Putting mental health on the agenda

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Access to mental health services remains a key challenge in Africa, but health experts say investing in mental health treatment for African countries would bolster development across the continent.

BRain

National health priorities have been overtaken by the UN Millennium Development Goals (MDGs) structure, which, with its specific targets for diseases like malaria and HIV, places them higher on countries’ agendas than other health issues. For example, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS.

However, the needs are enormous: the World Health Organization (WHO) estimates 75-85% of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50% in high-income countries. Mental health receives on average 1% of health budgets in sub-Saharan Africa despite the WHO estimate that it bears 13% of the global burden of disease. On World Mental Health Day in May 2013, a World Health Assembly action plan was passed which outlines four broad targets for member states. These are to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

Global experts welcomed the action plan as a landmark step, but in order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told the UN humanitarian and news analysis service, IRIN.

“Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.” In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care. “The surge of aid [that usually follows an emergency] combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the recently released report Building Back Better: Sustainable Mental Health Care after Emergencies.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which suffered a two-decade long war between the government and the rebel Lords’ Resistance Army (LRA) – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30trn by 2030, with mental health conditions alone costing an additional $16trn over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Uganda is part of a consortium of research institutions and health ministries (with Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems. Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment.

Experts met in the Ugandan capital, Kampala in July to press their governments to spend more on mental health care as well as train caregivers to treat patients with knowledge and compassion. The Peter C. Alderman Foundation, which underwrote the conference, says it seeks to build “mental health capacity in post-conflict countries,” especially by training caregivers and running clinics that treat thousands of patients each year. The conference drew more than 500 participants, including scores of African students who hope to swell the ranks of a Cinderella specialty. Uganda has only 33 qualified psychiatrists: one for every million people.

Kenya, a nation of about 40m people, has only 83 qualified psychiatrists, according to Prof. David M. Ndetei of Kenya’s University of Nairobi. Ndetei, who attended the Kampala conference as director of the Nairobi-based Africa Mental Health Foundation, said Africa’s biggest challenge was spreading mental health care to the family level in professional care that would help ease the stigma associated with mental illness. Only 4% of those with mental illness are able to access treatment in Kenya, he said.

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