Written by Hanifa Zakari Shuaibu
A recent report by the World Health Organization stated that about 1 billion people globally have a mental health condition. These mental health conditions are even on a higher rise in Africa due to the lack of access to mental health support, stigma, limited mental health professionals, and mental health care being underfunded. Africa CDC developed a continental strategy for Non-Communicable Diseases, injuries, and mental health (2022-2026), and for the first time, we have a roadmap in which mental health is put alongside major public health priorities. The strategy recognized mental health as a public health priority under the new public health order, and provides practical steps to building a better community-based system of care. I found it significant that mental health finally sits beside other major public health priorities, especially because in many African communities, mental health has long been separated from mainstream healthcare despite being an essential part of overall wellbeing. The widely accepted definition of health as a state of physical, mental and social wellbeing and not merely the absence of disease reinforces the reality that there is truly no health without mental health.
Currently, there is a huge treatment gap when it comes to mental health, with fewer than 10% of people in Africa having access to mental health care. This stems from issues such as the limited availability of mental health care professionals. Africa has about 1 mental health worker per 100,000 people compared to a global average of 9. This gap is huge, making access to mental health care not feasible for millions of people across the continent. In many of our communities, this shortage pushes a lot of families to seek help through traditional or spiritual medicines, often not by choice but because formal mental health services are either unavailable or unaffordable. And while these forms of care are culturally significant, most times they lead to delayed access to appropriate care and could also worsen these mental health conditions. Also, a lot of mental health services are being concentrated in tertiary hospitals and urban areas, which makes it difficult for the underserved and those residing in rural communities to seek access to support, because mental health care seems far fetched from them and almost unreachable. For many families, mental health care also requires out of pocket payment, which is simply not feasible amid widespread financial hardship and as a result care becomes inaccessible. This creates a vicious cycle where there is delayed care, worsening of symptoms and eventually a very poor health outcome.
Stigma and lack of awareness of mental health are also among the problems that are being faced especially when it comes to barriers in accessing mental health care across many African communities. A lot of people lack basic literacy on mental health, including signs to recognize they are struggling with mental health issues, which stop them from seeking care. This is mostly because mental health education is almost absent in our formal education systems. Unlike other health conditions, in our schools we are rarely taught what mental health is, the common mental health disorders, or even how to access support. Many mental health conditions begin to emerge in early stages of life, yet from my personal observations, a lot of young people cannot name what they are feeling and end up struggling silently. This silence is reinforced by stigma, in our societies mental health challenges are often framed as spiritual problems, a lack of faith, or a failure to pray enough. Seeking psychiatric care can attract ridicule or labels such as being mad, causing many people to avoid help altogether. These labels and judgement are constant in our society and as a result a lot of individuals continue to suffer in silence, a reality that that adds up to the rising burden of suicide across the continent. And this happens more often than we admit.
Many African countries still work on outdated mental health policies and are stuck with such laws, many of which violate the dignity and right to seek mental health care of affected individuals. In some African communities, individuals are still chained or confined in unsafe spaces or conditions in the name of treatment. Some of these laws across the continent also include criminalizing suicide attempts instead of prioritizing providing the right access to mental health care, support and prevention. There is also a significant lack of access to reliable data on mental health, such that many countries still don’t systematically track mental health data, unlike other health conditions, at least not consistently. This gap in data contributes to the deprioritization of mental health in aspects of policy making and a limitation when it comes to the government having a deeper understanding of their population’s health need in order to allocate the right resources to mental health systems.
The strategy proposes practical, systemic actions that directly address the continent’s mental health challenges. Reading through the strategy, what stood out to me personally was how much emphasis was placed on community-level care. This is really important because the focus on bringing services closer to people aligns with what many grassroots advocates have been calling for. As a mental health advocate I see this as a practical solution to many of the mental health challenges being faced, as people are more likely for help because of it being accessible and is rooted within their communities. Through my work as the founder of Voice for Health Initiative, an organization focused on health advocacy one of which is mental health, I have seen firsthand how peer-support spaces can make a difference. During our mental health peer support sessions, many young people who initially could not put a name to their feelings or symptoms were able to process their experiences, gain direct access to mental health professionals, and begin to understand that seeking help is both possible and necessary. For many of them, this awareness marked the first step toward improved wellbeing.
The priority interventions mentioned in the strategy include:
Strengthening leadership and governance by encouraging member states to establish national mental health taskforces, update outdated national mental health policies. This is really an important first step as it ensures a stronger political commitment toward mental health reform. Integrating mental health into primary health care through task shifting ensures psychological support at community level, and also embedding mental health into community health systems. This reduces dependence on psychiatrists and brings early detection closer to where people live. Embedding mental health into community health systems using community structures for awareness, anti-stigma efforts, and peer support ensures mental health becomes part of everyday conversations and care rather than a service that is only being accessed during crisis.
Improving surveillance and data systems through ensuring that member states collect data on mental health service uptake and outcomes, which is essential in planning, guiding policies and monitoring progress. This will be crucial in bridging the gap of limited data in mental health. Expanding access to essential psychotropic medicines to ensure they are available at the community and primary health care level supports a more equitable access to not only services but also treatments and medicines. Another major point is developing a sustainable financing model to ensure a commitment to funding and continuity of mental health initiatives. Because without the proper funding, many of these ideas mentioned would stay on paper.
Since the adoption of this strategy in 2022, Africa CDC and several member states have taken meaningful steps to implement the strategy through various channels, such as integrating mental health and psychosocial support into emergency responses in affected areas. By conducting training and supporting the upskilling of public health leaders across member states through the mental health leadership programs, embedding mental health into existing programs, the development of mental health workforce. By also building a network of civil society organizations this has increased community engagement and awareness, increasing implementation efforts. These steps put into place show progress and demonstrate how the strategy is shaping systems in real time.
Generally, this strategy brings mental health to the forefront of the national health agenda. It encourages prioritization of mental health in the same way other health conditions are being recognized and treated with a sense of urgency, which is actually long overdue. It ensures that people actually get the right access to mental health through their communities, which will improve their overall well-being. By training primary health care workers, this ensures that people will not suffer when it comes to seeking help and can access it right where they live. Overall, the strategy, if implemented effectively, will increase access to mental healthcare and will ensure preparedness in times of emergencies. It will also ensure mental health and psychosocial support is readily available at the time when it’s much needed. It is also very crucial to ensure there is a commitment to ensure that mental health funding is being prioritized, which is key. It won’t happen overnight, but it’s something that is achievable.
Despite this strategy being laid out and implementation being underway, African countries must ensure the continued implementation of this so that it doesn’t just become another well written document that has been put out. For me this strategy is a huge representation of what a future in Africa could be in terms of mental health, and I believe this strategy represents what the future of mental health in Africa could look like, one where mental health care is accessible to everyone regardless of their background, and this will happen only if we stay committed. Hence, there is a huge need to ensure the implementation of these objectives, which most importantly requires the right funding, political commitment, multisectorial partnerships, youth led initiatives, and community engagement to determine its long-term impact.