In Africa, gap between need and funding of mental health is huge

Adolescent boys in talk therapy group near Kampala, Uganda. Credit: StrongMinds

This was originally published on Global Health TV on June 29, 2015.

Sean Mayberry has spent his entire life surrounded by mental illness. As a child and an adult, people close to him have endured this affliction. But he had an epiphany when he happened upon a young man behind a farmhouse in Uganda, sitting in his own excrement and digging in the dirt.

“It was a turning point for me,” he recalls. “I left that young man knowing that I had to do something for the mental health of that continent.  He gave me the courage to try to make a difference for some of his mentally ill brothers and sisters.”

Pauline Muchina is dealing with mental illness in her family in Kenya. Her 50-something sister lost her job due to depression and had to come home to live with her mother. She is now on medication and attends counseling.

Muchina also has a nephew suffering from depression. While in a government hospital, he was chained to a bed for one week and his condition got worse. Now the family has found a private rehabilitation center for him. He is getting better but it is costing the family $2,500 for six months. Muchina’s family is middle-class and can pay the treatment (with difficulty), but the vast majority of Kenyans could never afford such expensive treatment.

Mental disorders and substance abuse are the third greatest contributor to the global burden of disability with 23% of the burden – greater than cardiovascular disease or cancer.

Yet the amount of resources expended on them is miniscule: A paper published earlier this month shows that the amount of development assistance for health attributed to mental health is less than 1%. And low-income countries themselves spend only 0.5% of their very limited health budgets on it, according to FundaMentalSDG, an initiative to strengthen mental health in the post-2015 agenda.

Here are some other facts about mental health, according to the World Health Organization (WHO):

1. Depression alone accounts for 4.3% of the burden of disease – with more than 350 million people all ages suffering from it – and is among the largest single causes of disability worldwide, particularly for women.
2. To describe the current accessibility of mental health services in Africa as deficient would be a gross understatement. Almost half of the world’s population lives in countries where there is only one psychiatrist to 200,000 or more people, according to the WHO. Ninety percent of African countries have less than one psychiatrist per 100,000 people.
3. Around 20% of the world’s children and adolescents have mental health problems.
4. About 800,000 people commit suicide every year.
5. Wars and disasters have a huge impact on mental health
6. Mental disorders increase the risk of getting ill from other diseases such as HIV, cardiovascular disease and diabetes, and vice versa.
7. In Africa, human rights violations of people with mental and psychosocial disability are common.

A 2011 study by Harvard School of Public Health estimated that the cumulative global impact of mental disorders in terms of lost economic output amounted to $2.5 billion in 2010, estimated to increase to $6 billion by 2030. The share of this in low- and middle-income countries is $870 million and $2.1 billion, respectively.

In fact, Mayberry makes the case that depression also reduces the effectiveness of development programs.

“When you have 25% of the population that is depressed in many African countries, these individuals do not respond to the variety other development efforts which aim to get them to practice safe sex or follow tuberculosis treatment protocols, for example,” says Mayberry. “Depression inhibits their ability to focus and concentrate, so donors end up wasting a vast amount of their development dollars trying to change the behaviors of these depression sufferers.”

Muchina says that mental health affects all areas of life including family and human relationships. “Someone with depression and low self-esteem is not going to do much to better her or his life,” she says. “A lot of violence against women and girls can be traced back to mental instability of the abusers. Most women who stay in abusive relationships, or fail to report abuse, also have mental and emotional issues. I believe that this has enabled abuse to go on from generation to generation. “

Mayberry created StrongMinds, to provide Africans with access to mental health.  In Uganda, StrongMinds is showing that using ordinary people from African communities to deliver mental health care through talk therapy – in many cases without medication – can be surprisingly effective. This is huge, because mental health professionals are scarce and medication expensive.

StrongMinds has treated over 1,000 women with depression in the last year using 12 weeks of group talk therapy led entirely by trained employees who are not mental health professionals. The New York Times described this as “a depression-fighting strategy that could go viral.”

Muchina says some Kenyan pastors, like her sister Anne, are counseling depression sufferers without psychotherapy training. In most cases, these pastors are the only hope for people encountering mental health challenges.  If these pastors could be trained, she says, thousands of counselors could be put to work.

For over 15 years, Muchina has been supporting orphans and vulnerable children affected by HIV/AIDS, which gives these children a second chance in life, through the Future African Leaders Project. Muchina says that all of the young people participating in the Future African Leaders Project have suffered some form of trauma that require psychotherapy or counseling. Government help is virtually non-existent and the project cannot afford private care for all of the youth.

“In 2013, we lost a 21-year-old man to suicide,” Muchina says. “He was suffering from depression and got into alcoholism – a nightmare combination. His brother is going through the same thing, and I worry about losing him, too.”

The world’s plan for dealing with mental health in Africa, and other developing countries, is embodied in WHO’s Mental Health Gap Action Programme (mhGAP), developed in 2008.  In 2013, the World Health Assembly adopted the WHO’s Mental Health Action Plan 2013-2020, which is global and designed to provide guidance for national action plans in all resource settings. Africa even developed its own Declaration of Mental Health in Africa last year.

Mental health was absent from the Millennium Development Goals, expiring this year, and some advocates fear that they will be similarly neglected in the Sustainability Development Goals (SDGs)now being finalized.

“I greatly fear that, despite a real and determined push to place mental illness more squarely on the SDGs, we will once again fail mentally ill people everywhere,” says Chris Underhill, founder president of BasicNeeds. “My fear is that the new SDGs will pass into international convention and once again the global community will have badly let mentally ill people down. Surely global development organizations and governments have to commit to the principle of proper access to treatment for the 450 million people who suffer mental ill health globally at any one time.”

For wrenching images of mental health disorders in Africa, view this visual report from PBS NewsHour, “Mentally ill shackled and neglected in Africa’s crisis regions.”