Nairobi — Prior to the COVID-19 pandemic, approximately 116 million people in the African region were living with mental health conditions. A large proportion of mental disorders is caused by depression and anxiety, and these conditions take a significant toll on health and wellbeing of people aged 15 to 59 years who are most affected.
In West and Central Africa (WCA) the prevalence of mental health disorders as reported in a book review by Juma et al ranges between 2-39%, with anxiety and depressive disorders as the leading causes of mental health disorders.
There is limited data on prevalence or burden of mental health disorders in West Africa, reflecting the insufficient attention given to mental health problems.
In one of few countries where a survey has been done, for example in Nigeria the most populous country in Africa estimated 12-month prevalence of anxiety at 4% from the Nigerian Survey of Mental Health and Well-Being - the first large scale mental health survey in SSA 2001-2003.
Furthermore, in SSA prevalence data for children and adolescents is available for only 2% of target population that is represented by available data on any mental health disorder.
The treatment gap i.e. the proportion of those in need who go untreated for formal mental health disorders in Sierra Leone was estimated at 98.8%. The population of young people in WA in particular is expected to double over the next decade. Many individuals may experience mental health challenges due to rising pressure from currently highly competitive labour market and infectious diseases.
Mental health is not only a problem in Sierra Leone, Nigeria or West Africa, it is a universal global problem and globally 1 in 8 (908 million people are living with a mental health disorder. Addressing these issues requires targeted interventions and support systems to ensure vulnerable age group receive care and resources needed.
In West Africa mental health systems face significant constraints partly due to local belief systems that often interpret mental health issues as spiritual rather than psychological or medical in nature. In West Africa, mental health problems are often viewed as spiritual or cultural diseases rather than as physical ailments.
Mental health is a legendary story in many African settings. Despite negative media attention about harsh practices used by traditional healers, they provide cheap services to individuals with mental illnesses including severe illnesses at spiritual centers or rustic facilities. These paraprofessionals far outnumber the medical professionals and hold social capital in communities because they fill a societal need.
Mental health is influenced by cultural beliefs, stigma, and barriers to accessing healthcare. It affects more women globally, recent World Health Organisation research indicates that about 3.8% of people worldwide suffer from depression and it affects roughly 5% of adults, affecting 4% of men and 6% of women.
In WHO ATLAS report 2021, the availability and reporting of sex and age disaggregated mental health data was available for 43% and 54% in WHO AFRO region respectively versus 78% and 82% in high income countries. The availability of mental health data varies across the region, the low burden of disease may reflect the lack of data in some places. With only a few data points available in some places, regional trends are difficult to assess.
The acute shortage of qualified mental health specialists in West Africa is a major obstacle to tackling mental health issues in the region. Psychiatric services are hard to come by, particularly in primary healthcare settings when patients most need them. In 2017, 24% of countries in Africa did not have standalone Mental health policies and the proportion of MH worker was 9.0 per 100,000 according to a WHO MH survey.
In West Africa Policy makers have grappled with how to enable healthcare systems to deliver better health services with limited resources, infrastructure and access to trained mental health professionals. One strategy to close this gap has been task-shifting, in which non-specialist healthcare professionals receive training to deliver fundamental mental health services. Nevertheless, the general lack of healthcare resources and the requirement for extensive training programmes limit this approach's efficacy.
It is over 20 years (2001) since the WHO and AU rolled out a comprehensive programme for promoting, development and integrating traditional medicine and mainstream medicine as another way of enabling affordable and accessible healthcare for the ever-growing African populations.
The reality is political commitment is one of the obstacles highlighted and collaboration, lack of policies or inadequacies of implementation, and absence of common treatment pathways. Many of the traditional medicine healers lack education and training as an enabler of integration because the lack of policy input to support integration activities is absent.
Mental Health exists on a complex continuum with substantial influence on well-being, economic and social impacts. At any one time the interaction of individual, family, community and structural factors intersect to influence a unique dynamic that may protect or undermine one's mental health continuum. Increased attention from governments towards mental health including commitments to improve mental health disorders is needed in achieving the commitment of SDG Target 3.4 which calls for the promotion of mental health and well-being.
Advocacy and education initiatives play a critical role in improving mental health outcomes in West Africa. Community-based initiatives that involve people who have personally experienced mental health problems can be very successful in influencing attitudes and motivating others to get treatment. Local mental health champions who can offer peer support and function as reliable information sources in their communities can also be identified and trained by these programmes.
In my opinion many mhealth and ehealth technologies among people with mental health disorders feasible and acceptable and improves access and health outcomes.
Preliminary evidence suggests a combination of accessible technologies and trained individuals delivering interventions in the field help transform the role of prayer camps or traditional healers in serving people with mental disorders. However further investigations are required to draw conclusions about their effectiveness and cost benefit in this population and how to scale up.
Most of the projects are rarely evaluated and few serve marginalised areas or populations and contribute to improvement in care for mental health disorders. While investments in these technologies has increased, poor infrastructure and power, insufficient skills and policies and lack of government ownership lead to projects that are not scalable.
We need to consider a multisectoral approach because the factors determining mental health are multisectoral. Another approach is to extend services beyond the clinic and make mental health a priority in West Africa's public health. A substantial impact can be achieved by expanding the pool of qualified mental health workers via specialised training initiatives, enhancing the healthcare system, and incorporating mental health services into basic healthcare.
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Policies that raise awareness of mental health issues, lessen stigma, and guarantee that everyone, regardless of gender, socioeconomic background, or place of residence, has fair access to care are also essential.
Initiatives such as the Mental Health Data Prize - Africa, aim at leveraging existing data to address mental health challenges across Africa and contributing to a more resilient future for all.
The prize delivered by the African Population and Health Research Centre (APHRC) in partnership with the Wellcome, aims to close data gaps and improve our understanding of how to tackle anxiety, depression, and psychosis while also enhancing evidence-based decision-making in Africa.
Since January 2024, APHRC has been running an open capacity-building program, which has included sessions in mental health research, data science and machine learning, lived experience and evidence-based policy decision-making. The five-month capacity strengthening initiative seeks to bring together researchers, data scientists, policymakers and those with lived experiences to address research leadership, policy and management gaps, to facilitate future sustainability and innovation
In conclusion, mental health solutions in West Africa will require a concrete plan that takes into account technology improvements and data insights in expanding access to care, education and joint multifaceted efforts involving governments, healthcare providers, and communities to make significant progress on improving mental health outcomes in the region.
Dr. Sylvia Muyingo is a research scientist at African Population & Health Research Centre
