On World Mental Health Day, UNICEF and WHO are calling for an end to historic under-investment in mental health services in Africa where the COVID-19 pandemic has helped shine a light on the gaps that exist in mental health care.
Children and adolescents are particularly vulnerable. Africa has one of the highest number of children and adolescents globally. Up to 60 per cent of the population in Africa are below 24 years of age. The last 12 months have seen families and communities under growing strain under the impact of climate shocks, global inflation and economic hardship. Ethiopia, Kenya and Somalia are facing extreme droughts, while in the Sahel area, armed groups have stepped up exactions on communities, leading to massive displacement.
“The psychological distress in which hundreds of thousands of children and parents live across the continent has a dramatic impact on individuals and by extension on the well-being and development of societies,” said Mohamed M. Fall, UNICEF Regional Director for Eastern and Southern Africa. “The impact of violence or humanitarian crises is not limited to economic impacts: the invisible wounds suffered by communities must also be at the heart of our interventions. Children and their parents demonstrate immeasurable resilience, and we must draw on their experiences to guide our strategies.”
People with psychosocial distress often come up against a lack of understanding of mental health at societal level and also widespread stigma. Nearly 37 million adolescents (aged 10–19 years) live with a mental disorder in Africa, and 1 in 4 children live with a parent with a mental health condition. Most mental health conditions in adulthood start in childhood.
For example, there is growing concern across the continent in the number of young people, 15 to 24 years of age, who consume alcohol, which can be linked to mental health issues. In Angola, Central African Republic, Congo, Democratic Republic of the Congo, Equatorial Guinea, Gabon, over 80% of drinkers aged 15–19 years are heavy episodic drinkers. This is likely to continue into adulthood, with increased risk of alcohol dependency and attributable disease conditions.
The serious gaps that exist in mental health care in the region are a result of historic under investment in mental health promotion, prevention and care. Only 29% of countries in the Region have Child and Adolescent mental health policies; there are only 0.2 child and adolescent mental health workers per 100,000 population, compared to 1.6 per 100,000 population for the adult services.
“Far too many people who need help for mental health conditions do not receive it, yet mental health is integral to wholesome health and well-being,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “The greatest challenge to adequate mental health service provision in Africa is the chronically low investments by governments. It’s time for a radical change.”
In 2020, UNICEF and WHO agreed a ten-year partnership on mental health, which seeks to address some of the main challenges to mental health and limitations in access to support. Already joint initiatives are underway in Nigeria, South Sudan, Ethiopia, Zimbabwe, Mozambique, with both agencies working with governments to scale up mental health and psychosocial support services across sectors.
“There is growing awareness and demand for more holistic and community-based approaches in all aspects of mental health care and psychosocial support (MHPSS), that address attitudes and behaviours in families and communities,” said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa. “We are particularly mindful of the mental health risks faced by adolescent girls, who report alarming levels of sexual violence. Research shows that mental health issues in childhood lead to an increased risk of drug or alcohol abuse, anxiety, depression, psychological trauma or self-harm.”
Responses to mental health need to encompass support beyond the area of specialised mental health services, to include child and family services, education, protection, violence prevention, community support, housing and social protection.
The lack of data and solid research on the needs in Africa and importantly understanding on what works hinders the ability of governments to make decisions and costed plans. UNICEF and WHO are supporting activities to gather this evidence by undertaking regional and local studies and situational analyses.
As part of World Mental Health Day activities UNICEF Eastern and Southern Africa Regional Office will be publishing a study into the effects of COVID-19 on the mental health of adolescents later this month. The study reveals the fragmented nature of current mental health services, barriers to accessing MHPSS services among adolescents, a lack of reliable delivery structures for MHPSS, and the enormity of MHPSS needs.
UNICEF is also working with governments in developing innovative digital technologies to reduce the stigma associated with mental health, gather information on the concerns of young people and increase access for support. Later this year UNICEF will trial a pilot of a mental health and psychosocial support chatbot designed with young people, helpline counsellors, mental health professionals and governments in Kenya, Tanzania and Uganda.
The WHO African Region Office has specific action on strengthening mental, neurological and substance use services for children and adolescents, including working with the education sector to increase access to services in the Framework to Implement the Comprehensive Mental Health Action Plan in the WHO African Region, adopted by Member States at the Regional Committee of 2022.
Together UNICEF and WHO urge all countries to take advantage of this WHO/UNICEF Joint Programme of Work to develop or strengthen programming for child and adolescent mental health.