Mental health information

Mental health in Swaziland

Swaziland is a kingdom in Southern Africa with the highest prevalence of HIV in the world, and 50% of the population living below $2 a day. There are over 100, 000 orphans and vulnerable children in a total population of 1 million, leading to issues such as increased dependence on the working population, lack of proper family support structures and increased rates of violence, exploitation and interpersonal conflict. With these compounding factors, the importance of mental health and psychosocial support is increasingly coming to the forefront.

Mental health is an important global discussion, with mental disorders making up 5 of the 10 leading causes of disability globally. Mental illness is a topic seldom discussed in the Swazi household. A culture of “tibi tendlu” which means “the dirt of the house” prevails, which means that families will often not discuss certain taboo topics, like mental illness, as it could cause their family to be viewed in a negative light and stigmatized by the local community.There is very little information available on the state of mental health issues in Swaziland, including the lack of an official mental health policy

Very little or no funding is available to both support the mental health and wellbeing of the Swazi population as well as to conduct empirical research into the mental health issues specific to this nation. Between 76% and 85% of people with mental disorders receive no treatment in low and middle income countries like Swaziland, compared to 35-40% of those in developed countries.

There is only one psychiatrist available in the public health system to serve the entire country, and only one psychiatric hospital where locals can seek support. Due to these limited resources, many health workers lack basic knowledge on the recognition and treatment of mental health issues. There is a great need to improve awareness and support for mental health in Swaziland in culturally appropriate ways to support people experiencing grief, loss, depression, anxiety financial stress, stigma and ill health.

In particular, coordinated action should integrate mental health into health services, education, social services, and economic strengthening programs.

Commonly asked questions

What is mental health?

Mental health is defined by the positive balance of all the various aspects of your life: social, physical, spiritual, emotional, financial, and mental. Often, when this balance is upset, it can be challenging to re-find an equilibrium.

Mental health problems are health conditions. Mental health problems can cause a big change in the way a person thinks, their emotions, the way they act, and their ability to work and carry on with their usual relationships. The person may be distressed and/or have impaired functioning. For example, the person may have trouble going to work or doing daily activities.

For some facts and figures, click here.

For more information on specific disorders, click here.

What are some of the most common mental health problems in Swaziland?

In Swaziland, depression and anxiety are two of the most common mental health problems.

What causes mental illness?

There is no one cause of mental illness or mental health problems. It is most likely several factors coming together. For example, we are learning that many of the major mental illnesses involve chemical imbalances in the body.

Mental health problems are:

biological: linked with problems with chemistry in the brain or other body system

psychological: linked with issues with thought or emotion

social: linked with life events and stresses

Mental health professionals look at all three of these when they design a plan for dealing with the problem or illness.

Who is more susceptible to mental illness?

Mental illness can happen to anyone, of any age, culture, education, and income level.

Where can I go in Swaziland to find help?

Visit our referral page, or contact us to find the most appropriate resources for your specific needs.

How do I help a friend, family member, someone I know, or co-worker who I believe may have a mental health problem?

Knowing the signs and symptoms of someone with a mental health problem is the first step to better supporting your loved ones. One of the ways you can help someone who you think is going through a mental health problem is encourage them to see their family doctor, a psychologist, or a qualified mental health therapist.

Another way to help someone going through a mental health problem is to simply listen (without judging) and reassure them that you will help them get the help they need.

It can be difficult when a friend or relative is struggling with mental health issues. It can be painful to see them behaving differently to how they usually behave, and may have a big impact on your life if you find yourself in a caring role you did not choose. However, facing a difficult time together and talking about how you both feel can bring people together, giving you a chance to express love and affection in a way that has not been possible before.

You might find it helpful to read more information about ‘How to cope as a carer

Why is it so hard to talk about mental illness?

It’s hard because there’s such a stigma attached to it. It causes people to fear and reject those who live with mental illness. Society doesn’t view mental illness and physical illness in the same way. Just as people can recover from heart disease and recover from their condition, they can recover from mental illness to lead full, balanced, and productive lives.







If you have any further questions that you would like information on, please do not hesitate to contact us at

Mental health topics

Check out our various monthly topics in the tabs below

Topics covered:

  • Depression
  • Mental Health innovation on the continent
  • Suicide Prevention

Useful sites on various other mental health topics to visit include:

For more mental health topics, check out our site each month.

Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

Depression - March focus


What is depression?

Depression is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances. Some examples are:

  • Persistent depressive disorder
  • Perinatal depression
  • Psychotic depression
  • Seasonal affective disorder
  • Bipolar disorder

What are some of the signs and symptoms of depression?

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many.

What are some of the risk factors?

Depression is one of the most common mental disorders. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors. Depression can happen at any age.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

For more information on depression, click here or contact us.

Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

    Mental health innovation on the continent - April focus

    Opinion piece written by: Aissa Huysmans (May 2017)

    The month of May is Mental Health Awareness month. Mental health is a topic seldom discussed in Swaziland and it carries with it a lot of stigma. Mental health is often viewed more in terms of illness than in terms of the health aspects, shown by a balanced mental and emotional state. Mental health challenges can be experienced by anyone; men, women, rich, poor, old or young. Facing mental health challenges is not a sign of weakness, but is more an indication that someone has had some tough experiences that have been difficult to cope with and have led to the development of mental health issues.

    Increasingly, the pervasive impacts of mental health challenges are being acknowledged and given a platform. The World Health Organization has found that the leading cause of disability around the world, and the fourth leading contributor to the global burden of disease, is depression. Supporting those who struggle with mental health challenges is crucial not only to improve the lives of patients, but also to improve the wellbeing and the productivity of a country. How does mental health impact productivity you might ask? To give just one example, if someone is struggling with anxiety or stress this can greatly impact one’s motivation and drive in the workplace, causing a loss of focus and energy, and in turn impacting the level of productivity.

    The increasing prevalence of mental health issues points to a greater need for us to respond both on a societal and professional level. Within our communities we must endeavor to make more time for one another and offer a listening ear. Professionally, our biggest challenge
    is that in many countries on the African continent, there is a large shortage of qualified psychiatrists and psychologists – there is just not enough accessible mental health support to meet the demands.

    In response to these challenges, all around the continent, exciting and innovative mental health approaches are appearing in the most unexpected of places. In Zimbabwe several health clinics have introduced “friendship benches” on their premises, where visitors are offered oneon-one counselling sessions with trained health care workers. These women are trained to offer problem-solving therapy, empowering their patients to have a sense of control over their own problems. Another example is in Cape Town, where Banetsi Andreas Mphunga, a psychology graduate and registered counsellor, has started offering counselling in Khayelitsha with a mobile counselling clinic in a renovated kombi. This free service aims to both reduce the stigma of seeking mental health support, as well as provide a much needed support for the community. The Khuluma Project in South Africa offers increased psychosocial support for HIV positive adolescents through a free chat service. This service offers peer-based psychosocial support
    and has resulted in more sharing and increased adherence to treatments. This can be linked to the positive effects of sharing one’s burdens with others; being reminded that you’re not alone and finding new ways to cope through hearing what others do. In a project in Ethiopia, there is a
    system of traditional healers who have been providing psychosocial support and treatment to the local population for many years. As a result of this, the Biaber Project aims to merge the two approaches – the modern psychological approach, and the traditional approach – in order to offer a culturally relevant and attuned support system for the local population.

    What kind of mental health innovations can we develop here in Swaziland, in our communities? How can we best respond to the local needs? There are currently two organizations, Duduza and IMERSE that are working to raise awareness of mental health challenges in Swaziland and find ways to improve access to support. Duduza offers both direct services in the form of counselling and support, as well as workshops to further capacitate
    organizations and communities with skills to better sustain one’s mental health. IMERSE focuses on building awareness for various mental health issues in the community. Across the continent, the biggest change in the approach to mental health shifts focus from institutional based care to more community based care by training local community members to provide baseline support. This is something that Duduza and IMERSE aim to do as well. Mental health services are not yet available in the places which need it the most, and perhaps this is where Swaziland too needs to start. We would love to hear your thoughts and answer any questions you may have. Contact us at

    For more inspiring support stories from the African continent visit the Mental Health Innovation Network.

    Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

    Suicide Prevention - May focus

    Suicide is often a difficult topic to bring up and discuss with others. However, it is very important to be aware of risk factors associated with suicide as well as warning signs that someone is considering suicide so when we are faced with such a situation, we are able to take action and seek help quickly.

