Friday, 9 February 2018

The Conversation/Crick Lund: Why Africa needs to start focusing on the neglected issue of mental health

The Conversation

Available editions

    Job Board

    Become an author
    Sign up as a reader
    Sign in

The Conversation
Academic rigour, journalistic flair

    Arts + Culture
    Business + Economy
    Environment + Energy
    Health + Medicine
    Politics + Society
    Science + Technology
    In French

Why Africa needs to start focusing on the neglected issue of mental health
February 8, 2018 4.49pm SAST

    Crick Lund

    Professor in the Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town

Disclosure statement

Crick Lund has received research grant funding from the DFID, the European Commission, the National Institute of Mental Health, Wellcome Trust and the National Research Foundation.

University of Cape Town

University of Cape Town provides funding as a partner of The Conversation AFRICA.

The Conversation is funded by Barclays Africa and seven universities, including the Cape Peninsula University of Technology, Rhodes University and the Universities of Cape Town, Johannesburg, Kwa-Zulu Natal, Pretoria, and South Africa. It is hosted by the Universities of the Witwatersrand and Western Cape, the African Population and Health Research Centre and the Nigerian Academy of Science. The Bill & Melinda Gates Foundation is a Strategic Partner. more
Republish this article

Republish our articles for free, online or in print, under Creative Commons licence.
The treatment gap for people living with mental illness in Africa is huge. Shutterstock


Mental health has historically been neglected on Africa’s health and development policy agenda. Faced with many challenges, including intractable poverty, infectious diseases, maternal and child mortality, as well as conflict, African political leaders and international development agencies frequently overlook the importance of mental health.

This trend is often compounded by three factors: ignorance about the extent of mental health problems, stigma against those living with mental illness and mistaken beliefs that mental illnesses cannot be treated.

Absence of treatment is the norm rather than the exception across the continent. The “treatment gap” – the proportion of people with mental illness who don’t get treatment – ranges from 75% in South Africa to more than 90% in Ethiopia and Nigeria.

Yet there are several reasons to give greater priority to mental health. These include the fact that doing so delivers other health benefits; that it helps tackle socioeconomic challenges; that there are economic benefits; and that human rights offences are reduced.
Mental and physical health are inseparable

Chronic non-communicable diseases such as hypertension and diabetes, as well as infectious diseases like HIV and tuberculosis, have high levels of co-morbidity with mental illness. This co-morbidity doesn’t only influence disability but also has direct consequences for mortality.

A study in Ethiopia showed that people living with severe mental illness – conditions like schizophrenia, bipolar mood disorder and severe depression – died 30 years earlier than the general population, mainly from infectious causes.

Maternal depression has also been shown to affect the development and growth of infants.

In addition, research shows that people living with mental illness or substance use disorders are more likely to become infected with HIV.

In a further twist, people with HIV have been shown to be twice as likely as the general population to be depressed. And treating them for depression improves adherence and boosts their immune systems.
Mental health and poverty

There are strong links between mental health and poverty. In a large review of 115 studies from 36 low and middle-income countries we found that poverty was strongly associated with common mental disorders. These included depression, anxiety and somatoform disorders (psychological disorders with inconsistent physical symptoms). The study included several African countries.

In addition, the relationship between mental health and poverty is cyclical. Conditions of poverty increase the risk of mental illness. This happens through the stress of food and income insecurity, increased trauma, illness and injuries and the lack of resources to cushion the blow of these events. Conversely living with a mental illness leads those affected to drift into poverty through increased healthcare expenditure, disability and stigma.
Human rights

People living with mental illness (particularly severe mental illness) are frequently stigmatised, shunned, and excluded from mainstream society. This is as true in Africa as it is in societies around the world.

Those with schizophrenia, bipolar mood disorder and epilepsy are frequently subjected to human rights abuses. They are often cast aside because of beliefs that psychosis or epileptic seizures are signs of demon possession or evil spirits. And they are denied access to life changing treatment.
There is hope

A range of mental health interventions across the continent are leading to clinical improvements.

