Why Africa needs a Mental Health Revolution in 2022?

With 50 percent of mental health conditions starting by age 14 and 75 percent by the mid-20s, the continent must come out of the slumber in 2022 and push for a strong mental health action plan, before it becomes too late.
mental health africa
(Representative Image. Source: www.afro.who.int)

Uganda, in East Africa, has a population of over 42 million and 87% of its people live in rural areas. The country has only one mental hospital – Butabika Hospital. Established in 1955, the hospital has 500 beds, and is located about 12 km east of the capital city Kampala, making it not only inaccessible to a large majority of rural population but also proving grossly inadequate in meeting the mental health needs of the city dwellers as well.

Rao Narender Yadav

Somewhat same scenario prevails in a majority of African countries, as mental health care continues to face social stigma, political apathy and economic deprivation. Most African governments devote less than 1% of their budgets to mental health services. Many sub-Saharan African countries have only one psychiatrist per million population, and some countries have none. As per the Lancet Global Health article “Mental health in Africa”, “there are 1.4 mental health workers per 100,000 people, compared with a global average of nine per 100,000. The region also performs relatively poorly concerning the number of psychiatrists, the number of hospital beds for patients with mental illness, and the coverage of outpatient facilities. Partly as a consequence, the proportion of Africans who receive treatment for mental health problems is extremely low.”

COVID-19 in Africa, as in most other geographies, has increased the demand for mental health services. Financial loss, bereavement, lockdown, fear are triggering mental health conditions among millions or exacerbating existing ones. Increased levels of alcohol and drug use, insomnia, and anxiety are becoming more common, making people with pre-existing mental, neurological or substance use disorders more vulnerable to COVID, particularly among youth. Undoubtedly, as pointed out by WHO, the COVID-19 pandemic has generated a “parallel epidemic” of deteriorating mental health, especially among young people.

Several pre-COVID as well as recent studies have shown the abnormally high prevalence of various mental health issues among Africa’s young population. A study, published in PLOS ONE, shows that “in sub-Saharan Africa, one in seven children and adolescents experiences significant psychological challenges, and almost 10% qualify for a psychiatric diagnosis.” The study also highlighted that impoverished living conditions and high prevalence of HIV/AIDS were extra risk factors for mental health morbidity in Africa. During this large scale research, across 37 studies published between 2008 to 2020 and spanning 97,616 adolescents, the researchers found 26.9% with depression, 29.8% with anxiety disorders, 40.8% with emotional and behavioural problems and more than 20% having suicidal thoughts.

As per UNICEF and WHO 2021 report, children in Africa “have been exposed to even greater threats with school closures, increased exposure to armed conflicts, and lack of opportunities to play and socialize with their peers. The long-term lockdowns have reportedly increased early marriage, teenage pregnancies and sexual and domestic violence towards children – especially girls.” 

Lack of political commitment on issues of social good and equity have always been a major hindrance in the development of Africa and mental health space is no different. In an interesting study “Setting Mental Health Priorities in Ghana: A 15-Year Contextual Analysis of the Presidential State of the Nation Address”, researchers from Accra carried out a summative qualitative content analysis of the state of the nation addresses (SONAs) presented by presidents of Ghana from 2007 to 2021. It suggested a “conspicuous absence of any mental health condition in the speeches analysed, mental health policy priorities were low, superficial, and woefully incomparable to that of medical/physical health”. This is immensely important during the pandemic as emerging evidence suggests that public speeches by heads of governments and popular leaders around the world are having a positive influence on their citizens’ adherence to preventive protocols of the current COVID-19 pandemic.

Political apathy, at the highest level, is naturally resulting in mental health policy processes that are inadequate, leading to either weak or non-existent policies. Even though a few African countries have made mental health and psychosocial support part of their national COVID-19 response plans, but none of them have provided additional funding for covering these activities. To further decelerate the process of adequate and contemporary public policy formulation, only 21% of African countries have recent mental health legislation compared to a global average of 40%, as they continue with decades old regressive legislative framework.

What 2022 could change in Africa?

Commitment to implement WHO’s Comprehensive Mental Health Action Plan: Seven years before the pandemic, the sixty-sixth World Health Assembly, consisting of Ministers of Health of 194 Member States, adopted the WHO’s Comprehensive Mental Health Action Plan 2013-2020 in May 2013. In 2019, the action plan was extended until 2030 by the seventy-second World Health Assembly. This year, the seventy-fourth World Health Assembly further endorsed the updates to the action plan, which aims to promote mental health and well-being for all, to prevent mental health conditions for those at-risk and to achieve universal coverage for mental health services. The pandemic has necessitated that African countries make dedicated efforts to achieve these goals at a much faster pace by creating better policy framework for more effective leadership and governance on mental health issues. In addition, governments at the national level as well as more decentralised scale must create provisions for a comprehensive, integrated mental health and social care services in community-based settings for wider reach.

Creating a strong foundation of MH intervention based on research and data: Lack of credible data and scientific insights about MH prevalence and key triggers should be addressed on priority by facilitating more research studies. Currently, there are very few large scale research studies on Mental Health in Africa e.g The African Mental Health Research Initiative (AMARI) – a mental health research capacity building grant funded through the Developing Excellence in Leadership, Training and Science (DELTAS) in Africa, a programme of the African Academy of Sciences (AAS) implemented with the support of Wellcome Trust and the UK Department of International Development. Study’s overall goal is to build an Africa-led network of future leaders in mental, neurological and substance use (MNS) research in Ethiopia, Malawi, South Africa and Zimbabwe. More such studies, preferably with international collaborations, must be taken up in other parts of Africa, as new avenues for research funding are opening due to COVID-19.  

UNICEF and the WHO has also committed to a 10-year Joint Programme on Mental Health and Psychosocial Well-being and Development of Children and Adolescents in Africa. Signed in 2020, this decade-long collaborative effort is working with local governments to strengthen mental health and psychosocial support systems for children, adolescents and their caregivers.

Strengthening the network and capacities of CSOs: Public education and awareness campaigns, and projects run by grassroots organizations to address the mental health crisis need to be further strengthened and supported by individual governments, with support from international donors. Organisations like Mentally Aware Nigeria Initiative (MANI), founded by Victor Ugo, StrongMinds and several others can definitely create a pathway to reach out to a large cross section of people. MANI is a youth-led and youth-focused non-governmental organisation working to end the stigma and discrimination attached to mental health in Nigeria and the rest of Africa. It claims to have over 130 million unique social media users reached every year, and providing crisis support to more than 30,000 people in the last four years. StrongMinds has been providing mental health care to low-income women and adolescents in Uganda and Zambia, and estimates that more than 66 million women are suffering from depression in Africa, and 85% have no access to treatment.

Economic benefits in the long run: Even in purely monetary terms, it make sense to invest in mental health care today. Pre-COVID-19 estimates reveal that nearly US$ 1 trillion in economic productivity is lost annually from depression and anxiety alone. However, studies show that every US$ 1 spent on evidence-based care for depression and anxiety returns US$5. Young people in Africa are particularly at risk of mental disorders and current healthcare systems are not well equipped to deal with them. Investing in child and mental health in Africa now, will give rich dividends fore sure. The latest UNICEF State of the World’s Children Report reveals that school-based interventions addressing anxiety, depression and suicide provide a return on investment of US$21.5 for every US$1 over 80 years.

Africa is fast getting trapped in the quagmire of mental health crisis and a well-planned and timely intervention by multiple stakeholders at pan-African level is the need of the hour.

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