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First Person: Supporting Mental Health in Madagascar, One Consultation at a Time


Henrielle Emasignavy works for WHO in Ambovombe, where the Androy regional reference hospital is based. She spoke about caring for people experiencing mental health crises.

Henrielle Emasignavy from WHO at the Androy regional reference hospital.

Henrielle Emasignavy from WHO at the Androy regional reference hospital.

“In Ambovombe town we see a number of mental health problems including psychotic episodes, schizophrenia and depression.

The number of young people suffering from mental health problems has increased. We think that in young men it could be linked to cannabis use, and in young women between 13 and 18 years old it could be the breakdown of a relationship or depression following the birth of a child.

One of the contributing causes, among both men and women, is the anxiety of constantly living in stressful conditions caused by the ongoing humanitarian crises in southern Madagascar.

We have recently experienced droughts and cyclones in different parts of the south, which have worsened the effects of climate change as well as deep-rooted underdevelopment. The many vulnerable people who live in the south of the country are therefore fighting for their survival. When crops fail, they have no safety net and often go hungry. Access to health and other social protection services can also be problematic.

“Victims of witchcraft”

I met a woman called Elodie who suffered from postpartum psychosis after giving birth at age 20 and losing her child six months later.

When I met her, I noticed that a chain was attached to her ankle.

Her mother told me it was for her own safety, as her daughter was trying to escape. People suffering from mental health disorders are heavily stigmatized. They are said to be “possessed” and victims of witchcraft.

Mental health problems can be cured medically, but growing ignorance and poverty force people to resort to drastic measures, such as immobilizing patients, which exacerbates the mental illnesses they suffer from. .

The mother (center) of Elodie (right) says she responded well to the medication.

The mother (center) of Elodie (right) says she responded well to the medication.

Access care

Access to treatment is extremely difficult for patients. The nearest specialist hospital for mental health treatment is approximately 600 kilometers away. To meet the growing need for services, WHO has called on medical teams for periodic outpatient care.

Over a three-day period, there were a total of 93 free consultations; 67 percent of these patients were women, including Elodie, who was seen by a neurologist. Following this consultation, she received medication which, according to her mother, improved her mental health. Elodie is taking better care of herself; for example, she takes care of her personal hygiene.

The WHO would like there to be more services available for people like Elodie, and while it is clear that there is only so much a visiting psychiatrist can do, I am happy that we can help some patients on the path to recovery.

Elodie has the support of her mother and sister, but unfortunately the rest of the family rejected her and so she and her mother were forced to leave the family home.

Her mother hopes for a full recovery soon so that Elodie can lead a normal life again and can earn some money and contribute to the needs of the household of three women.

  • Promote mental health and well-being and strengthen drug prevention and treatment
  • Reduce the number of deaths and illnesses due to pollution, contamination and tobacco
  • Achieve universal health coverage and ensure access to essential and affordable vaccines and medicines
  • Reduce the global maternal mortality rate to less than 70 per 100,000 live births and the under-five mortality rate to at least 25 per 1,000 live births
  • End the epidemics of AIDS, tuberculosis and malaria and combat hepatitis and other communicable diseases

Sustainable development is based on ensuring healthy lives and promoting well-being at all ages.


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