Community Psychologist Intern Lillian Shoko explores the policy reforms needed to make
halfway homes and home-care a reality.
Mental health policy is not simply a document that determines where people receive treatment. It
reflects how a society understands human dignity, recovery, and the role of communities in
supporting people experiencing psychological distress. From a Community Psychology
perspective, Zimbabwe’s mental health system must move beyond a predominantly hospital-
centred model towards a decentralised, recovery-oriented continuum. However, to be effective,
this shift cannot be aspirational—it must be brutally practical.
Zimbabwe has made important strides. The country has strengthened primary-health-care
approaches and participated in the WHO Special Initiative for Mental Health. Notably,
the Friendship Bench has been a global success story for addressing common mental disorders
like depression and anxiety in primary care.
Yet, we must be clear: the Friendship Bench is not a cure-all. It is not designed for severe
conditions such as schizophrenia, bipolar disorder, or prolonged psychosis. These require a
robust, step-down infrastructure—and here, the system is failing. The WHO’s situational
assessment found that Zimbabwe has only two psychiatric hospitals, with 0.42% of the total
health budget allocated to mental health, the bulk of which goes toward maintaining these
centralised institutions.
This concentration of resources raises a critical question: If we are committed to community-
based care, where do clinically stable patients go when they are not yet ready to return to
independent living?
The Missing Link: Why We Need a Bridge
One of the gravest weaknesses in our current system is the abrupt transition from a highly
structured ward directly back to the family home. Without an intermediate level of
care—halfway homes, supported accommodation, or community residential
rehabilitation—discharge often becomes an abandonment of responsibility.
To fix this, we must explicitly establish and fund a graduated continuum of care:
Psychiatric hospital → Halfway Home/Supported Residence → Home-based Care →
Community Participation → Independent Living.
However, building this continuum requires confronting several uncomfortable realities head-on.
- The Funding Dilemma (Where does the money come from?)
Advocating for new facilities without addressing the national purse is naive. However,
evidence from global health economics shows that community-based residential care
costs significantly less per patient-day than a bed at a central psychiatric hospital. We do
not necessarily need a massive new budget allocation; we need reallocation. The Ministry
of Health should mandate that a fixed percentage of the current mental health budget be
ring-fenced for community step-down facilities. Additionally, the government must
aggressively pursue public-private partnerships with faith-based organisations and NGOs
that already operate residential facilities, converting existing infrastructure into licensed
halfway homes. - The Burden on Families (Home is not always a sanctuary)
From a Community Psychology standpoint, we cannot romanticise “home-based care.”
Many Zimbabwean families are economically strained, lack basic psychoeducation, and
are influenced by cultural/spiritual interpretations of illness that may lead to neglect or
harmful practices. We cannot simply discharge a patient into a home without a support
structure for the caregivers.
The policy must therefore mandate caregiver training, routine respite care (to prevent
burnout), and modest state stipends for families acting as primary caregivers.
Deinstitutionalisation without supporting the family unit results not in empowerment, but
in institutionalising the burden within the household. - The Workforce Crisis (Who will staff these homes?)
Zimbabwe is suffering a catastrophic brain drain of nurses, clinical psychologists, and
occupational therapists. A halfway home without skilled staff is merely a holding cell. To
solve this, we must pivot to task-shifting and upskilling. Psychiatric nurses should be
trained to lead these community residential units, supported by environmental health
officers and community health workers. We do not need a psychiatrist in every halfway
home; we need a robust, well-supervised tier of mid-level practitioners who can
administer medication, provide occupational therapy, and oversee relapse prevention.
- Infrastructure and Medication (The basics are non-negotiable)
Operationalising a halfway home in Zimbabwe means dealing with erratic water supplies
and power outages. These facilities must be designed with sustainable boreholes and
solar energy from the outset. More critically, a halfway home is useless without
consistent access to psychotropic medicines. The policy must explicitly tether these
community residences to the national Essential Medicines Supply Chain. Relapse is often
caused by empty pharmacy shelves; community care must guarantee biological treatment
continuity alongside psychosocial support. - The Stigma Barrier
We cannot ignore the “Not In My Backyard” syndrome. Communities often resist hosting
facilities for mental health recovery due to deep-seated stigma and fear. Placing a
halfway home in a suburb without preparation will likely trigger protests. Therefore, the
policy must budget for intensive community sensitization campaigns that must
precede—not follow—the establishment of any such facility. Neighbours must be
engaged, educated, and turned into allies before a single patient is moved in.
The Path Forward
Zimbabwe does not need to choose between psychiatric hospitals and community care. It needs a
functional continuum where hospitals provide acute specialist treatment, halfway homes provide
rehabilitation, and families are supported to provide long-term wellness.
Deinstitutionalisation without community alternatives results in abandonment, not
empowerment. But deinstitutionalization with a pragmatic, fully-costed, and sensitively
implemented plan for residential rehabilitation, family support, and workforce upskilling will
save lives and restore human dignity.
The policy document must not just state what we want; it must detail how we will pay for
it, who will run it, and how we will keep the medicine stocked. That is the practical revolution
Zimbabwe’s mental health system
