Mental Health Education in Africa: Challenges & Current Interventions
A Growing Issue
Education is a critical tool that can be used to combat the increasing burden of mental health disorders in Africa. Comprehensive mental health education can help by increasing mental health literacy, increasing awareness of available services, and reducing misinformation and stigma (Grant et. al, 2021). It is for this reason that incorporating comprehensive mental health education into school and community settings is critically important for tackling this growing issue.
An Overview of Mental Health in Africa
Mental illnesses are a growing issue in Africa. While the population of the continent increased by 49% between 2000 and 2015, the years of life lost to disability and substance use disorders increased by 52% in the same time period (Lancet, 2018). Rates of suicide are also high, with three African countries (Lesotho, Eswatini, & South Africa) being within the top 10 countries by suicide rate, and Lesotho being ranked number one (World Population Review, 2022). While there is limited data on the prevalence of mental health disorders among adolescents in Africa, it is estimated that one in seven adolescents’ experiences significant psychological challenges, and one in ten qualifies for a psychiatric diagnosis (Jörns-Presentati et. al, 2021). Rates of depression amongst adolescents were 17% in Egypt and 11% in Sudan (Barakat & Al Anouti (eds.), 2022). While the global annual rate of those who utilize mental health outpatient services is 2000 per 100 000, the rate in Africa is 94 per 100 000 (WHO, 2020). This is the lowest rate of any WHO region.
An Overview of Current Education Services
As can be seen in the 2020 Mental Health Atlas from the WHO, 9 of 36 (24%) responding African countries identified a formal collaboration with their Ministry/Department of Education (WHO, 2020). This is the lowest percentage of all WHO regions. For the reasons outlined above, collaboration between the health and education sectors is critical for addressing the burden of mental health. Targeting children and adolescents with school-based programs could be an effective way to combat the growing burden. While there is more research that needs to be done to properly assess this, current mental health programs embedded into the school curriculum are lacking in most countries in sub-Saharan Africa (Atilola, 2016). This is a larger issue in low-income and low middle-income countries, such as Tanzania and Nigeria, where there is a distinct lack of focus on mental health within the school curriculum (Kutcher et al., 2017; Bakare et al,2010.). Northern African countries are also lacking in their school curriculum. While information is limited, there is little mental health discussion within the education curriculum of Egypt and Tunisia (Barakat & Al Anouti (eds.), 2022). Certain lower-middle income countries, such as Nigeria and Egypt, may also have school psychologists who focus on counselling, but rarely on education or prevention (Chiumento et al., 2022; Mogaji, 2007).
Outside of schools, community health workers can be equipped to provide information to increase mental health literacy within their communities (Atilola, 2016; Eaton et al., 2008). This helps ensure that mental health care provided is culturally appropriate, and recognizes the importance of family, social networks, and community in the treatment of mental health disorders (Atilola, 2016; Guidance, Counciling, & Youth Development Centre for Africa; 2013).
Programs that Have Addressed these Issues
The demand for mental healthcare services is low in sub-Saharan African nations and is influenced by the literacy rate for mental health, accessibility to services, and cultural and religious beliefs. Despite these challenges, successful health education programs have been implemented where important roles in health promotion, screening, and linkage with different sectors of the health system have been established. The Community Mental Health Education and Detection (CMED) Tool was used by community health teams in the Newcastle sub-district of South Africa to provide suitable facilities for people seeking mental health solutions.
A process called the prototype matching approach was introduced using vignettes and illustrations that were coherent with the African culture of oral storytelling. The vignettes consisted of local idioms and used everyday rhetoric to convey mental health knowledge. This allowed people to be engaged with knowledge in a non-threatening way and without the stigma of labelling. The CMED tool has been able to help families to self-identify, leading to a referral rather than a process of labelling (Grant et al., 2021).
Instead of hospitals, community based psychosocial rehabilitation services can also be a cost-effective way to ensure early diagnosis of illness, respect for human rights, and mitigation of stigma (Eaton & Agomoh, 2008) There is still much to be done to familiarize young people with mental health literacy (MHL) and that is why schools are ideal settings for such implementation. To emphasize this, an example can be used from where a Canadian school based MHL resource was adapted for application in Tanzania called the African Guide (AG). This included a curriculum that consisted of all aspects of mental health literacy and was conducted in classrooms where students were taught by teachers who were trained in MHL. The results demonstrated students approaching teachers with mental health concerns, increased efficacy of help-seeking for mental healthcare, and positive attitudes towards mental illness for both teachers and students. There is a clear positive impact on this study from using MHL activities and AG resources (Kutcher et al., 2016)
There is still much work to be done in the realm of mental health education. Closer ties to the Ministries/Departments of Education of African countries would be an important connection to establish for their health sectors. The importance of mental health education is clear. We hope that there is emphasis on making improvements in school curriculum and continuing to create community-based health education programs for future interventions.
Abhiraj Virk is a 4th year Health Sciences student at Simon Fraser University. He has an interest in topics of health ethics and health education and hopes that his future career will involve contributing to these sectors.
Rafayat Ahamed is a Health Sciences student at SFU and wants to pursue a career in epidemiology and health promotion education. His hobbies are listening to music and running on mountain trails.