Navigating the Complexities of Mental Health and Legal Reforms: A Personal Reflection on Botswana's New Mental Health Bill

Written by: Dumi Gatsha, Co-chair of the Mental Health & UHC GMHAN Working Group

I have been depressed for all of August. I have no explanation or reason. It makes no sense and isn’t anything new to me. One would think that being used to depression would mean understanding why I get so. However, the past half decade has all the signs of burnout. I cannot confirm if this progressively happened or had a starting point.

My foray into activism was triggered by a realisation that I was a ‘victim’ all whilst navigating adolescence and various stages of youth. The one most memorable milestone in my mental health [or lack thereof] journey happened amidst COVID-19 hard lockdowns. I was supporting someone who had tried to take their own life and had been in the waiting room when a psychiatrist asked me to sit with her. I remember denying, refusing and feeling shame when that conversation turned into a consultation. I had time and did not think of what to expect. I knew I could have cycles of ups and downs. I understood my erratic behaviour at moments of stress and accepted that my downtimes were as a result of exhaustion. What I did not expect was for this normal to be deemed bi-polar.

This reflection on my journey is a succinct way in which I welcome Botswana’s new mental health bill after over 5 decades. Like many others, it is preceded by an archaic, colonialist and infantilising law inherited from the British Empire. It was one of the few that never had amendments or improvements – for over 50 years. There are some improvements in language, non-discrimination and ensuring care close to one’s residence and community. However, elements of ethics and human rights emerge as the law prescribes police assistance in instances of involuntary assessment or reviews of someone’s health. Also, it provides for nominated representatives, whom within our culture can create conflict and perpetuate abuse. Botswana’s health system remains gendered, ableist and unequal. This new law, although welcome; remains largely reflective of an aspiring democratic society with all the hallmarks of human rights shortcomings. The right to health is not guaranteed in Botswana’s constitution.

These shortcomings are reflected in the new mental health law. Civil society is rarely engaged to ensure meaningful inputs that reflect community interests and not just needs. We can no longer accept the bare minimum where our lives and wellbeing are concerned. It could not be a more important time, as we head to the UN General Assembly, where three key health High Level Meeting (HLM)s will be held. The draft versions of the political declaration on Universal Health Coverage have consistently improved, reflecting the UHC movement’s action agenda and some progressive elements for improving mental health. UHC serves as an entry point for meaningful engagement and collaboration across public, private and development sectors. This should reflect in how laws and policies on mental health are developed.

Human rights are universal and indivisible. This isn’t the case in Botswana’s context. This new law should trigger reviews of how prepared, resilient and community-driven our health system is. It provides an opportunity for all Batswana to better understand how inclusive our primary health care system is. As civil society, we continuously advocate for improvements within the system, as done towards, at the multistakeholder hearings in May and more recently in a Joint Dialogue on the three HLMs. I am privileged enough to have the knowledge on how to navigate my diagnosis – even though I do not have medical aid. This is the contrast of activism, where we provide community health referral services but do not have adequate social protections. We exist amidst these contradictions in the hope that we aren’t left behind. We raise these contradictions in the hope that one day, Universal Health Coverage can improve everyone’s life regardless of work.

Bio

Dumi Gatsha is a Co-Chair of the Mental Health and UHC Working Group, UHC 2030 steering committee alternate member and founder of Success Capital Organisation, a grassroots organisation working in the nexus of human rights and sustainable development.