The silent crisis: mental health in Africa

Lazarus Sauti

Mental health is a silent crisis in African nations as most of the people who suffer from the infirmity do not have easy access to the health care they need.

Mental health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the World Health Organisation’s definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease”.

Adds the WHO: “Mental health is related to the promotion of well-being, the prevention of mental disorders, and the treatment as well as the rehabilitation of people affected by mental disorders.”

Forlornly, in most African nations, communities are often not sympathetic towards people with mental disorders: depression, bipolar affective mayhem, schizophrenia and other psychoses, dementia, intellectual disabilities along with developmental disorders including autism.

These people face discrimination, social exclusion over and above the violation of basic human rights, all due to on-going stigmatisations associated with mental health problems.

In some communities, for instance, mental health patients are exiled to the edge of towns and cities where they are left semi-naked or in rags.

“The stigmatisation tied to mental disorders is a serious obstacle to care. In Africa, the reaction is also deeply rooted in cultural beliefs and associations that some communities make between mental disorders and witchcraft,” explained Dr Abel Kabalo, Eastern Province medical officer in Zambia, adding that many mental health problems among African populations are also tied to poverty, warfare and natural disasters.

He went on to say: “Ironically, gross violations of basic human rights occur in institutions where people with ill mental health (problems) seek treatment.

“Most facilities are unhygienic and improper for human living. Patients are contained with metal shackles, detained in caged beds, denied clothing, decent bedding, clean water or proper toilet facilities.”

Dr Kabalo also stated that people with mental health conditions face discrimination on a daily basis including in the fields of education, employment and housing, and their welfare have been neglected for far too long.

He blames lack of funds as a challenge in expanding mental health services. “Lack of funds and difficulties such as finding adequate transportation and medication are impediments for health workers attempting to reach rural inhabitants,” he added.

Limited access to the necessary drugs is also a complication, according to Atalay Alem, an Ethiopian researcher in psychiatry and principal Africa Focus on Intervention Research for Mental Health (AFFIRM) investigator.

Alem, like Dr Kabalo, also worries about the lag time before primary health care professionals and district health bureaus make mental health care an integral part of health services.

Accordingly, Alem and Dr Kabalo urge public and private sectors as well as generous development partners in the health sector in Africa to enter into Public Private Partnerships with governments so as to effectively close the gap in the mental health service delivery.

Dr Kabalo affirmed: “To bridge the gap in mental health service delivery, development partners in health and development along with private and public enterprises need to increase their focus on mental health issues and support governments with the much needed financial support. Investing in mental health treatment for African countries is a springboard to social and economic expansion.”

Mahlet Atakilt Woldetsadik, an assistant policy analyst at RAND Corporation, a non-profit and non-partisan research organisation that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous, agrees.

“Mental health receives on average one per cent of health budgets in sub-Saharan Africa despite the World Health Organisation estimate that it carries 13 per cent of the global burden of disease.

“Therefore, governments sectors need to increase their budget allocations towards health services,” she asserted. 

The World Health Organisation also said low and middle income countries must increase their health budget allocations to adequately respond to the burden of health issues such as mental disorders.

“In low- and middle-income countries, between 76 per cent and 85 per cent of people with mental disorders receive no treatment for their disorder. Because of this, governments must increase their funding towards this health crisis,” said the WHO.

The United Nations international public health agency added, “In addition to financial inducements as well as support from health-care services, people with mental illness require respect, social support and care.”

Ministries of health, organisations of people with mental health conditions, health professionals, non-governmental organisations including disabled peoples’ organisations, academic institutions, professional organisations and other stakeholders should, thus, unify their efforts in educating and changing public attitudes towards mental illness and in advocating for the rights of people with mental disorders.

All African countries must also ratify the United Nations Convention on the Rights of Persons with Disability (CRPD). The coming into force of the Convention is a major milestone in efforts to promote, protect and ensure the full and equal enjoyment of all human rights of people with disabilities.

African states should also align their policies and laws to the Convention, ensuring that these promote self-sufficiency, liberty, legal capacity, participation of people with mental health conditions, as well as the range of services required for independent community living.

Woldetsadik agrees and adds, “African states need to update plans, strategies, policies and laws on mental health and make sure that development programmes that respond to mental health needs of citizens are integrated into community based settings.”

Zimbabwe’s Minister of Health and Child Care, Dr. David Parirenyatwa says that in most African societies, people seek help from traditional healers once their relatives become victims of mental illness; as a result, there is need for governments to work closely with traditional as well as faith healers to stem the problem of mental health.

He also encouraged African governments to improve human rights in mental health facilities through investing in infrastructure rehabilitation in addition to providing the necessary equipment compatible with certain conditions of mental illness.

“Avenues to evaluate the quality of care and human rights conditions should be instituted so as to protect against inhuman and degrading treatment of people living with mental health conditions,” he said.

David Okello, Zimbabwe’s World Health Organisation director, believes that more trained experts are required in this field if the calamity of mental illness is to be halted.

“African countries need more trained staff, not just doctors.

“They need to train more staff from lower levels including paramedics, more therapists and social workers,” he said.

Okello added that governments should empower people with mental health conditions and their families as such groups are in a better position to highlight mental problems, specify their needs and help find alternative solutions to prevent human rights violations.

Mental health, without doubt, is a silent emergency that needs urgent attention and a multi-sectoral approach to address it. African governments, therefore, need to recognise and implement the World Health Organisation’s Mental Health Actions Plan 2013-2020.

The action plan, endorsed by the World Health Assembly in 2013, recognises the essential role of mental health in achieving health for all people, and it includes four major objectives: more effective leadership and governance for mental health; the provision of comprehensive, integrated mental health and social care services in community-based settings; the implementation of strategies for promotion and prevention; and strengthened information systems, evidence and research.