Joanna
Health
02 / 2021

10 Major Challenges Shaping African Attitudes to Mental Illness

Every continent has its share of struggles in dealing with the rising scourge of mental illness. Africa, in particular, is facing a unique set of challenges that has limited its capacity to respond adequately to the mentally ill. Together, they have shaped African attitudes regarding mental health, with public opinion ranging from disbelief, mockery to outright dismissal. 

These challenges range from sociocultural factors like stigma and spiritual beliefs to professional ones like lack of psychiatric personnel and inadequate legal protection. Understanding how they affect the African society's response to mental illness will provide an excellent foundation in tackling them and giving people the help they need.

1. Lack of Awareness

Another major challenge shaping African perspective on mental illness is the lack of awareness. Not just about the existence of mental diseases but the range of conditions a person could have. Most people's understanding of mental illness is limited to people with unkempt hair who sleep on roadsides and dumpsters, often referred to locally as madmen or madwomen. 

Of course, we know this is not true. A wide range of mental diseases like depression, eating disorders, anxiety, schizophrenia have less overt symptoms. There is also borderline personality disorder, which has abstract symptoms like fear of abandonment, mood swings, and anger. You can read more about it here.

Additionally, many believe mental illness is self-inflicted due to personal failings like drug or alcohol abuse, unemployment, or divorce. This perception limits how the African society reacts to episodes or symptoms of mental illness, with many often reacting with derision and anger.

To solve this challenge, public institutions and mental health bodies will have to launch major public campaigns to undo years of misinformation. But first, it will have overcome a more stubborn problem in Africa.

2. Social stigma

A safe and welcoming environment is necessary for the treatment of mental diseases. However, what we find in most African countries are societies that often discriminate against those with mental issues. In many countries, families with mentally ill members are considered cursed, and people tend to refrain from interacting with them.

A typical display of this involves discouraging sons and daughters from marrying into families with a history of mental illness. This culture of stigma often leads to marginalization, and sometimes, violence. For instance, in South Sudan and Uganda, people who have mental illness have been put in jail or prison, with some spending up to 16 years in confinement.

Sadly, even as the continent continues to open its physical and digital borders to the outside world, this stigma persists. A lot of it is driven by the misguided belief that the mentally ill committed a great crime in a past life or are being punished for ones committed in the present one.

The rampant nature of this kind of stigma prevents people from not only seeking help but denying they need it even when offered to them. To end this discrimination requires social reeducation with joint efforts from government institutions, non-governmental organizations, and health professionals.

3. Ethnocultural beliefs

Social stigma is the dilapidating symptom driving the negative African attitude to mental illness. However, it does not exist in a vacuum. It is vigorously fuelled by strong ethnocultural beliefs that have existed for hundreds of years, passed down from one generation to another.

Some of the beliefs exist in various forms. Some claim mental illness is a curse inflicted on a person or group for wrongdoing. Others consider them a result of spiritual warfare. These differences are mostly down to the ethnic diversity in Africa, where each tribe and culture has its explanations for mental illness.

These cultural beliefs about mental illness in Africa make it harder to build a consensus on treating those suffering from it. For example, some cultures do not stigmatize the mentally ill. Others do and believe they should be cast from society. 

Additionally, despite the growing modernization of the continent, a significant portion of the population still has a strong attachment to their ethnic identity. This makes it harder to separate them from past notions and introduce modern ideas.

4. Poverty

A common sentiment among the young population in Africa is that depression is curable with money. Although it is often expressed humorously about the continent's economic instability, it speaks to a greater misconception about mental illness.

For many, depression and acts like suicides only affect poor people. This keeps many from offering the necessary help or support when friends and family exhibit depressive behavior. To them, medical treatment is unnecessary. They simply need to "get money."

At the same time, many Africans (especially those with regular access to the internet), consider mental illnesses like anxiety, eating disorders or depression, like rich people's problems. This widely held opinion comes from the fact that relatively well-off people generally drive the conversation around these illnesses.

Despite these opinions' contradictory nature, they both hinge on the idea that a person's economic status directly causes mental illness. It is not wrong that external factors can affect a person's mental state. But the proliferation of claims that there is direct causation between mental illness and financial status distorts African society's response to people suffering the condition.

5. Religious practices

Christianity and Islam, two of the world's dominant religions, account for 91% of Africa's religious population. This provides a strong foundation for the spread of harmful religious practices concerning mental health. In many African countries where mental illnesses are acknowledged, they are considered the work of witchcraft or spiritual attacks.

In countries like Togo, Benin, and Nigeria, mental illness is a metaphysical problem that makes thousands seek out metaphysical solutions. As a result, many spend time and effort going after unproven solutions like faith healing, exorcisms, and indigenous healing to treat mental disorders.

The result is the abundance of stories of people getting tied for weeks or months, often beaten and left without food as part of the healing process. With many unwilling to subject themselves or their wards to these conditions, mental illness symptoms are either wished away or ignored entirely.

Those willing to take the plunge often find themselves waiting weeks, months, or years, waiting for results. While sometimes it occurs, most of the time, it doesn't. The lack of guarantee combined with financial and emotional stress often leads many to avoid the conversation entirely or turn to orthodox treatment, which also has its struggles.

