Kampala – Poor access to mental health care in many African countries due to low government investment is one of the major hurdles to prevention and care services. On average African governments allocate less than 50 US cents per capita to mental health, well below the recommended US$ 2 per capita for low-income countries. Christina Ntulo, Country Director of StrongMinds Uganda – an organization working for better access to mental health care – discusses the implications of underinvestment and how to overcome the challenges.

Why is mental health care underprioritized in many African countries?

African countries have competing health and development priorities with insufficient funds to address them all. As a result, mental healthcare is severely underfunded. Data recorded in health management systems do not include mental health, which contributes to an underappreciation of the disease burden in countries across the continent. Lack of data means that policymakers cannot comprehend the depth of the problem that countries are facing. 

Globally, 280 million people are living with depressive disorders. Approximately 85% of people in low-income countries receive no treatment. At StrongMinds we see depression rates as high as 20% among the people we screen. Despite the high prevalence of mental illnesses across the continent, mental health remains underprioritized in many African countries. 

What are the barriers to accessing mental health care?

Mental healthcare for people living in sub-Saharan Africa is inefficient, inadequate and inequitable. Due to high treatment costs, most young people in sub-Saharan Africa are left with no choice but to live with untreated mental disorders or to visit traditional or religious leaders for treatment. 

Limited mental health education and awareness and shame and stigma are also barriers. Name-calling, ridicule, and chastisement are the types of things that people with mental illnesses are met with in the community. Stigma devalues and disfavours people with mental health conditions and often prevents people from accessing treatment. Sometimes a person’s own beliefs about mental illness can prevent them from acknowledging their condition, seeking help, or sticking with treatment. People may fear that family and friends will avoid them or treat them differently or that disclosing a mental health condition will lead to adverse treatment and perceptions at work.

How have you overcome these challenges, and what are some of your achievements?

WHO endorses group interpersonal psychotherapy as a first-line mental health intervention for vulnerable populations in low-resource settings. StrongMinds is scaling up this cost-effective solution to help end the depression epidemic in Africa. 

Since starting fieldwork in 2014, we have provided group talk therapy to over 160 000 depressed women and adolescents in Uganda and Zambia. Over 80% of the women we treat are depression-free at the conclusion of therapy and remain so six months post-treatment. StrongMinds estimates that for every woman treated for depression, up to four members of her family benefit. Sixteen per cent of women report an increase in work attendance and 13% report an increase in family food security, and 30% of women say that their children have fewer school absences.

We also continue to educate the public about depression, its signs and symptoms, and its triggers. Over the past two years, we have spread mental health messages via radio spot ads, DJ mentions, talk shows and community dialogues about mental health, depression, and treatment options. This information is presented in seven of the major languages in Uganda. 

Other activities include advocacy initiatives with the Ministry of Health to include people treated for depression in the health management system, the recognition of group talk therapy as a first-line treatment for depression and collaborating to contribute to the knowledge base on mental health by conducting research. 

What more can be done to improve mental health services?

Many don’t realize that investing in mental health yields long-term benefits for people, enabling them to take the necessary steps to improve their lives. Conversely, undiagnosed and untreated mental health conditions can create negative outcomes with long-term impacts that can span a lifetime and affect the health, education, and livelihood outcomes of future generations.  With mental health so underprioritized in most global health budgets, it’s important to take a cross-sectoral approach to improve access to care. 

For just over US$ 100, StrongMinds can provide an entire course of free treatment to a woman or adolescent in need of mental health services. Additionally, our therapy supplies individuals with the knowledge to recognize the symptoms of depression and deploy skills gained to prevent future depressive episodes.

We must ensure that the number of people treated for mental illnesses is accurately recorded in the Health Management System. This will support policymakers in decision making including ministries of finance when it comes to budget allocations 
Finally, we can continue to build the knowledge base around mental health signs and symptoms across the continent. The more people we can help educate, the more people we can reach. Our goal is to ensure that every woman and adolescent experiencing depression across Africa can readily access the high-quality health care that is their human right.