Steven Bernardus /Hara#geib

The argument for transformational investment in mental health globally, especially on the African continent, is clearer than ever. Despite the enormous implications for global health, mental health gets just a fraction of the support from governments and development partners. There is a significant gap between the demand for therapy and its availability as a consequence of poor investment in public mental health. 

This disparity affects not only the health and wellbeing of people with mental illnesses and their families, but it also has unavoidable consequences for employers and governments in the form of lower productivity at work and lower labour force participation rates.  

Various mental health stakeholders, including the Health Care Professionals Council and non-governmental organisations (NGOs), have advocated for more human resources for health, equal access and more effective integration of mental health, but progress is slow. 

Gender disparities 

The reported gender disparities in suicides raise serious concerns among people about the need to expand mental health services, especially early intervention. Variations in mental health, health-seeking behaviour of individuals afflicted, and reactions of the health sector and society as a whole are all influenced by socially-created differences in duties and responsibilities, status and power between men and women. 

Adolescent girls and young women have a much greater rate of depression as well as suicide ideation and attempts than boys. However, adolescent boys are more prone than girls to struggle with anger, participate in risky behaviour and attempt suicide. Adolescent girls and young women are more prone to have inward-directed symptoms, whilst adolescent boys and young men are more likely to exhibit outward-directed symptoms. In adulthood, women have a much greater incidence of depression and anxiety, while males have a higher prevalence of substance use disorders and anti-social behaviour. Furthermore, transgender, non-binary and agender persons often endure substantial harassment and trauma, which may have a negative impact on their mental health. These vulnerable groups are yet to receive targeted interventions that address their needs, but alas

Trauma 

The normalisation of trauma, as well as its generational consequences, continues to plague Africa and Namibia. The discrepancy is evident all around the world, and some groups, such as women and the poor, are disproportionately impacted. This demonstrates another universal trait of mental health: it is impacted by a broad variety of social, political and economic issues. 

Inter-generational trauma is seldom, if ever, mentioned until a therapist or other mental health professional brings it up. While it is an extremely important issue, many mental health practitioners are either unaware of it, or just uninterested in it. However, as trauma therapists, we must investigate how trauma may have adversely affected generations of family members. 

Financing 

Government can be a tremendous instrument for long-term and structural change. The existing Mental Health Act of 1973, which is backed by the Mental Health Policy of 2005, requires a resource mobilisation strategy. Global investment in mental health is currently quite low.  According to data from the WHO Mental Health Atlas (WHO, 2015), many low- and middle-income nations devote less than 2%—or even 1%—of their health budget to the treatment and prevention of mental health disorders, and the majority of government funding are mostly for operational expenses. The specialised mental health services that are offered at the Windhoek Mental Health Care Centre and the Oshakati Psychiatric Unit are not sufficient to meet the requirements of the whole country at this time. Despite the fact that certain services are also offered at the district hospitals, these services are not based in the community, and are not well-integrated into primary healthcare.

The main issue underpinning the push for mental healthcare within universal healthcare is the sometimes high, possibly catastrophic cost to families of obtaining the mental health services and medications they need. This direct, out-of-pocket payments are a regressive type of health funding; they punish people who can least afford treatment, and create or worsen poverty. It fosters the notion that mental health treatment is only available to the wealthy. Equally, we need to address the limited coverage for private patients while paying exorbitant fees for medical aid. 

Beyond rhetoric 

Inequality in terms of mental health, gender inequality and limited social mobility, in addition to other concurrent health, economic and social problems, are colliding as a series of epidemics that need to be addressed comprehensively and holistically, rather than as individual and independent issues.  

“Make mental health for all a global priority” will be the theme for World Mental Health Day on 10 October 2022, and while I hope that we can move past rhetoric and sloganeering to provide clear, substantive and actionable solutions to address mental health and the concurrent challenges this year, I fear that we won’t be able to do so.

* Steven Bernardus /Hara#geib is a development practitioner 

@stevenharageib