Considering the stigmas surrounding mental healthcare, practitioners should use terminology carefully to prevent further harm.
Overcoming mental health challenges isn't just a matter of personal wellbeing but a crucial element in creating robust, peaceful and prosperous societies worldwide, including in Africa. This was underscored earlier this month on World Mental Health Day.
For generations, Africans have faced sustained adversities due to insecurity, humanitarian crises and colonial repression. Communities have had to cope with continued trauma stemming from genocides, insurgencies, terror attacks, political turmoil, socio-economic disparities and religious and ethnic discrimination. Trauma in Africa is often transgenerational, affecting the collective mental wellbeing.
According to the World Health Organization (WHO), in 2022, over 280 million globally were living with depressive disorders, and 85% of those in developing countries had no treatment for mental health issues. Given that most Africans suffering from anxiety, depression and post-traumatic stress have limited access to mental healthcare, these statistics should be treated with caution. Stigmas also hinder the complete representation of mental health issues.
According to a recent report exploring the United Nations' (UN) renewed approach to transitional justice, mental healthcare and psychosocial support services are pivotal across Africa. They can bridge gaps in development, humanitarian efforts, violence prevention and post-conflict transformation. By providing these services, nations and communities can foster individual wellbeing and societal resilience, and find a path towards lasting peace.
Trauma in Africa is often transgenerational, affecting the collective mental wellbeing
However, in the face of Africa's many development and governance problems, mental healthcare is underprioritised and underfunded. Most African states haven't achieved the WHO's Mental Health Action Plan goals, and despite 25% of African countries having revised or developed mental healthcare legislation, it is still the second-lowest performing region.
A significant obstacle to providing mental health and psychosocial support services throughout Africa is the lack of financial support from governments and human resource deficiencies. On average, African Ministries of Health allocate only around 90 US cents per person for mental health - up from US 10 cents reported by the UN Children's Fund in 2016.
According to WHO, Africa has an average of 0.1 psychiatrists per 100 000 people. In some European countries and the United States, expenditure is much higher, generally averaging several hundred to over a thousand US dollars per capita annually.
Another challenge in Africa (and elsewhere) is the abundance of gender-, religious- and culture-based stigmas that prevent individuals from seeking help or participating in psychosocial support workshops. Stigmas usually arise due to misinformation, ignorance and a lack of awareness of mental illness and trauma. Mental health is a socially constructed concept, so different cultural, religious and ethnic groups have various ways of conceptualising it and deciding which interventions are appropriate.
Due to a lack of conversation, mental illness and trauma are often disapproved topics, so they attract stigmas. This discourages open discussions and efforts to address the issues, furthering stigmatisation.
Mental health is a socially constructed concept, so cultural, religious and ethnic groups understand it differently
Worldwide, people dealing with mental health issues encounter discrimination, isolation, and sometimes violence. Traditional notions about the origins of mental illnesses can sometimes result in detrimental actions like exorcisms or isolation rather than relying on evidence-based treatments. Eliminating stigma and fostering awareness can encourage individuals to seek help without worrying about negative consequences.
Uganda provides useful insights into one country's challenges. Stigma, poverty and drug abuse are highlighted as leading contributors to the country's mental health problem. The historical backdrop of instability and slow economic development has rendered Ugandans, like those in other conflict-affected nations, more susceptible to mental health issues.
Traditionally in Uganda, mental health disorders were widely believed to be caused by external spiritual forces including satanic powers, curses, and bewitchment. Omulalu is the term used to refer to someone with mental health challenges, literally translating as 'mad', 'crazy' or 'insane'. Local beliefs around causation, strong local terminology and the resultant stigma partly explain why those with illnesses are hesitant to seek treatment.
The Ugandan Health Ministry reported that one in three Ugandans had a mental illness, which calls for immediate remedial action. There is an ongoing effort to review the Mental Health Act, which human rights groups and civil society organisations said was colonial and discriminatory. Improving funding for regional mental healthcare is an important step towards addressing the problem.
Collective approaches focused on communities or groups are less affected by the harmful effects of stigma
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Measures to tackle stigmas include integrating mental health into primary healthcare and using community education to focus on terminologies, signs and symptoms. Uganda's Village Health Teams engage vulnerable communities and incorporate cultural strength and resilience into the assessment and training of caregivers. Other practitioners have developed handbooks for religious leaders on how to offer timely and informed psychosocial support and make faith spaces safe for those seeking help.
The role of language is crucial. The UN Development Programme report on integrating psychosocial support into peacebuilding says practitioners should reconsider the language used in Western, individualised and medical concepts of mental health. They should instead promote collective approaches that focus on communities or groups as beneficiaries. While some mental illnesses may need individualised treatment, group approaches are less affected by stigma. Practitioners can also reduce stigma by using language relevant to the local environment.
International, government and local level stakeholders should jointly secure funding for research to understand the scale and complexities of Africa's mental health challenges. This will enable the delivery of suitable mental health assistance and help reduce stigma.
Isel Ras, Research Consultant, Southern Africa, ISS Pretoria and Nuwagaba Muhsin Kaduyu, Executive Director, Allied Muslim Youth Uganda
