OAG examines the state of investment in and provision of adolescents and children’s mental health services in Africa
In recent years, there has been increasing acknowledgement about the importance of children’s mental health and the role it plays in achieving global development goals, as illustrated by the inclusion of mental health in the Sustainable Development Goals.
Depression is one of the leading causes of disability. Suicide is the fourth leading cause of death among 15- 29-year-olds. People with severe mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions.
Despite progress in some countries, people with mental health conditions often experience severe human rights violations, discrimination and stigma.
Many mental health conditions can be effectively treated at relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low.
Increased investment to become a priority
Increased investment is required on all fronts: for mental health awareness to increase understanding and reduce stigma; for efforts to increase access to quality mental health care and effective treatments; and for research to identify new treatments and improve existing treatments for all mental disorders. In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.
In sub-Saharan Africa, at least one in seven children experiences significant psychological hardship.
Children and adolescents are always at risk of developing mental health problems, especially vulnerable children facing poverty, discrimination and violence. The lack of access to basic social, health and education services, combined with wide-ranging structural inequalities, are all known to be aggravating risks for mental ill-health.
Outside factors impacting children’s mental health
The effects of climate change, compounded by high rates of HIV infection, adolescent pregnancies and humanitarian emergencies, are also ongoing threats for the mental wellbeing of children and adolescents in Africa. Research shows that 50% of mental
health conditions start by age 14 and 75&=% by the mid-20s.
“Addressing child and adolescent mental health in Africa is urgent. Over the years, millions of young people have been exposed to challenges most adults would find very difficult to cope with, often having to deal with the psychological impacts on their own. Our systems are still failing them,” said Mohamed M Fall, UNICEF regional director for eastern and southern Africa.
In order to respond to this growing crisis, UNICEF and the WHO committed to a 10-year Joint Programme on Mental Health & Psychosocial Wellbeing and Development of Children & Adolescents in Africa. Signed in 2020, this decade-long collaborative effort is working with local governments to strengthen mental health and psychosocial support systems for children, adolescents and their caregivers. This would also help bring mental health into national preparedness efforts and take away any stigma that might come with mental
Investment in mental health remains extremely low in Africa, with average government expenditure across the continent at less than one US dollar per capita.
“We simply cannot afford to let millions of children needing care go without help,” said Dr Matshidiso Moeti, WHO regional director for Africa. “It is time to make a difference and ensure that children grow into adulthood free of the potentially lifelong and devastating impacts of unaddressed mental health challenges.”
The impact of COVID-19 on mental health care
Covid-19 has further shone a spotlight on global inequalities, including mental health care. The well documented statistics regarding vaccine availability in Africa compared to high income contexts is a stark reminder.
Children in Africa have been exposed to even greater threats with school closures, increased exposure to armed conflicts and lack of opportunities to play and socialise with their peers. The long-term lockdowns have reportedly increased early marriage, teenage
pregnancies and sexual and domestic violence towards children – especially girls.
Despite this high burden, availability and quality of mental health services for children and adolescents in Africa are greatly lacking. Even in countries where specialised child and adolescent clinical psychologists and psychiatrists exist, on average there is only one per
4 million population, with health and social care professionals skilled in mental health often
concentrated in larger cities, unreachable by most of the population at risk.
Preventative measures and policies on mental health
Preventive measures remain key, most notably promoting healthy lifestyles including exercise and good nutrition, and protection against harmful practices and violence, including strengthening skills in communication and conflict resolution.
Updated and costed child and adolescent policies on mental health do not exist in many of the countries in Africa. Out of 39 countries that responded to the Mental Health ATLAS 2019, 11 countries indicated they had standalone child and adolescent mental health policies and/or strategies. Nine countries out of the 39 that responded indicated they had in-patient services for children and adolescents, while 12 indicated they had out-patient services for children and adolescents.
Only five out of 39 countries that responded had community-based child and adolescent mental health.
The most recent data indicates that on average, African ministries of health allocate about 90 US cents per capita to mental health, up from 10 US cents in 2016. This is often allocated to large psychiatric institutions in the bigger cities, with only about 15% getting to the primary and the community health levels.
Yet the evidence shows that investing in child mental health in Africa will pay off in the future. The UNICEF State of the World’s Children Report reveals that schools-based interventions addressing anxiety, depression and suicide provide a return on investment of US$21.5 for every US$1 over 80 years.
“Covid and the response measures have created an environment on uncertainty, isolation and anxiety. The number of children targeted for mental health and psychosocial support across West and Central Africa since the pre-Covid period has almost doubled (87%) from just below 1.1 million in 2019 to almost 2 million in 2021. Sadly, these estimates are probably only part of the real need. Long-term investments for child and adolescent mental health care in Africa is needed to turn recent donor support into sustainable services,” said Marie-Pierre Poirier, UNICEF regional director for West and Central Africa.
“We urge member states and regional bodies to prioritise and commit to further investing in the mental health of children and young people across Africa. This is an essential part of our care for children.”