Walani, a student helpline in Malawi

We have noticed many of our students are stressed, overwhelmed and mentally withdrawn. We have concerns for their mental well-being. Mental health problems are on the rise throughout the world but are already notably higher in Africa where there are fewer health services available.

Trainee health workers are exposed to physical and emotional trauma and deal with the impact of death and dying during their training, at a time when they do not yet have the skills to manage complex conditions and patient interactions. They are vulnerable to burn out, which exacerbates existing stressors related to sourcing tuition fees, accommodation and food and may help explain why mental health problems are higher in this vocational group.

In 2019, a study from Cape Town showed that almost 25% of medical students reported levels of depression and anxiety, significantly higher than age-based expectations. It was recommended that there should be multidisciplinary efforts targeting initiatives to strengthen mental well-being and resilience in future health care professionals.

There is no existing research to show the levels of depression in trainee health workers in Malawi. Anecdotally during our interactions with students, we have been concerned at the levels of stress experienced by student health workers in our community. In March 2022 we conducted a survey and needs assessment of our student community by asking the validated Patient Health Questionnaire 9 (PHQ9) depression screening survey together with other acceptability questions.

We had a response rate of 54% of Medic to Medic students. 94% of respondents had been overwhelmed in their studies. 56% of students felt there were inadequate psychosocial supports available at their college. Overall, 60% of students had a level of mild – moderately severe depression. This was broken down into 27% of students with mild depression, 19% with moderate depression and 14% with moderate – severe depression. If extrapolated, these rates are likely to be an underestimate to the student community in Malawi given students on scholarships do not have the same degree of financial burden as other students who do not have tuition fee support. Students who took part in this survey were offered a follow up phone call with a Medic to Medic MBBS graduate with several years of clinical experience. 62% of students requested a follow up phone call.

Our survey demonstrates an overwhelming need to provide additional psychosocial supports to students throughout Malawi. We would like to embark on a new initiative, setting up a confidential and free helpline for students to access psychosocial counselling services. The helpline will be staffed by psychosocial counsellors and mental health workers. All counsellors will have undergone a rigorous selection process and training programme. The helpline will be an evening phone line from 5pm – 10pm to ensure that students have access to psychosocial supports outside of business hours when other services may not be available. This initiative will not take over existing psychosocial supports available to students at university, but will compliment existing services. 

Results from our survey showed 100% of student respondents felt a helpline would be acceptable and all stated they would recommend such a service to their friend. 100% of faculty members from 10 universities and colleges in Malawi felt that a student helpline was an acceptable initiative and 100% would recommend it to their students.

In 2023 we aim to launch this initiative.  This timeframe enables us to work towards protocols and training pathways such that it is well organised and effective.