Mental health in Africa

On the “About the journal” page of its website, The Lancet Global Health explains that its focus is on “disadvantaged populations, be they whole economic regions or marginalised groups within otherwise prosperous nations”. The journal has, to a large extent, lived up to this pledge in its 5 years of existence—by May, 2018, it had published 637 papers that referenced the world's most economically disadvantaged region, Africa. With regard to the topics on which the journal has pledged to focus, however, there is a lacuna in its coverage of Africa. Most of its key topics of focus have received strong attention. A search of the journal's online database on April 25, 2018, combining key Lancet Global Health research topics with the word “Africa” found 191 papers that allude to maternal health in Africa. Infectious diseases have been covered greatly with HIV or AIDs mentioned in 252 papers, malaria in 165 papers, and tuberculosis in 114 papers. Health systems in Africa have been referred to in 346 papers, and health policy in 282 papers. In the area of mental health, another of the journal's key topics, The Lancet Global Health has been much less prolific. Only 21 articles have alluded to depression in Africa, only seven to anxiety, six to suicide, four to addiction, one to psychosis, and none to schizophrenia. A search for “mental health disorders” in Africa produces just 16 items. This weakness reflects a dearth of research into mental health problems in the region. Sheriff and co-authors1Sheriff R Adams C Tharyan P et al.Randomised trials relevant to mental health conducted in low and middle-income countries: a survey.BMC Psychiatry. 2008; 8: 69Crossref PubMed Scopus (14) Google Scholar found that mental health was the subject of just 3% of clinical trials conducted in low-income and middle-income countries, and that the majority of these were done in China. The scarcity of research mirrors the weakness of mental health services on the continent and the blind eye turned to the problem by many Africans and their governments. Worldwide, 24% of countries that reported to the WHO's 2014 Mental Health Atlas survey did not have or had not implemented standalone mental health policies; in Africa, this proportion rose to 46%. The region has 1·4 mental health workers per 100 000 people, compared with a global average of 9·0 per 100 000, and also performs relatively poorly with regard to the number of psychiatrists, the number of hospital beds for patients with mental illness, and the coverage of outpatient facilities. Partly as a consequence, the proportion of Africans who receive treatment for mental health problems is extremely low. While the global annual rate of visits to mental health outpatient facilities is 1051 per 100 000 population, in Africa the rate is 14 per 100 000.2WHOMental Health Atlas 2014. World Health Organization, Geneva2015http://www.who.int/mental_health/evidence/atlas/executive_summary_en.pdf?ua=1Date accessed: April 28, 2018Google Scholar In Sierra Leone, for example, the treatment gap (that is, the proportion of those in need who go untreated) for formal mental health services has been estimated at 98·8%.3Yoder HN Tol WA Reis R de Jong JT Child mental health in Sierra Leone: a survey and exploratory qualitative study.Int J Ment Health Syst. 2016; 10: 48Crossref PubMed Scopus (18) Google Scholar Mental health problems appear to be increasing in importance in Africa. Between 2000 and 2015 the continent's population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%. In 2015, 17·9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18·5 million years lost to disability.4WHOGlobal Health Estimates 2016: Burden of disease by cause, age, sex, by country and by region, 2000–2016.http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlDate: 2018Date accessed: April 28, 2018Google Scholar As Africa's population is expected to double over the next three decades,5United Nations Department of Economic and Social AffairsWorld population prospects: the 2017 revision.https://www.compassion.com/multimedia/world-population-prospects.pdfDate: 2017Date accessed: April 28, 2018Google Scholar the pressures on young people in particular, who across the region are already struggling to earn a livelihood in highly competitive labour markets, are likely to ratchet up. Many will experience psychological problems as they fail to realise their ambitions, and some will turn to substance misuse as a means of alleviating their frustration.6British CouncilNext generation Kenya: listening to the voices of young people. British Council, 2018https://www.britishcouncil.co.ke/sites/default/files/h198_next_generation_kenya_a4_final_web.pdfDate accessed: April 28, 2018Google Scholar Increased attention to mental health by governments, researchers, and journals is therefore essential. In 2013, the member states of the World Health Assembly committed to the Comprehensive Mental Health Action Plan, in which they pledged, among other national targets, to increase service coverage for severe mental health disorders by 20% by 2020 and to reduce suicide rates by 10%.7Saxena S Funk M Chisholm D World Health Assembly adopts Comprehensive Mental Health Action Plan 2013–2020.Lancet. 2013; 381: 1970-1971Summary Full Text Full Text PDF PubMed Scopus (126) Google Scholar The third goal of the Sustainable Development Goals adopted by all the world's governments in 2016 also includes commitments to improve mental health and prevent and treat substance use disorders.8United NationsUnited Nations development programme: sustainable development goals.http://www.undp.org/content/undp/en/home/sustainable-development-goals.htmlDate: 2018Date accessed: April 24, 2018Google Scholar In the next 5 years and beyond, The Lancet Global Health can play an important part in helping to direct research and policy attention towards mental health in Africa. As one of the most influential journals in the global health field, it is well placed to use calls for papers, editorial articles, special supplements, and conferences to raise awareness of the subject and to encourage more researchers to devote their time to the mental health of African people. Additionally, it can assist policy makers by devoting more space in its pages to research that assesses the prevalence of and risk factors for mental health disorders; the effectiveness—and cost-effectiveness—of prevention and treatment interventions; and the role of policy and health systems in responding to the challenge. The Lancet Global Health has made a good start in addressing the physical health problems facing African people; it is now time to turn to the mental health challenge. We declare no competing interests.