Since the early 2000s, a series of randomised controlled trials in African countries have provided compelling evidence that mental health interventions are highly effective. These include pharmacological and psychological interventions. Many of these have used non-specialist health providers in local communities, reducing the cost of care.

In northern Uganda for example, scientists have shown significant improvements in depression and daily functioning by using group inter-personal therapy. These were delivered by local non-specialist facilitators.

In Zimbabwe primary care clinics in Harare have introduced a “Friendship Bench”, a counselling intervention delivered by lay health workers. Significant improvements in depression, anxiety, disability and health related quality of life have been noted.

Read more: How a community-based approach to mental health is making strides in Zimbabwe

Mental health interventions also improve the economic circumstances of people and households affected by mental illness.

We’ve conducted a systematic review of interventions that break the cycle of poverty and mental illness. Most studies that evaluated the economic impact of these interventions showed how clinical and economic improvements went hand in hand.

As this new evidence emerges, the tide is beginning to turn. In April 2016, the World Bank and the World Health Organisation held a high level meeting in Washington DC titled “Out of the Shadows: Making Mental Health a global development priority”. This led to these two global bodies committing to the WHO global Mental Health Action Plan (2013-2020) and the World Bank’s recently established Mind, Behaviour and Development Unit.

The critical question is how evidence-based interventions can be taken to scale using existing health care systems, while maintaining quality.

This question has occupied the consortium of researchers working under the umbrella of Programme for Improving Mental Health Care since 2011 in Ethiopia, India, Nepal, South Africa and Uganda.

In a similar vein, studies are being conducted in low and middle-income countries by the Emerald consortium which is working in the five countries as well as Nigeria. The aim is to strengthen information systems, improve governance and calculate the costs of scaling up integrated packages of care.
A good investment

By neglecting mental health, it will be difficult to attain many of the Sustainable Development Goals related to poverty, HIV, malaria, gender empowerment and education.

Improving mental health is a means of unlocking development potential – a neglected link in the development chain in Africa. Investing in mental health means promoting resilience on the African continent. Mental health is both a means to social and economic development, and a worthy goal in itself.

This is an edited version of an article that appeared in the African Policy Review.

    Mental health
    Mental illness

    Get newsletter

You might also like
How social media can make life better for young people in care
Raising awareness of mental health issues is not enough
Suicide isn’t just a ‘white people thing’
How the placenta can shed light on HIV mothers and their babies
Sign in to comment

    There are no comments on this article yet.
    Have your say, post a comment on this article.

Most popular on The Conversation

    Zuma’s reluctance to leave office is offering sound lessons in democracy
    South Africa’s future hinges on Ramaphosa’s strategic skills
    Achille Mbembe on how to restore the humanity stolen by racism
    Research shows shocking rise in obesity levels in urban Africa over past 25 years
    South African news station ANN7 is on the skids: why it won’t be missed

    Cape Town water crisis: crossing state and party lines isn’t the answer
    What southern Africa can learn from other countries about adapting to drought
    Turkey’s foray into Somalia is a huge success, but there are risks
    How the continent’s languages can unlock the potential of young Africans
    What spurred six countries to join the AU’s mission in Somalia

Expert Database

    Find experts with knowledge in:*

Want to write?

Write an article and join a growing community of more than 62,400 academics and researchers from 2,275 institutions.

Register now
The Conversation

    Community standards
    Republishing guidelines
    Research and Expert Database
    Job Board
    Our feeds


    Who we are
    Our charter
    Our team
    Partners and funders
    Contributing institutions
    Resource for media
    Contact us

Stay informed and subscribe to our free daily newsletter and get the latest analysis and commentary directly in your inbox.
Email address
Follow us on social media

Privacy policy Terms and conditions Corrections

Copyright © 2010–2018, The Conversation Africa, Inc.
Post a Comment