    Suicide is the intentional ending of one’s own life. There are many feelings and situations that can lead one to such an action, and often people feel as though it is their only way out. People who attempt suicide usually feel overwhelmed, hopeless, helpless, desperate and alone.

    Risk factors are characteristics or conditions that increase the chance that a person may try to take their life.

    Some of the risk factors for suicide include:

    • A previous suicide attempt
    • Family history of suicidal behaviour
    • A serious physical or mental illness
    • Problems with drugs or alcohol
    • A major loss, such as the death of a loved one, unemployment, or divorce
    • Major life changes or transitions, like those experienced by teenagers and seniors
    • Social isolation or lack of a support network
    • Family violence
    • Access to the means of suicide

    An important thing to remember is that mental illnesses may increase the risk of suicide, but everyone at some point in their lives can experience suicidal thoughts. Experiencing risk factors doesn’t necessarily mean someone will think about or attempt to take their own life. We all have different ways of coping with challenges, and strong family relationships and connections also help to balance out difficult or negative life issues.

    Some of the warning signs are:

    • Ideation: thinking about suicide
    • Substance use: increased problems with drugs or alcohol
    • Purposelessness: feeling like there is no purpose in life or reason for living
    • Anxiety: feeling intense anxiety or feeling overwhelmed and unable to cope
    • Trapped: feeling trapped or feeling like there is no way out of a situation
    • Hopelessness or Helplessness: feeling no hope for the future, feeling like things will never get better, feeling like a burden to others
    • Withdrawal: avoiding family, friends, or activities (calling people to say goodbye)
    • Anger: feeling unreasonable anger
    • Recklessness: engaging in risky or harmful activities normally avoided
    • Mood change: a significant change in mood

    The main thing is to be aware of any challenges that the person is facing, keep an eye out for changes in their behaviour, and check in with them if you’re concerned.

    Protective factors for suicide

    Protective factors buffer individuals from suicidal thoughts and behavior. To date, protective factors have not been studied as extensively or rigorously as risk factors. Identifying and understanding protective factors are, however, equally as important as researching risk factors:

    • strong, positive relationships with parents and guardians – feeling secure and supported
    • connections to other non-parental adults
    • closeness to caring friends
    • academic achievement
    • school safety
    • feeling a sense of belonging to something bigger than themselves – community, culture, religion, sports team
    • neighbourhood safety
    • awareness of and access to local health services overall resilience

    How can I help myself?

    If you are experiencing thoughts of suicide, this is often very distressing. Reaching out to experienced doctor’s or mental health professionals is recommended. If you aren’t comfortable seeking professional help on your own, confiding in someone you trust who is close to you is very important. It can be very helpful to talk to others to assist you in finding coping mechanisms which work for you.

    If you are in distress, please contact us here at Duduza or browse through our referral network to find help nearest and most appropriate to you.

    How can I help others?

    It can be very difficult to find ways to help a loved one who you are concerned may be thinking of suicide. It is important to be direct and talk to them, ask them if they are considering suicide. If someone is seriously considering suicide, they may be relieved that someone has noticed that they are struggling and that they now have someone to talk to about it.

    The two most important things you can do are listen and help them connect with mental health services.

    Below are some steps you can take to help prevent suicide (source):

    1. Reach Out – Ask them directly if they are thinking about suicide. It needs to be a direct question that can’t be misinterpreted.

    “Are you thinking about suicide?”

    Most people with thoughts of suicide want to talk about it. They want to live – but desperately need someone to hear their pain and offer them help to keep safe.

    2. Listen to them – Allow them to express their feelings. Let them do most of the talking. They will often feel a great sense of relief someone wants to talk to them about their darkest thoughts.

    3. Check their safety – If you are really worried don’t leave them alone. Remove any means of suicide including weapons, medications, drugs, alcohol, even access to a car. Get help.

    4. Decide what to do and take action – Talk about steps you can take together to keep them safe. Don’t agree to keep it a secret, you shouldn’t be the only one supporting this person. You may need help from someone else to persuade them to get help. You can also help by finding out information on what resources and services are available for a person who is considering suicide.

