By WHO Regional Director for Africa, Dr. Matshidiso Moeti
World Mental Health Day, on 10 October, is an opportunity to draw attention to an often-overlooked and neglected aspect of our well-being.
Almost two years into the COVID-19 pandemic, many people are experiencing isolation, anxiety or depression. World Mental Health Day is a chance to reflect on how we can improve our own health, and to reach out and ask how other people are feeling.
This year’s theme is “Mental health care for all: let’s make it a reality” because too many people in the African Region and beyond, lack access to care for mental health conditions.
Overall, there is fundamental underinvestment in mental health that makes providing access to care incredibly difficult. There has been little progress in terms of government spending on mental health, which remains below US$ 1 per person in most countries of the Region. This means that for most people, the lion’s share of mental health care costs is either borne by households and families or that people needing care don’t receive it. Analysis suggests that low-income countries need to be spending a minimum of two dollars per person on mental health – and middle-income countries at least double this – if there are to be acceptable levels of access and coverage for people living with these conditions.
A further challenge is that over 80% of the scarce resources available are allocated to large psychiatric institutions in big cities. Less than 15% is spent on mental health services provided in the community or in primary care facilities.
This is a missed opportunity. The majority of resources for mental health should go towards primary care and community-based programmes, to promote re-integration of “long-stay” patients back into society, and to provide support for carers so they are better able to support people with mental health conditions.
Unfortunately, most people with mental health conditions in Africa do not have access to quality care. There are fewer than two mental health workers per 100,000 people in the African Region, compared to a global average of 13. Looking specifically at psychiatrists, psychologists, and social workers, there is less than one specialist per million people. So, there is a severe dearth of experts to provide specialized care.
In the latest data collected by WHO in 2019, only 10 African countries shared information on treatment coverage for psychosis, a severe mental health disorder. This data indicated that nine out of 10 people with psychosis do not have access to care.
As WHO we are working with countries to develop strategies to expand access to specialized care and to provide training to primary health care workers, to make mental health care more accessible in communities.
We are also providing support in protracted crises, such as north east Nigeria and South Sudan, where minimum service packages for mental health and psychosocial support are being implemented in partnership with UNICEF. In Tigray in Ethiopia, training for mental health and psychosocial support is being provided for primary health care workers. In partnership with UNICEF and UNHCR, plans are underway to train teachers too, so that they can provide psychosocial support to children in conflict situations.
Making sure people have access to mental health care, regardless of their location, income level, age, ethnicity or other factors, and addressing the underlying causes of mental illness, will require holistic action. Causes such as trauma, loneliness, poverty, and job loss must be addressed by action to improve the conditions in which people live, work, play and age.
So, this World Mental Health Day I urge governments to invest in the social determinants of mental health and to work with civil society groups and the private sector to strengthen mental health services in communities.
I call on individuals to talk about mental health issues and to share good practices, such as socializing, getting a good night’s sleep, eating healthy meals and setting daily goals. Together we can make progress towards a world where everyone has an equal opportunity to experience good mental health.