African leaders need to be serious with mental health

Francis Kokutse is a journalist based in Accra and writes for Associated Press (AP), University World News, as well as Science and Development.Net. He was a Staff Writer of African Concord and Africa Economic Digest in London, UK.

Africa needs the sound mind of all to be able to solve its economic problems. That is why it is important that the governments around the continent should start looking at what to do to improve mental health. This is a problem that is crying for a solution. Unfortunately, it does look like those who walk the corridors of power, do not read or listen to what their academics write about, to provide solutions to problems facing the continent. The latest attempt to find a solution to our numerous ills, is an article on mental health, a condition that the continent has ignored even though it exists and continues to plague thousands of people.

Perhaps, it is because the condition has been stigmatised all over the continent, so, it is not surprising that it has become a taboo subject for African governments. They have therefore forgotten that, like any condition, mental health can affect anyone at any time. In fact, its place in the national budgets across the continent is nothing to talk about. The facilities for treating those with mental health are few and far between and those who are unfortunate to suffer the condition, receive the worst form of treatment.

It is like African governments do not heed to what the World Health Organisation (WHO) has been drumming home about the condition for years. As a reminder, the WHO says, mental health “is an integral and essential component of health.”

The WHO constitution has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” They have also made it clear that mental health is more than just the absence of mental disorders or disabilities.

It is a “state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community,” said the WHO.

That is why it is sad that it is not well talked about. It is for this reason that suicide rates are growing all over the continent. A recent study of undergraduates at the Nigerian universities show that, suicide, considered as a mental condition, is growing among the students.

Worried  by what is happening to mental health on the continent, a group of African academics have called for “Reimagining global mental health in Africa,” in an article published in the BMJ journal of September 4, 2023.

The authors of the article said, “mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life. On this basis, the promotion, protection, and restoration of mental health can be regarded as a vital concern of individuals, communities, and societies throughout the world.”

They expressed worry that, since 2001 when the WHO recommended a huge investment in developing training programmes for mental health professionals (including psychiatrists, psychologists, mental health officers and psychiatric nurses), with programmes proliferating across the continent, there are only 1.4 mental health  professionals per 100,000 population on the African continent.

The global average of mental professionals of any discipline is 9 per 100,000 population. They said, using another indicator that gives a dismal picture is the fact that, in 2020, annual mental health outpatient visits in Africa was 94 per 100,000 population whereas the global average was 2001 per 100,000 population.

“Mental health outpatient visits are far higher in some high-income settings: for example, in Ontario, Canada, between 2017 and 2022 the monthly rate of mental health outpatient visits was over 4,000 per 100,000 population across all physician specialties and over 1,000 per 100,000 population for psychiatrist visits,” the authors said.

They pointed out that the prospect for improved mental health access in Africa is further confounded by an increase in demand as a result of increased population.  “In addition, while supporting mental health research was one recommendation, with resources invested over the past two decades, the amount and relevance of research that comes from the continent is still extremely limited,” the study said.

According to the authors, mental health has become a neglected public health issue in Africa, adding that some countries do not even have mental health services. In countries where services are available the outlook is gloomy.

They pointed out that special challenges are both structural and attitudinal. “For example, in some places in Africa, such as South Sudan, mental health services are organised in response to the outcomes of a civil war that led to the suffering of millions of people through displacements and surviving the trauma of war.”

“Whether the developed model of care is organised based on these specific societal realities or based on the principle of universality, the Western norm needs further exploration. On the other hand, South Africa has mental health services organised in accordance with Western models owing to its history,” the authors said.

In their view, attitudinal challenges determine resource allocation and prioritisation for mental health services, research and education in most parts of Africa, and pointed out that the notions of causation, perceptions of available remedies and prejudice towards the mentally ill all influence decision-making.

Besides all the problems with poor mental health services across the continent, the authors also said, the WHO has recommended increased funding commitment by governments as the way forward. Among other things, the WHO has reported that some Western countries spent 6%–15% or more of their health budget on mental health with 24% of countries – Lower- and Middle-Income Countries (LAMICs) – spending 1% or less.

“Given this dire statistic, even if governments commit to following their policy proclamations with more money and action, we suggest they will still fall short of meeting a desired target in the provision of mental health,” they said.

Against this background they have proposed that, since “Western foundations of mental health knowledge are not universal nor are their assumptions of society globally applicable, real change in the mental health of low income and middle-income countries (LAMICs) requires reimagining.

“Local idioms of distress and healing, and explanatory models of suffering within particular populations, are needed to guide the development of training curricula, research and services,” the authors said.

The authors have done their duty to bring out the problems that the continent faces in dealing with mental health. Unfortunately, and as is usually the case, the paper will not get to be read by those who should. Even if policy makers get hold of it, it will just be pushed into a file somewhere like other papers that have been produced by researchers. If it gets into the hands of other researchers, it will only be cited in their work to either be promoted or get recognition. With this cycle of events, one wonders why African academics even bother to produce papers on serious issues on the continent.

It is hoped this timely paper on mental health will go into the right hands, so that the continent can see some reforms. Let us be reminded by the words of a politician who was quoted as saying that he invested in improving facilities at prisons because he was fully aware that, as a politician, his chances of ending up in prison were very high.

Mental health is a condition that exists for all of us. Like any known sickness, no one can tell when it will strike. So, politicians and policy makers must start improving the facilities!