28. Februar 2025

Behandlungsmöglichkeiten psychischer Erkrankungen (insbesondere bei PTBS)............. 1

 Zugang zu Krankenversicherung........................................................................................................ 5

 Behandlungskosten................................................................................................................................. 6

Die folgenden Ausschnitte aus ausgewählten Quellen enthalten Informationen zu oben genannter Fragestellung (Zugriff auf alle Quellen am 28. Februar 2025):

Behandlungsmöglichkeiten psychischer Erkrankungen (insbesondere bei PTBS)

·      The Borgen Project: Mental Health in Namibia, 7. November 2024
https://borgenproject.org/mental-health-in-namibia/

„The country has only two major mental institutions: Windhoek Central Hospital, which dedicates only 220 beds to mental health care, and Intermediate Hospital Oshakati, which offers 60 beds but often deals with 200 patients at once.” (The Borgen Project, 7. November 2024)

Die Psychological Association of Namibia (PAN) veröffentlicht auf ihrer Webseite eine Liste der verfügbaren Psycholog·innen in Namibia und deren Kontaktdaten:

·      PAN - Psychological Association of Namibia: Practitioners, 2025
https://www.psychologynamibia.org/practitioners

·      Thanises, Atelma & Meshelemiah, Jacquelyn: An incongruence between policy, practice, and cultural values: implications for mental health services in Namibia. In: Journal of Ethnic and Cultural Diversity in Social Work, 5. Juli 2024
https://www.tandfonline.com/doi/epdf/10.1080/15313204.2024.2374805?needAccess=true

„According to the National Policy for Mental Health, diagnosis and treatment of mental illnesses are to be done at the district hospital level, and referrals to specialized care are to be made when the case is deemed too difficult to further treat (Ministry of Health and Social Services, 2005). Additionally, the Namibia Standard Treatment Guidelines are used by medical officers to diagnose and treat all types of medical conditions in Namibia. These guidelines were developed through a consultative process involving experts in health care in consideration of current treatment policies, prevalent disorders in Namibia, as well as universal evidence-based medicine approaches (Ministry of Health and Social Services, 2021). Since its enactment in 2005, Namibia’s National Policy for Mental Health (NPMH) has been criticized for not being successfully implemented. Ashipala et al. (2016) found that when interviewing 52 nurses and 12 healthcare administrators spread throughout 13 health facilities in the Oshana region in Namibia about the country’s NMHP, it was concluded that mental health services were not fully implemented into primary health care due to budget issues, poor mental health leadership, few available medications, and the lack of preparedness of practitioners to offer mental health services. The study further revealed the limitations of implementation being due to a lack of clear guidelines on diagnosis, treatment, and management of mental disorders, lack of adequate secondary referral systems, a shortage of mental health professionals, and lack of training on the implementation of the policy. While the country continues to waddle in inaction, Namibians with mental disorders wait and suffer in isolation due to the stigma associated with mental disorders.” (Thanises & Meshelemiah, 5. Juli 2024, S. 3)

„As previously stated, the vastness of Namibia has had a detrimental effect on its mental health services. Nearly 70% of Namibians live in rural areas (Chipare et al., 2021), and Namibia has only two hospital-based mental health units for the whole country and only one of them has a full multidisciplinary team (Dipura, 2019; World Health Organization, 2020). When patients need specialized mental health services, they must travel long distances and endure overcrowded hospitals (Namene & Jamu, 2021).” (Thanises & Meshelemiah, 5. Juli 2024, S. 3)

·      Government of Namibia: Second periodic report submitted by Namibia under articles 16 and 17 of the Covenant, due in 2021 [30 January 2023] [E/C.12/NAM/2], 3. Mai 2023
https://www.ecoi.net/en/file/local/2093303/G2308704.pdf

„Mental Health Patients

180. Specialized mental health services are available at the Windhoek Mental Health Care Center (‘WMHCC’) and Oshakati Psychiatric Unit. Patients from outside Windhoek and Oshakati are first handled at their nearest health facilities. The responsible doctors follow referral guidelines provided to all regions by the psychiatrist. According to these guidelines, the patient should first be treated for at least 72 hours in the service at which they present. After 72 hours if there is no improvement in the patient’s condition, the doctor should refer the patient to the psychiatrist.

181. Emergency mental health services are also provided at district hospitals as part of general wards. Follow-up services and a limited range of psychotropic medications are available at some health care centres and clinics.

