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Experts gathered in Kigali at the second International Conference on Public Health in Africa suggested that community-based interventions can help in addressing mental disorders.
Community-based psycho-social interventions and integration of mental health services can assist in dealing with the disorders, which account for 28 per cent of the non-communicable diseases burden in the continent. Depression alone contributes 10 per cent to this.
Globally, 70 per cent of the burden of mental disorders is in low- and middle-income countries and 30 per cent is in high-income countries, said Jibril Abdulmalik, professor at the Univesity of Ibadan and founder of Asido Foundation, a non-profit which focuses on mental health in Nigeria.
Still, in terms of financial resources, low-income countries have 10 per cent of global resources to address 70 per cent of the burden. In contrast, high-income countries have 90 per cent of the resources to manage 30 per cent of the global burden, Abdulmalik added.
He advocated for community-based interventions over building more hospitals. “We don’t need to build more specialist hospitals, we need to change our mindset. We have a lot of daunting challenges. Let’s stop lamenting that we don’t have resources,” he added.
Abdulmalik said:
Let us look at the resources we have — primary care workers, school teachers, religious teachers and community leaders. We should equip them, educate them, change their mindset and let them be champions of promoting mental health awareness.
This will ensure significant progress towards achieving universal health coverage for mental health services, he said. Generally, universal health coverage promises to leave no one behind.
It is one of the comprehensive mental health action plans. Universal health coverage’s objectives include providing comprehensive and integrated mental health and social care services in community-based settings.
One successful model in this regard is the Friendship Bench initiative in Zimbabwe.
Here, the elderly women in villages spoke to women with depression and listened to them. The results were astonishing. The initiative was very effective in addressing the problems, Abdulmalik said.
“We need to pay attention to four aspects of public health — mental health promotion, prevention, early identification and treatment as well as rehabilitation — in addressing these issues,” he said.
The first three aspects can be effectively addressed within the community, in primary care, schools and so on, he noted.
Africa has very few mental health professionals — psychiatrists, clinical psychologists, social workers working in mental health and psychiatric nurses.
Low-income countries have less than one psychiatrist per 100,000 population, according to the World Health Organization’s (WHO) world mental health Atlas.
But in reality, it might be about one psychiatrist per one million population. On the other hand, high-income countries have over 10 psychiatrists per 100,000 population.
All countries have agreed to work towards universal health coverage as part of the 2030 Agenda for Sustainable Development.
“We cannot wait 10 years. We need universal health coverage, including mental health coverage, now, to strengthen efforts against the pandemic and prepare for future crises,” the UN Secretary-General, António Guterres, said in 2020.
A WHO World Mental health survey, conducted 15 years ago across 14 countries, found that treatment gap was higher — between 76 and 85 per cent — in developing countries, while it was 35-50 per cent in developed countries.
This means that for every 10 individuals with a mental disorder, only two were able to access care in the preceding year.
As highlighted in the conference, some challenges include a lack of governance documents or their non-implementation, ignorance, and superstitious beliefs.
Most individuals with mental disorders in the continent will go to traditional healers before they think of going to the hospital.
Social stigma and discrimination worsen the situation. Mental disorders fuel poverty as well.
“We know that many African countries do not have adequate health insurance,” Abdulmalik said.
In some countries with health insurance, mental health is not adequately covered. In such cases, he added, one has to make out-of-pocket payments for services, impacting access to mental health services or medications.
Besides social and economic challenges, countries are also affected by their limited capacity to develop and produce medications. This imperils their access to drugs.
For instance, drugs such as methylphenidate used for treating ADHD — one of the most common neurodevelopmental disorder in children — are highly expensive.