6. Limited resources

Africa is not unique in its misconceptions about mental diseases. But while other continents have been able to flush them to the fringes of society, traditional African cultural perspective on mental health/illness has persisted due to a lack of resources to change the narrative.

Reshaping public opinion requires significant investment in programs and social movements online and offline. Unfortunately, most African countries are poor, with many often needing external debt or aid to meet yearly budgets. With no substantial investment to change public opinion, current and potential leaders have zero incentive to improve the budgetary allocation of resources towards mental health.

The result? Poor infrastructure. In many African countries, few psychiatric hospitals cater to millions of mental health patients. In Nigeria, where WHO estimates there are 40 to 60 million people with mental illness, there are only about eight psychiatric hospitals. It means fewer than 10% of the country's mental health patients have access to a psychiatrist or health worker.

Despite pledges by the Nigerian government and 20 other African nations to earmark 15% of its federal budgets to health care, many still routinely fall behind this target. This top-down lack of interest by African governments worsens public attitude to mental illness, even as the continent's suicide rate continues to rise.

7. Prioritization of other forms of diseases and illness

Limited resources mean the application of opportunity cost. And due to the social and cultural beliefs about mental illness in Africa, mental illness often finds itself at the bottom of the list. This applies to governments and individuals, who often must distribute scarce resources to various health issues.

In this scenario, greater attention goes to physically tangible diseases like malaria, tuberculosis, and AIDS, two deadly illnesses common on the continent. An example is Nigeria, where only 3% of the national health budget goes to mental health. Across Africa, 70% of federal governments earmark less than 1% of their health budget to mental health.

At the individual level, the small fraction of people who believe mental illness requires medical treatment has to ration their resources due to the high cost of treatment. In Nigeria, a therapist session costs about twenty thousand Nairas, about 67% of the national minimum wage.

In public hospitals like the Federal Neuro-Psychiatric Hospital, Yaba, patients spend more than four thousand nairas for tests. A 72-hour hold cost as high as N25,000. This high cost of treatment ultimately induces patients to prioritize treatment, making them adopt a dismissive mindset towards mental issues to ensure their survival.

8. Lack of Psychiatric personnel

The African perspective on mental illness harms not only the continent's mentally ill on an individual level. It also affects its ability and preparedness to tackle the problem systematically. There is an alarming lack of qualified psychiatric personnel to care for the sick or provide the expertise needed to reorientate societal responses to the mentally ill.

In Nigeria's most popular mental health facility, there are less than 50 resident doctors and 30 consultants to attend to over 5,000 patients a year. A doctor treats up to 50 to 80 patients a day, at an average of five minutes per patient as opposed to the recommended 25-30 minutes. The entire country itself has less than 150 psychiatrists, expected to cater to over 180 million people.

Likewise, in Kenya, there are about 80 psychiatrists, 30 clinical psychologists, and less than 500 psychiatric nurses, with only about half of them working in mental health. 

A lot of these struggles with personnel come down to the lack of resources and adequate infrastructural investment. Many are paid poorly, and some do not get paid at all. This results in an exodus of trained personnel, leaving for greener pastures in Western countries.

9. Conflict

One of the benefits other continents such as Europe and North America have enjoyed regarding public attitude on mental illness is socio-economic stability. With only a minority of the population living in poverty or political instability, most people can aspire to the psychological desires in Maslow's hierarchy of needs.

In Africa, where a substantial part of the population is still living in political conflict and insecurity, mental health issues rank low on prioritized interests. From Cameroon, Mali, to Ethiopia and Northern Nigeria, the level of unrest and terrorism has pushed mental health issues to the background, even though these conflicts create psychological problems of their own.

This issue's lasting presence makes it harder to reshape the attitude to mental illness in African culture. And until governments and international bodies work to reduce or eradicate these struggles, they will continue to pose a serious challenge to improving mental health on the continent.

10. Inadequate Legal Protection

Lastly, as more African countries adopt democracy and legislative rule, adequate legislation can fix the negative social and cultural aspects of mental health in African societies. In this regard, there is still much room for improvement, especially in protecting the rights of those with mental health conditions.

From Nigeria, Ghana, to Kenya and South Africa, there are several gaps in current mental health laws that stifle improvements on African attitudes to mental issues. This is particularly true from a local and international perspective. As of now, there are a ton of legislative opportunities, from budgetary allocations to human rights protection, to redefine African attitudes to mental illness.

These laws can improve and eradicate challenges like stigma, abuse from religious practices, limited resources, and grow available psychiatric personnel. Unfortunately, because lawmakers are mostly products of their society, there is little to zero pressure to enact these laws.

Thus, people with mental health issues are often left at the mercy of private groups and international bodies to lobby and coerce lawmakers.

Final Word

A variety of challenges shapes the African attitude to mental illness. Each one poses a sufficient obstacle to improving the quality of response to mental health on the continent. Together, they form a large boulder that has left many frustrated and hopeless. However, understanding these challenges presents us with an excellent pick, to break it one strike at a time.

Start here...
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