182. The WMHCC provides outpatient and inpatient services to adults and children and has a bed capacity of 200 beds (120 at Civil and 80 at Forensic). It provides services according to the bio-psycho-social model of health, which is employed in a multi-disciplinary and inter-disciplinary setting. The model looks at three components that affect mental health, namely biological, social and psychological. All the activities and procedures at the centre are guided by: Mental Health Act, 1973 (Act No. 18 of 1973) currently under review; the Criminal Procedure Act, 1977 (Act No. 51 of 1977) and the Correctional Services Act, 2012 (Act No. 9 of 2012).

183. Services are rendered by a multi-disciplinary team at WMHCC consisting of:

• Medical Services (Doctors) – The medical services are responsible for conducting Mental Status Examination (MSE), coming up with a diagnosis and prescribing medication.

• Mental Health Nursing – The nurses are responsible for providing mental health nursing to all in-patients and out-patients at the centre. Nurses also identify and care for the physical aspects of the patients’ problems.

• Clinical Psychology – The clinical psychologist performs psychometric tests, come up with diagnosis and provide psychotherapy. Clinical psychologist also treats individuals with emotional problems and behavioural disturbances.

• Occupational Therapy – Occupational therapy focuses on the restoration of function and improvement of social participation levels through the use of occupations such as work, self-care and leisure/play. Occupations are activities that bring meaning to the daily lives of individuals, families, and communities and enable them to participate in society.

• Clinical Social Work – Social workers promote social change and development, social cohesion and empowerment of people with mental health challenges. Social Workers carry out assessments for disability grants and also investigate the socio-economic circumstances of patients through interviews and home visits. In addition to the above mentioned, Social Workers also educate families and communities about mental health as well as accepting diagnosis, treatment and adherence to medication.

• Pharmacy – The pharmacist dispenses psychiatric medication to both inpatients and out-patients and ensures that patients have access to the safest and most efficacious drugs.

184. The WMHCC conducts outreach clinics in and around Windhoek. The WMHCC has different Units with different wards:

• General Psychiatry, with an outpatient department and the inpatients wards. The inpatient wards have five (5) wards:

• Male A ward for acute psychotic patients, both state and private patients.

• Male B ward for substance abuse related disorders.

• Ward C for acute psychotic female patients, both state and private patients.

• Ward D for non-psychotic patients both male and female, state and private patients.

• Ward E for children

• Forensic Psychiatry section is comprised of five wards:

• Ground Floor A ward for male State President’s Decision (SPD) patients.

• Ground Floor B for male SPD admission, female SPD patients and female observation patients.

• First Floor ward for male SPD with intellectual disability/mental retardation.

• Maximum Security ward for male observation patients.

• Rehabilitation ward for male SPD pre-discharge ward.

185. The Oshakati Psychiatric Unit, which is located in the Oshakati Hospital has a bed capacity of 120. There is a large outpatient clinic that provides service to a minimum of 100 patients per day.

186. Psychotropic medication in Namibia is made available, according to the Namibian Essential Medicines List (NEMLIST). The list has a sufficient range of drugs for the treatment of the mentally disordered individuals who require medication. These drugs are available through district hospitals. The Government of the Republic of Namibia has prioritised mental health through legislative reform processes and the advancement of health facilities and specialists. However, a number of challenges have been experienced in order to ensure structural processes and access to services are attained.“ (Government of Namibia, 3. Mai 2023, S. 34-35)

·      Government of Namibia: Third periodic report submitted by Namibia under article 40 of the Covenant, due in year 2020 [4 August 2021] [CCPR/C/NAM/3], 23. Mai 2022
https://www.ecoi.net/en/file/local/2072771/G2234962.pdf

„There is one psychiatric hospital in Namibia, located in the capital city Windhoek and three (3) more are to be built in other parts of the country when funds permit.” (Government of Namibia, 23. Mai 2022)

·      WHO – World Health Organization: Mental Health Atlas 2020; Member State Profile; [Namibia], 15. April 2022
https://cdn.who.int/media/docs/default-source/mental-health/mental-health-atlas-2020-country-profiles/nam.pdf?sfvrsn=38db3a0f_5&download=true

„Mental health workforce

Total Number (gov. and non gov.) […]

Psychiatrists: 3 […]

Mental health nurses: 7 […]

Psychologists: 3 […]

Social workers: 4 […]

Other specialized mental health workers (e.g. Occupational Therapists): 4 […]

Total mental health professionals: 21 […]

Mental health outpatient facilities attached to a hospital: 2 […]

Psychiatric units in general hospitals: 2“ (WHO, 15. April 2022, S. 2)

Zugang zu Krankenversicherung

·      Afro Barometer: Most Namibians lack health insurance; citizens say government should ensure access to adequate health care for all, 21. August 2024
https://www.afrobarometer.org/wp-content/uploads/2024/08/News-release_Most-Namibians-lack-health-insurance-Afrobarometer-21aug24.pdf

„▪ More than eight in 10 Namibians (85%) say they do not have any medical aid coverage (Figure 1).

