The urgent need for mental health investment in Africa: Challenges and opportunities
By Faith Nassozi of United for Global Mental Health
This year’s World Mental Health Day (WMHD) was observed with the theme “Make mental health and well-being for all a global priority”. This was an opportunity to highlight a pressing matter that is often neglected.
Mental health is a crucial issue for the well-being of an individual, however, according to the World Health Organization (WHO), 1 in every 8 people, or 970 million people around the world have mental health disorders. Despite the significant challenge, most African countries pay little attention to mental health financing and services.
At a recent event to mark World Mental Health Day in Uganda organized by Awesome Minds Speak, one of the members of the Global Mental Health Action Network, identifiable challenges which limit access to mental health services were discussed. These include inadequately funded healthcare systems that are ill-equipped to address mental health concerns.
The Ugandan healthcare system is currently overburdened with the provision of primary healthcare and the threat of emerging infectious diseases such as COVID-19 and Ebola. This makes it hard for people to access mental health care services and also makes it extremely hard for the government to extend mental health services to vulnerable populations, especially within rural areas.
Furthermore, according to the Ugandan Ministry of Health, approximately 14 million of the country’s 43·7 million people are estimated to have a mental illness. This is almost 32% of the total population. In addition, an article published on 12th October by New Vision, (the leading newspaper in Uganda) noted that Butabika National Referral Mental Hospital, which is the only specialized hospital for mental health in Uganda is overwhelmed by high numbers of mental health cases. The 550-bed hospital is currently caring for over 1000 patients compared to 800 patients in the past.
The problem is further magnified by the limited number of specialists. There are only 53 psychiatrists serving a population of over 43 million people in Uganda. Not surprising is the fact that these psychiatrists are mainly found in urban areas - but furthermore most of them are not in the practice of seeing patients but are rather employed as researchers and in academic institutions as lecturers. This further adds to the challenges faced by rural areas-based patients in accessing mental health services.
Many countries across Africa experience similar human resource challenges in accessing mental health services.
Zimbabwe for one faces a critical shortage of mental health specialists with only 12 psychiatrists serving a national population of 15.3 million.
In Kenya, the psychiatrist-to-population ratio is 1:500,000, and most of the psychiatrists in Kenya work outside the public sector.
While good mental health services need more than psychiatrists (including psychologists, nurses and community health workers) having such a small number of psychiatrists shows how difficult it is to develop a strong mental health service.
Stigma and discrimination limiting access to mental health care
Lack of knowledge about mental health and health care services is another challenge that cuts across African countries. As shared by people with lived experience during the World Mental Health Day event in Uganda, mental health conditions are highly stigmatized because of the association of mental illness with witchcraft or curses. This stigma further limits access to health care. Due to fear and shame, families which have relatives with mental health conditions often lock them up in houses and keep them isolated.
Read The Lancet Commission Report on Ending Stigma and Discrimination in Mental Health
Based on the challenges above, governments need to invest more in mental health services. A critical step in East and Southern Africa would be integrating mental health into HIV programs. This is because poor mental health contributes significantly to the acquisition of HIV and other related infections, which affects the treatment course.
670,000 new HIV infections were recorded in East and Southern Africa in 2021 indicating that HIV remains a significant burden in the region.
According to the findings from the Bending the Curve published by United for Global Mental Health, without addressing mental health, there will be no end to HIV or TB. Therefore, there is an urgent need to incorporate mental health services and psycho-social support into the general care of HIV in time for the New Funding Model (NFM4) of the Global Fund.
The Global Fund New Funding Model 4 runs through 2023 to 2025 to enhance the Global Fund’s ability to support strategically focused programs that have a greater and more sustainable impact in the fight against AIDS, tuberculosis (TB) and malaria.
The WHO has recommended that governments within low-income countries invest at least 5% of their health national budget in mental health. Governments like Uganda need to implement this recommendation which will ensure that funding is available for mental health care.
This funding could contribute towards an increase in awareness-raising programs on mental health, availability of health care workers, and provision of mental health care services at the primary health level and integrating these into the HIV/TB systems. As we concluded on World Mental Health Day in Uganda, we need to make mental health and well-being for all a priority.
Faith Nassozi works for United for Global mental health as a communications advisor and was recently a panelist at the generational perspective dialogue event to mark WMHD in Uganda.