission at the Tanka Tanka Psychiatry Department (TTPD).
To Marega, the aforesaid health facilities sometimes receive patients whose mental illnesses are caused by hallucinogenic substances because they sniff surgical spirits and glue. She said the use of substances has become a public health concern in The Gambia as many youth are using drugs and have become addicted to different types of psychoactive substances.
“The youth and school children, and even adults are addicted to psychoactive and intoxicating substances such as cannabis, benzodiazepines, ecstasy, and others,” Mariga told Foroyaa.
Health experts hold the view that the majority of young people are aware of the dangers of using these substances and the potentially severe impact on their mental health especially with different campaigns and awareness-raising initiatives reaching users, experiences of users with substance induced mental health disorders for instance, Psychosis, Bipolar and other Substance Use Disorders (SUDs). However, several factors can be attributed to the use of psychoactive substances in The Gambia.
“Firstly, socio-economic issues such as poverty, unemployment, perceived sense of injustice, lack of educational opportunities and the environment to pursue and achieve or fulfill dreams can drive individuals to seek solace in substances. Additionally, the easy availability of substances due to crafty drug dealers, porous borders, and lack of rehabilitation centers contribute to the prevalence of substance use,” Madam Marega added.
Foroyaa has learned from Tanka Tanka that peer pressure and the desire to escape from personal problems or trauma are also contributing factors to substance abuse in The Gambia. Mental health-related illnesses in The Gambia have also been associated with substance abuse with recent trends of the use of “Kush” (a blended cannabis with other harmful chemical substances).
Due to this menace, the lives and safety of people in The Gambia, especially in the urban areas where the incidences are high, are at risk.
Addiction to substances has led to the collapse of family life, the economy, education of children, and also the increasing level of adverse childhood experiences such as exposure to child hawking, torture, rape, and other human suffering which ought not to be.
There is only one psychiatric inpatient facility, which is a department under Edward Francis Small Teaching Hospital with limited capacity for those in need of services.
“In addition to these issues, there is also the risk of spreading HIV/Aids and deaths in The Gambia as there is a high correlation of substance use with risky sexual behaviors, rape, fighting, crimes such as theft and robbery, and road traffic crashes,” Mariga said.
“There are no rehabilitation centers and we have few mental health practitioners with skills and knowledge on addiction treatment. In addition, the only available facility for admission of people with severe effects or psychosis due to substance abuse is Tanka Tanka.”
Experts believe it is important to continue the sensitization on the effects of using these substances and to explore innovative ways of engaging the youth on the subject to prevent and protect them from venturing into such negative options.
Health practitioners at Tanka Tanka lament that most often people using substances are not receiving suitable treatment, are sent to prison as hardened criminals and are denied health services, especially psychiatric services.
“While law and order approaches to drug control are expensive in terms of money, they have not proven to be more effective than drug prevention and treatment programs. Stigma and discrimination among many other factors all weigh heavily on risk and harm concerning substance use,” Marega argued.
The link between cannabis and schizophrenia
It is important to note that the relationship between cannabis use and schizophrenia is complex and not fully understood, as ongoing research and discussion in the scientific and medical community continue.
So far, research has indicated that there is a potential link between the use of cannabis and the development of schizophrenia, and it is believed that cannabis use, especially during adolescence, may increase the risk of developing schizophrenia in individuals who are already genetically predisposed to the condition.
Thus, genetic predisposition is involved and other factors such as frequency of use, potency of the cannabis, and age of onset of use may all play significant roles.
The link between Ecstasy and Mental Health
Mental health experts believe Ecstasy, also known as 3,4- Methylenedioxymethamphetamine (MDMA), can cause mental illness due to its impact on the brain. Marega said the use of ecstasy is associated with an increased risk of developing psychotic symptoms, such as hallucinations and delusions.
“These symptoms can be indicative of underlying mental illness or can be triggered by the drug’s effects on the brain,” she added.
