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Mental health: an urgent priority for Africa

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Mental health's physical and socioeconomic repercussions are taking a toll on the African continent, according to Africa Health 2021 speaker Prof Shekhar Saxena.

Untreated mental health can have harrowing implications that can also compromise socioeconomic prosperity in nations.

Across Africa, there is insufficient government support in mandating policies towards driving change: according to the World Economic Forum, most African governments allocate less than 1 percent of their budgets to mental health services. An estimated 100 million people in Africa furthermore suffer from clinical depression, including 66 million women.

In an Africa Health 2021 interview with Omnia Health Insights, Shekhar Saxena, Professor of the Practice of Global Mental Health at the Department of Global Health and Population at the Havard T. H. Chan School of Public Health, revealed why mental health and psychosocial support needs to be an urgent priority for Africa.

What is mental health and why it is important for Africa?

It is crucial to distinguish between mental health and mental diseases. For patients who are suffering from mental diseases, they require treatment and support, however, mental health is important for everyone.

Throughout our lives, we may experience shifts in our mental health and well-being, varying from good periods and challenging ones. When addressing mental health in Africa, contributing factors such as infectious and nutrient-related diseases are significant.

It is also vital to recognise that mental health issues, if not diagnosed or treated, can be a cause of physical and mental disease and disability, which is frequent in Africa.

What is the current state of recognising and supporting mental and psychosocial health in Africa?

There is nominal allocation of budgets when it comes to mental health. This is universal neglect, even in high resource countries. For Africa, the burden of mental health problems is severe, with a large gap between what is needed and what is being done financially.

There is also a lack of psychologists and psychiatrists; hence we need to pay more attention to mental health as a policy, and invest.

Why does Africa need to invest in mental health as an urgent priority? How can these investments unlock social and economic development potential and fulfill sustainable development goals in Africa?

Mental health needs to be integrated into the healthcare system, as it is a significant part of development. The hypothesis is that mental health can cause economic loss, which is sometimes direct when patients have a disability and require treatment and care.

Very often, it can also be indirect, when individuals suffering from mental health issues are unable to work and therefore can not contribute to the economy. In many instances, family members and guardians undertake care of those suffering from acute mental illness.

This is a tremendous economic loss. In fact, a study that I was part of clearly demonstrated that for anxiety and depression, the return on investment is five dollars for each dollar invested.

This is not only eye-opening for Ministries of Health, but also Finance. Countries in Africa need to consider these factors when they decide on investments. It is very important to invest in necessities such as infrastructure, and roads, and bridges, but investment in health and education have long-standing outcomes.

Mental health is not only a key part of healthcare but also of education and labour. If ignored, the economic development of the countries in Africa will be compromised. The message is clear for policymakers: invest in mental health and get good returns.

 

What challenges and factors are being faced presently regarding mental health in Africa? How large is the treatment gap?

Often, patients living with mental disorders, diseases, and disabilities do not receive appropriate treatment or any treatment at all. They are not diagnosed or misdiagnosed, and this is largely due to a lack of trained mental health specialists.

Therefore, the gap for the treatment of mental health disorders can be as large as 90 percent. This means nine people out of 10 are not identified and not treated.

This is a major setback, the solution is not only to populate healthcare facilities with psychiatrists and psychologists, but also train all doctors, nurses, and all healthcare providers, including community health workers in the identification of common mental disorders.

70 percent of mental health problems, including disorders can be treated by trained doctors and nurses with adequate supervision and support. This will develop a mental health care system, integrated within the health system, in unison with commitments made by countries as a part of the universal health coverage.

Through this, the treatment gap will be markedly reduced and people will get the treatment that they need.

Are there some examples of effective and affordable delivery of mental health in Africa?

In the last 10 years, there has been gradual progress in countries such as South Africa and Ethiopia. Doctors and nurses have been trained in identifying and treating common mental disorders using some of the WHO resources in the public domain.

One of them is called MhGAP Intervention Guide, which has been translated into many languages.

In fact, Ethiopia trained hundreds of nurses who are providing vital care for people who check into facilities. Other initiatives such as ‘the friendship bench’ in Zimbabwe, are starting to train people, generally, women belonging to the middle or older age group. They provide counsel and care for other women who required help.

The effectiveness of this model has been tested in very well-designed studies and replicated in many other African countries, and globally in cities such as New York.

What have the policy responses been to mental health recovery during and post-pandemic and as part of a national recovery plan?

The pandemic highlighted the necessity of mental health support; however, several lost their lives to the disease while many continue to face stress which can develop into anxiety and depressive disorders.

Africa was not largely affected by COVID-19, compared to other continents, but its mental health care system was already poor and now the needs have increased. Travel bans, work on infrastructure for schools were stalled, hindering economic growth.

The World Bank has suggested a very large number of people, including in Africa, are going back into extreme poverty. UNICEF has stated that schools physically closing down and taking a digital route has affected millions of children in Africa.

These factors are going to have a tremendous impact on the mental health and development of children. The implications will affect a whole generation.

Due to COVID, many doctors and nurses who provided mental health care were placed in COVID care. Fortunately, other models of care, including telepsychiatry and tele-mental health are making positive progress.

Countries need to step up their efforts for mental health. We also must be realistic because many countries are investing in COVID care and vaccinations.

The possibility to fund some of the mental health programs has decreased as opposed to the increasing needs. The solution lies in integrating mental health within the overall healthcare system, as it is more economic than creating a separate system.

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