▪ The vast majority (74%) of citizens who lack health insurance cite its unaffordability as the primary reason for not having medical aid (Figure 2).

▪ Among the 15% of respondents with medical aid coverage, nearly half (46%) enjoy private health insurance, while 28% are covered by a public sector insurance scheme and one-fifth (20%) are covered by national health insurance (Figure 3).” (Afro Barometer, 21. August 2024)

Es konnten keine weiteren allgemeinen aktuellen Informationen zum Zugang zur Krankenversicherung gefunden werden.

Im Rahmen der Onlinerecherche wurden die Webseiten folgender Krankenkassen bzw. Krankenversicherungssysteme gefunden:

·      Bankmed Namibia: Startseite, ohne Datum
https://bankmednamibia.com.na/

·      Nammed Medical Aid Fund: Home, ohne Datum
https://www.nammed.com.na/

·      NHP – Namibia Health Plan: Startseite, ohne Datum
https://nhp.com.na/

·      NMC – Namibia Medical Care: Startseite, ohne Datum
https://www.nmcfund.com/

·      Republic of Namibia: Public Service Medical Aid Scheme (PSEMAS), ohne Datum
https://mfpe.gov.na/medical-aid

Behandlungskosten

·      New Era Live: EMDR – Dealing with Trauma through Therapy, 25. August 2023
https://neweralive.na/emdr-dealing-with-trauma-through-therapy-2/

„Namibia was found to have the fourth highest suicide rate on the continent; factors that contribute to this high suicide rate include high unemployment and substance abuse Deputy Minister of Health and Social Services, Esther Muinjangue, revealed at a Life Line International Forum held in the capital in June. The deputy minister, stated in an interview, that lack of access to mental health treatment leads to poor health outcomes for the country’s citizens. The psychologist agrees with the deputy minister’s assertion and added that mental health treatment is inaccessible to most Namibians largely due to cost and the price patients have to pay for treatment.

‘Medical aid funds misunderstand mental health disorders and even though they are covered by medical aid they are limited to an amount of sessions which are not enough for complete treatment. Unlike a broken arm which can be fixed and the patient heals and does not require further treatment, dealing with the brain is a much more complex, expensive and intensive undertaking,’ the psychologist emphasised.

Medical aid consultant, Gabriel Emvula, however, disagrees with the psychologist’s assertion that medical aid funds misunderstand the intricacies of mental health treatment and lay the burden on the cost element of providing medical care to mental health patients.

‘You should understand that medical aids are businesses, and unlike the government medical aid which is a scheme, private medical aids are driven by the need to make a profit to ensure sustainability, so from a commercial standpoint, one can understand why patients will only be limited to a certain amount of therapy visits in a given financial year,’ Emvula explained.“ (New Era Live, 25. August 2023)

·      WHO – World Health Organization: Mental Health Atlas 2020; Member State Profile; [Namibia], 15. April 2022
https://cdn.who.int/media/docs/default-source/mental-health/mental-health-atlas-2020-country-profiles/nam.pdf?sfvrsn=38db3a0f_5&download=true

„Insurance for mental health

How the majority of persons with mental health conditions pay for mental health services: Persons pay nothing at the point of service use (fully insured)

How the majority of persons with mental health conditions pay for psychotropic medicines: Persons pay nothing at the point of service use (fully insured)

The care and treatment of persons with mental health conditions (psychosis, bipolar disorder, depression) is included in national health insurance or reimbursement schemes in your country: yes“ (WHO, 15. April 2022, S. 2)

Im Rahmen der Onlinerecherche wurde die Webseite einer Psychiaterin in Namibia gefunden, die auch Informationen zur Zahlungsweise bietet:

·      Psychiatry Namibia: Specialist Psychiatrist, ohne Datum
https://psychiatry-namibia.com/

Es konnten keine Informationen zu den exakten Kosten für die Behandlung von psychischen Erkrankungen in Namibia gefunden werden.