Challenges face by Tanka Tanka
Tanka Tanka has five (5) psychiatric nurses and four psychiatrists – one is stationed at TTPH, and the other three, who are Cubans, visit the facility twice a week for the review and discharge of patients. This number is quite insufficient when compared to the number of persons in need of services, making it overwhelming for the system.
“We have one psychiatric nurse for the night shift, one on weekend duties, and the other three on the day shift. So, if we look at the ratio, sometimes, it is 50 inpatients to one psychiatric nurse or 150 to one psychiatric nurse. For the most part, it is one psychiatrist for the total number of inpatients,” Marega said.
The Government of The Gambia has made psychiatric services free in the Gambia. However, most patients/caregivers are advised to purchase prescribed medicines for patients before they get to the Tanka Tanka Psychiatry Department. TTPD has emergency medication, however, other drugs used continuously are not available and even if they are supplied by the EFSTH, they run out of stock quickly. The Gambia has no specialized services such as rehabilitation and addiction treatment centers.
A report from Tanka Tanka indicates that in 2018, psychiatric services were decentralized, which means all regions have at least one focal person providing mental health services. However, the majority of these psychiatric nurses posted in those regions left the country in 2021 and 2022. So, there is a high attrition rate of mental health specialists, especially psychiatric nurses.
Mental health services in The Gambia are composed of inpatient, outpatient, and Community Mental Health (CMH) services. The inpatient facility Tanka Tanka Department of EFSTH was established in 2009 with 80 capacity beds, but it has now increased to 150-bed capacity.
“Due to the limited bed capacity, it is sometimes difficult to accommodate other patients needing inpatient services especially those found without family and those from provincial Gambia,” lamented Marega.
There are also no specialized services such as rehabilitation and addiction treatment units for patients in The Gambia.
Combating Drug Abuse
Marega advised that harm reduction strategies minimum standard treatment guidelines for psychoactive substance use, and prevention strategies will go a long way in minimizing the bad effects of substances on children and young people.
“To curb psychoactive substance use in The Gambia, it is also important to focus on education, prevention, and access to treatment and rehabilitation,” she added.
Marega believes that implementing comprehensive drug awareness programs in schools and communities can increase understanding of the dangers. In addition, she said providing accessible and affordable treatment, and rehabilitation services for individuals struggling with drug addiction are crucial in addressing the issue effectively.
“Law enforcement efforts to target drug trafficking and distribution networks are also important in reducing the availability of illegal substances. Ultimately, a multi-faceted approach involving education, prevention, treatment, and law enforcement can help in curbing substance use in The Gambia,” Marega said.
Knifing Municipal Youth Committee Chairperson, Isatou M Secka, is of the view that drug abuse in teens is a pressing issue that raises concerns among parents and health professionals alike.
And as such, she said there is a need for stakeholders, including the Gambia Government to employ strategies that include “preventive education, awareness creation, identification, counselling, treatment and rehabilitation of drug dependent persons.”
“The issues surrounding substance abuse in The Gambia are enormous, thus a dire need for national rehabilitation and addiction treatment centers,” she added.
As part of efforts aimed at combating substance abuse among young people, the National Drug Law Enforcement Agency conducted a weeklong regional schools sensitization program targeting schools in the Upper River Region, Central River Region, Lower River Region, and North Bank Region from 3rd – 8th July 2023.
The agency launched new chapters of its Drug-Free Clubs in Mbullum Upper Basic and Senior Secondary School and No–Kunda Basic Cycle School on 4th February and 3rd March 2023 respectively.
The agency’s Public Affairs and Drug Demand Reduction Unit conducted one hundred and forty-nine (149) radio talk shows over six (6) radio stations.
Ousman Saidyba, the Public Relations Officer of the anti-narcotic agency, confirmed that his institution in 2023 seized “1ton, 954 kilograms, 34 grams and 492 milligrams of cannabis sativa, 133 kilograms, 600 grams of cannabis plantations, 9 kilograms, 598 grams and 883 milligrams of hashish, 1 kilogram, 841 grams and 554 milligrams of skunk and 385 tablets of ecstasy.”
