Mental illness, Africa's 'invisible' health challenge

Up to 200m Africans may be affected in their lifetime, yet official government funding remains chronically low, while stigma further compounds matters

Up to 200 million Africans—one in every five people on the continent— will in their lifetime suffer from mental disorders, yet governments continue to chronically underfund treatment, with less than 1% of already small health budgets channelled towards such illnesses. 

This bleak picture is compounded by how poorly mental illness is misunderstood on the continent, with some communities even seeking to treat patients by locking them up with a hyena, on the advice of quack doctors.

Mental health issues are routinely ignored on the continent leading to growing international calls for urgent recognition of the extent of the problem, including by Global Health Action, an international peer-reviewed journal in its recent ‘Declaration on mental health in Africa: moving to implementation’.  

The declaration urges African governments to take the lead in encouraging national dialogue on the issue and highlighted the need to address stigma and social exclusion. It further explains that a growing body of scientific evidence shows that much can be done for treatment—at moderate additional costs to the state, and for significant economic benefits to the country. 

Data on mental health in Africa remains scarce, but according to the Mental Health and Poverty Project, one in five individuals will suffer from a diagnosable mental disorder in their lifetime. 

These include those that cause a high burden of disease such as depression, bipolar affective disorder, schizophrenia, anxiety disorders, dementia, substance use disorders, intellectual disabilities, and developmental and behavioural disorders. 

Despite the high figure presented by the Project, the 2011 World Health Organisation Mental Health Atlas shows that while 110 of its 184 member states have an identifiable mental health policy, only 19 of 45 African member states surveyed are part of this group. 

This means that less than half of African nations have policies in place for an illness that affects 20% of their population. 

Conflict link
Many of these disorders are also linked to conflict, a major concern for a continent that the United Nations High Commissioner for Refugees estimates had 3.4 million refugees and asylum seekers in 2014. 

WHO estimates that half of all refugees have mental health problems ranging from post-traumatic stress disorder to chronic mental illness. 

Consultancy Africa Intelligence’s Public Health Unit states that the psychiatrist-to-patient ratio in Africa is less than 1 to 100,000. In Ghana, only 1.17% of those suffering from mental health problems have received the required treatment while in Liberia, where 44% of adults exhibit symptoms indicative of post-traumatic stress disorder, there are only 0.06 mental health professionals per 100,000 people.

In Tanzania in 2001, only 10 active psychiatrists were recorded, attending to a population of 30 million. 

Despite such worrying numbers, there are several reasons why mental illness in Africa continues to slip through the cracks, with some unexpected culprits.

One reason is the well-intentioned Millennium Development Goals (MDGs). Whilst giving Africa clear targets, the MDGs, which are international development goals established by the UN in 2000, have also resulted in the sidelining of other issues that should be included in national policy planning, such as non-communicable diseases.

MDG goal 6 for example, which relates to health issues, looks to tackle HIV/Aids and diseases such as malaria or tuberculosis, leaving out other  illnesses such as mental disorders, which WHO notes leads to increased health expenditure, loss of employment, reduced productivity, stigma and a drift into poverty, leading to a vicious cycle.

Lack of data
Lack of information has also contributed to the under-prioritisation of mental health. The Leeds Institute of Health Sciences has shown that a lack of data can mean a government does not recognise an issue as a policy concern: if there are no numbers showing the high costs, nothing will be done about it.  

This is further complicated in that people with mental illnesses rarely come forward due to cultural beliefs, generally preferring self-care or a traditional approach. In South Africa, mental illness can be viewed as  just odd behaviour,  while in Ghana it was feared and associated with punishment for bad behaviour.

In Somalia, a known quack in recent years made it his mission to treat the mentally ill, including through the use of hyenas, which some in the country believe can see everything including the evil spirits thought responsible for mental illnesses. Families would pay the man about $560 to have their relative locked in a room overnight with the animal. By clawing and biting at the patient, the hyena is thought to force the evil spirit out. Many have been known to die during the process.

The life outlook for untreated patients is dire: a lack of access to health and social services, emergency services and educational opportunities. Many are also denied employment, and even the ability to exercise political rights.

African governments therefore need to face up to this “invisible” illness, or risk missing out on the benefits of a healthy population.


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