Investing in Africa’s mental health improves lives — and the economy
Both the WHO and UN recognise the growing, global burden of mental-health disorders, writes Crick Lund, but with the right type of interventions, there is hope
The growing burden of mental disorders is a worldwide problem. This was recently acknowledged by the World Health Organisation (WHO) when the UN secretary-general António Guterres said that "one in four people experience a mental health episode in their lifetime, but the issue remains largely neglected". He confirmed the UN’s commitment "to working with partners to promote full mental health and wellbeing for all".
Mental health problems are particularly neglected in developing countries and 45% of the world's population live in a country with less than one psychiatrist per 100,000 people. It is predicted that by 2030, depression will be the second leading health-related disability in the world, and an estimated one third of SA’s population is affected by depression at some time during the course of their lives.
Great strides have been made by successfully treating people with mental illness, improving the quality of their lives and wellbeing. However, resource and capacity constraints in developing countries widen the treatment gap. Some researchers suggest that between 75% and 90% of those living with mental illness in developing countries do not even receive the most basic forms of mental healthcare.
Interventions for low-and middle-income countries
The University of Cape Town’s department of psychiatry and mental health has set out to close the mental health service gap and find cost-effective interventions suitable for low-and middle-income countries (LMICs). The aim is to generate evidence and pioneer new approaches to address the challenges of mental-health detection and treatment.
Over the past 20 years it has become increasingly critical to include mental health in Africa’s health policy and development agenda. During a recent lecture, 10 reasons to invest in mental health in LMICs in Africa were highlighted; among them was the need to increase awareness around mental health as a development challenge, to break the cycle of mental illness and poverty, as well as to understand the economic and social benefits of investing in mental health.
Depressed economic output
Depression and anxiety disorders are not only highly prevalent and disabling but can also result in reduced economic output since depression has a negative influence on productivity and the ability to work. A recent study found that scaled-up treatment of common mental disorders could lead to a substantial amount of extra healthy life years gained, thereby increasing economic productivity.
According to the study, Scaling-up Treatment of Depression and Anxiety: A Global Return on Investment Analysis, it is estimated that every $1 invested in mental-health treatment could yield between $3 and $5 return on this investment at an economic and healthcare level.
Earlier research assessed the effects of financial poverty alleviation interventions on mental health to explore what interventions are needed to break the cycle of poverty and mental health. These findings showed varied effects: some cash-transfer interventions improved mental health, but some interventions, such as loans, even increased stress levels. However, when examining the economic impacts of mental health interventions, a very compelling story emerged: interventions that showed clinical improvements also showed economic improvements, in some cases including both individual and household economic benefits.
More research is needed to find the most impactful and sustainable interventions.
Mental disorder co-morbidities
Growing concern for developing countries is the co-morbidity between mental disorders and major non-communicable diseases (NCDs). The high burden of mental disorders and major NCDs poses a high risk for reduced healthy life expectancy. Mental disorders can be a symptom or a consequence of chronic conditions, such as cardiovascular disease, diabetes, cancer or HIV. Some of the risk factors for these diseases are also risk factors for mental disorders, such as substance and alcohol abuse.
Furthermore, people with mental disorders are at increased risk of contracting HIV/AIDS and the prevalence of mental disorders among HIV-positive individuals is more than double that found in the general population.
However, there is hope — mental health has been included as one of the 17 UN Sustainable Development Goals (SDGs). Goal number three specifically aims to "reduce by one-third premature mortality from NCDs through prevention and treatment, and promote mental health and wellbeing" and to "strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol".
Mental health problems are particularly neglected in developing countries and 45% of the world's population live in a country with less than one psychiatrist per 100,000 people
In reviewing to what extent the major social determinants of mental disorders are addressed by the SDGs, the study sheds new light on how the SDGs are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders.
The interruption of negative cycles of poverty, violence, environmental degradation, and mental disorders is possible, as is establishing virtuous cycles of mental health, wellbeing, and sustainable development. Evidence presented in the study indicates opportunities for action in demographic, economic, neighbourhood, environmental events, and social and cultural domains.
And there is more good news — the number of African countries with an existing mental-health policy has increased from less than 50% in 2001 to 75% in 2014. The next challenge is to implement these policies. The focus should be on the establishment of interventions that enable healthcare systems to care for people with mental-health problems, as part of integrated healthcare.
Evidence-based packages of services for people with mental disorders are needed that combine interventions with poverty alleviation measures and a commitment to the protection of human rights.
Investing in mental health means promoting resilience on the African continent. Mental health is both a means to social and economic development, and a worthy goal in itself.
• Prof Lund is the director at the Alan J Flisher Centre for Public Mental Health, University of Cape Town.