    5. Ask for a promise – Thoughts of suicide may return, so ask them to promise to reach out and tell someone. Asking them to promise makes it more likely they will tell someone.

    6. Get help – There are lots of services and people that can help and provide assistance.
    • GP (doctor)
    • Counsellor, psychologist, social worker
    • School Counsellor
    • Emergency Services
    • Community Health Centres
    • Seek support from family and friends, youth group leader, sports coach, priest, minister or religious leader etc.

    Supporting a loved one can be a difficult experience for anyone, so it’s important to take care of your own mental health during this time and seek support if you need it. In some situations they may refuse help and you can’t force them to get help. You need to ensure the appropriate people are aware of the situation. Don’t shoulder this responsibility yourself.

    • U.S. Public Health Service. The surgeon general’s call to action to prevent suicide. Washington DC: US Department of Health and Human Services; 1999.  
    • Suicide Prevention Resource Center, & Rodgers, P. (2011). Understanding risk and protective
    factors for suicide: A primer for preventing suicide. Newton, MA: Education Development Center, Inc. 

    Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

    Anxiety Disorders - June Focus

    Anxiety Disorders

    Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships.

    There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.

    Signs and symptoms

    The symptoms of anxiety conditions are sometimes not all that obvious as they often develop slowly over time and, given we all experience some anxiety at various points in our lives, it can be hard to know how much is too much.

    Normal anxiety tends to be limited in time and connected with some stressful situation or event, such as a job interview. The type of anxiety experienced by people with an anxiety condition is more frequent or persistent, not always connected to an obvious challenge, and impacts on their quality of life and day-to-day functioning. While each anxiety condition has its own unique features, there are some common symptoms including:

    • Physical: panic attacks, hot and cold flushes, racing heart, tightening of the chest, quick breathing, restlessness, or feeling tense, wound up and edgy
    • Psychological: excessive fear, worry, catastrophizing, or obsessive thinking
    • Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life

    Types of anxiety 

    Many people with anxiety experience symptoms of more than one type of anxiety condition, and may experience depression as well. It’s important to seek support early if you’re experiencing anxiety. Your symptoms may not go away on their own and if left untreated, they can start to take over your life.

    There are different types of anxiety. The six most common are:  

    • Generalised anxiety disorder (GAD)
      A person feels anxious on most days, worrying about lots of different things, for a period of six months or more.
    • Social phobia
      A person has an intense fear of being criticised, embarrassed or humiliated, even in everyday situations, such as speaking publicly, eating in public, being assertive at work or making small talk.
    • Specific phobias
      A person feels very fearful about a particular object or situation and may go to great lengths to avoid it, for example, having an injection or travelling on a plane. There are many different types of phobias.
    • Obsessive compulsive disorder (OCD)
      A person has ongoing unwanted/intrusive thoughts and fears that cause anxiety. Although the person may acknowledge these thoughts as silly, they often try to relieve their anxiety by carrying out certain behaviours or rituals. For example, a fear of germs and contamination can lead to constant washing of hands and clothes.
    • Post-traumatic stress disorder (PTSD)
      This can happen after a person experiences a traumatic event (e.g. war, assault, accident, disaster). Symptoms can include difficulty relaxing, upsetting dreams or flashbacks of the event, and avoidance of anything related to the event. PTSD is diagnosed when a person has symptoms for at least a month.
    • Panic disorder
      A person has panic attacks, which are intense, overwhelming and often uncontrollable feelings of anxiety combined with a range of physical symptoms. Someone having a panic attack may experience shortness of breath, chest pain, dizziness and excessive perspiration. Sometimes, people experiencing a panic attack think they are having a heart attack or are about to die. If a person has recurrent panic attacks or persistently fears having one for more than a month, they’re said to have panic disorder.

    Click here to learn more about these 6 different types of anxiety disorders

    Treatments and Therapies

    Anxiety disorders are generally treated with psychotherapy, medication, or both.

    • Psychotherapy

    Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs. A typical “side effect” of psychotherapy is temporary discomfort involved with thinking about confronting feared situations.

    • Cognitive Behavioral Therapy (CBT)

    CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
    Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.
    Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.
    CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.

    For more specific information and diagnosis of anxiety disorders, please consult a medical practitioner or psychologist in your area.

    Additional resources and references:

    Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

    Disclaimer: The information found on is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on

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