Sparking a mental health revolution in Africa through an Academy - Part 2 (How to do it)

April 04, 2018

Screenshot from a Feb 2016 interview I did with BBC (watch it here)

Sparking a mental health revolution in Africa through an Academy’ is a 3 part series through which I aim to share why I feel we need a mental health revolution in Africa, how to spark one and what I am doing in my corner. Read through Part 1 - The Status Quo, Part 2 - How to do it and Part 3 - The Academy to get the full picture. I am looking forward to your thoughts via email or in the comments section after each post. Also share the series with your networks...and remember, as long as you have a mind, you are a stakeholder therefore a much needed ally in this revolution.

Where to start?
In Part 1 of the series - The Status Quo, I touched on the way things are in the mental health space in Africa and shared my interest in the field (partly based on my personal experience). In Part 2 - How to do it, I will touch on what needs to be done to spark a mental health revolution in Africa and what is already being done. 

The World Health Organization introduced the mhGAP (mental health gap) program aimed at equipping lay workers to be able to intervene early in areas where mental service provision is not available. The program has worked in some countries and not really caught up in others. 

There is therefore need, and room, for more innovative, sustainable and impactful models of addressing the gaps in mental health in the continent ~ Sitawa Wafula 

Of course countries are not starting from zero as mini mental health revolutions have been happening across the continent through organisations and individuals who have decided not to wait for the governments to intervene.

In Zimbabwe, my good friend, Dr. Dixon Chibanda (1/12 psychiatrists in the country) runs the friendship bench project which works with grannies as listeners. This has greatly helped the overstretched mental health space.

In Ghana, Kenya, Nigeria, Tanzania, South Sudan and Uganda, Basic Needs, whose model addresses the medical, psychosocial and livelihood, goes a long way in reducing relapses and the promotion of dignity of those who have mental health conditions as they become productive members of society.  

Personalities like myself who through my platform my mind, my funk began changing the African mental health narrative by continuously sharing my journey living with epilepsy and bipolar, providing content for people in Africa and running a support line for people in Kenya made it easier for others to come out and share their journeys and ask for support.

So how do we really Spark a Mental Health Revolution in Africa

Bringing the words by The United Nations Special Rapporteur on the right to health - Dainius Pūras - closer home, I think to spark such a revolution in Africa, the citizenry and states should look at mental health literacy, mental health service provision, mental health data and research, mental health leadership and policies and mental health funding.

1. Mental Health Literacy - Through collaborative efforts by health promotion units, the media and those living with mental health conditions, African nations should create communication strategies aimed at creating awareness about mental health, sharing positive African mental health narratives and reducing the stigma faced by those with a diagnosis and their families.

The strategies should speak to different stakeholders from the citizenry, policy makers, governments and health service providers including those in the mental health field. These promotion programs should then be continuously distributed through the curriculum in schools, entertainment avenues, mainstream media, opinion shapers like artists, social media influences, and religious leaders.

2. Mental Health Service Provision - African governments should aim to make mental health services affordable, accessible, available, and acceptable. This can be achieved by strengthening the existing systems by making sure there is a mental health unit with a workforce and infrastructure in every health care facility.

Mental health literacy informs that not all mental health issues require hospitalisation and having services like psychosocial support goes a long way in mental health care and treatment. This also reduces the need for people to sit with a psychiatrist freeing them up for more severe cases, hence reducing the burden of few mental health workers.

3. Mental Health Data and research - Currently there is no proper estimate of the magnitude of the mental health problem in Africa. Whenever one wants to quantify, they use the worldwide World Health Organization (WHO) estimate of one in every four people will experience a mental health condition in their lifetime.

Without showing the magnitude of problems and gaps to be addressed, it is hard to convince governments to invest in mental health. Data collection and research also helps develop prevention programs. Giving medical and psychological services is not enough, getting to know the main causes of mental ill health in Africa goes a long way in governments program planning, if social issues like unemployment or drug abuse and easy access to drugs are identified. Mental health data across the continent should be mined and shared and indicators continuously updated.

4. Mental Health Leadership and Policies - There is a need for an inclusive, people centred, human rights, multisectoral approach to mental health. This approach should not just be on paper through policies launched with much fanfare then left to gather dust with no implementation follow up.

Every arm of the government is a mental health stakeholder, from the education sector, finance, social welfare to justice system and they should be part of the mental health mainstreaming process. All this needs to be overseen by a body, be it a unit and/or a board that is specifically appointed to oversee the mental health promotion, prevention of mental ill health and care of those living with mental health conditions and their families.

5. Mental Health Funding - In 2001, through the Abuja Declaration, African nations agreed to increase their annual funding on health to at least 15% of their national budget. A handful have been able to make progress in this which directly dictates the percentage that mental health gets.

The World Bank in a joint meeting with WHO last year mentioned mental health as a global development issue. Governments need to stop looking at it from just a health and/or human rights angle but also a development angle and invest in the mental health of the citizenry as it does on other infrastructure.

Cultural issues also must be taken into account as all this happens.

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