Reaching the home of 79-year-old Matlohang Moloi involves a steep ascent through the mountainous terrain that defines Lesotho’s high elevation. As a mother of ten, Matlohang welcomes visitors into her meticulously maintained home, showcasing photos of her large family. The discussion revolves around her eldest son, Tlohang.
At the age of 38, Tlohang became part of a disheartening statistic: Lesotho, known as the kingdom in the sky, has the highest suicide rate globally. Matlohang remembers her son as a loving individual who had confided in her about his mental health struggles.
She recalls him mentioning, on the day he took his own life, that she would one day hear he had ended his life. His passing was a profound blow, and she wishes he had been able to explain his troubles more clearly. He had been concerned that sharing his struggles might lead others to perceive him as weak and incapable of managing his own problems.
The World Health Organization reports that Lesotho has a suicide rate of 87.5 per 100,000 people each year, a figure that is more than twice as high as that of the next leading country, Guyana, which has just over 40. This rate is also nearly ten times the global average of nine suicides per 100,000 people.
Organizations like HelpLesotho are actively working to change this troubling statistic by providing young people with tools to manage their mental health. In the town of Hlotse, about two hours from Maseru, social worker Lineo Raphoka conducts regular group therapy sessions for young women.
During one session, 24-year-old Patience addresses the group’s concerns, noting that there is often resistance to discussing mental health issues due to cultural and spiritual beliefs. She shares her own experiences of losing three friends to suicide and her own past attempts, highlighting the urgent need to address these issues openly.
In this community, nearly everyone has confronted suicidal thoughts or knows someone who has died by suicide. Thirty-five-year-old Ntsoaki becomes emotional as she recounts her harrowing experience of being raped in a hospital. “The doctor told me I was too attractive,” she recalls, her voice trembling. “He then pulled out a gun, saying he wanted to have sex with me, and if I refused, he would kill me.”
Despite frequently thinking of suicide as the only way out, Ntsoaki explains that she never had the resolve to act on these thoughts. “What kept me going were the faces of my brothers,” she says. “They believe I am strong, but I feel like I’m failing.”
The group supports her, acknowledging her bravery in sharing her story. As the session wraps up, the women talk and laugh, expressing relief at having voiced their experiences.
The reasons for suicide are multifaceted, but Ms. Raphoka observes certain patterns in Lesotho. “Many people struggle with issues such as rape, unemployment, and loss from death, and they often turn to drug and alcohol abuse,” she explains.
A 2022 World Population Review report highlights that 86% of women in Lesotho have faced gender-based violence, while the World Bank notes that 40% of young people are neither employed nor in education. “They often don’t receive the necessary support from their families, friends, or other connections,” Ms. Raphoka adds.
In Lesotho, discussing mental health can be uncomfortable due to fear of judgment. One evening in a Hlotse bar, where patrons enjoy local beer and watch football, I bring up mental health. “We do talk about it,” says Khosi Mpiti. “We agree that we need to open up about these issues.”
Some people worry that sharing too much about their mental health might lead to gossip. Despite these concerns, progress is being made. “Our group of friends is very supportive,” one individual notes. “If I’m facing an issue, I share it with them, and we help each other.”
Those who seek assistance, however, often encounter challenges within the public health system. The ombudsman criticized the country’s only psychiatric unit last year for operating without a psychiatrist since 2017 and for having “conditions that infringe on human rights.” Additionally, there was no national mental health policy in place to address the crisis, though the new government, which took office in October 2022, is now working on creating one. “Mental health has become a crisis,” admits Mokhothu Makhalanyane, a member of parliament leading a committee on health issues.
“We are intensifying advocacy efforts across all levels, from primary and high schools to popular youth venues like football tournaments,” he notes. “The new policy will include clear guidelines for treatment and ensure that those affected have access to rehabilitation services.”
He also believes that lessons can be learned from Lesotho’s approach to HIV/AIDS. In 2016, the country became the first to adopt a “test-and-treat” strategy, allowing people to start treatment immediately after diagnosis. This method has led to a consistent decrease in infection rates. “Our experience showed that open dialogue, without assigning blame or criticism, played a key role in improving the situation,” he adds.
Meanwhile, in the mountainous region, Ms. Moloi walks to Tlohang’s grave. His final resting place offers a stunning view, surrounded by streams, lush greenery, and small homes.
Ms. Moloi, like many others in Lesotho, is coping with the grief of losing someone to suicide. As she reflects on the view, she emphasizes a message for those who may be struggling with similar thoughts. “I want to tell people that suicide is not a solution. It’s important to talk to those around you and seek their support.”