The Issue of Stigmatization
The stigmatization of mental illness is a persisting issue in Africa. It is critical that this issue is addressed as it has been shown that stigmatization of those with mental illness contributes to feelings of shame, anger, and low self-esteem, as well as impeding access to care (Monnapula-Mazabane & Petersen, 2021). Some of these feelings can lead to self-stigmatization, worsening these feelings and may prevent one from seeking care (Egbe et al., 2014). Stigma can also create misinformation around mental illness, which may contribute to future stigmatization (Bonsu & Yendork, 2019).While currently limited, community-based interventions have shown promise in tackling mental health stigma in African countries like Nigeria, South Sudan, Burundi, and Uganda to name a few (Atilola, 2016). The advantage of a community-based intervention is that it allows for more culturally relevant care to the communities that the interventions are targeting (Atilola, 2016). Africa is a diverse continent, with different views on mental illness. It only makes sense to develop a system of interventions that could be applied broadly across the continent but allows for issues unique to communities to be addressed.
An Overview of Mental Health Stigma in Africa
Literature about mental health stigmatization has mainly focused on high income countries worldwide, however there has been some examination of stigma in low- and middle-income countries. As of right now, a majority of African governments are behind on meeting the goals outlined in the World Health Organization Mental Health Action Plan for 2013-2030 (Aguwa, Carrasco, Odongo & Riblet, 2021). In the World Health Organization Mental Health Atlas of 2020, 25% of African countries had reported on mental health law changes or since 2017, the second lowest of all WHO regions (World Health Organization, 2020). Stigma is commonly a result of misinformation or ignorance of mental illness. In some communities, mental health issues, such as depression, may not be viewed as illness but as personal defects (Schweitzer, 2021). The lack of programs to address mental health and emotional literacy has allowed this to continue (Schweitzer, 2021).
Currently Implemented Programs
There is still much to be done in African countries in order to address the prevalence of stigma, but there are community interventions that have been implemented that could potentially serve as guides for developing future programs. One such intervention is the DIALOGUE project by the Africa Mental Health Research and Training Foundation in Kenya. This project empowered and provided support to traditional and faith healers in the community to be able to deliver psycho-social interventions in areas where there is limited access to care (Africa Mental Health Research and Training Foundation, 2013). By empowering key members of the community, this can lead to an increase in mental health literacy and a decrease in alternative explanations for problems caused mental illness. These community leaders have a lot of influence and may be able to explain things pertaining to mental health in a way that would be more understandable to their community. It is evident that the intervention was effective in increasing access as referrals of individuals living with mental illness went from 0 to 1,593 (Wellcome, 2016).
Another observably effective intervention was a study that was conducted in Tanzania. This study used a culturally-adapted version of a Canadian Mental Health Literacy Guide, which was called the African Guide (AG) (Kutcher et al., 2016). Secondary school teachers in Tanzania participated in training workshops on how to utilize the AG within their curriculum (Kutcher et al., 2016). Following the study, teachers displayed a reduced amount of stigma against mental illness in a pre-post assessment, and also described a higher rate of help-seeking efficacy for themselves, students, family members, and peers (Kutcher et al., 2016). This displays the effectiveness in incorporating mental health literacy into school curriculum. Teachers are seen as key figures in some communities and will be able to spread this knowledge to more than just their students. It shows the importance of having government investment into mental health education, so that these types of interventions can be implemented. While there are other examples that can be highlighted, both of these endeavors have displayed the importance of transferring knowledge to important members of the community, and how that can be used to combat mental health stigmatization.
Interventions to address mental health stigma can also build on community capacity especially cultural norms. A creative example of an intervention in rural Zimbabwe was to engage young adults through the participation in a drama competition (Gudyanga et al, 2021). Drama and the elements that it relates to, music and dance, are viewed as important elements in community socialization in Zimbabwean culture (Gudyanga et al, 2021). It is for this reason that utilizing drama can be an effective way to reach youth in a local community in Zimbabwe. The drama competition served as way of connecting youth of different socioeconomic statuses (Gudyanga et al, 2021). The event also served as a vehicle for community conversations and information exchange through a psychosis-themed drama (Gudyanga et al, 2021). The project leaders have theorized that this project will lead to a reduction of psychosis stigmatization and discrimination among the participants and will overall help development of mental health engagement model in areas of low-resources (Gudyanga et al, 2021). While data analysis is still currently underway, it is exciting to see the development of an arts-based project that incorporates the cultural context of the area the intervention is being delivered to.
Much needs to be done to address the effects of the stigmatization of mental health in Africa. It is evident that community-based interventions are effective at addressing this issue and can incorporate the unique values of the communities while implementing interventions in local areas. There is the added advantage that these interventions can be more easily implemented into communities with low resources, as well as being a more cost-effective solution (Gudyanga et al, 2021). It is critical that African governments invest more into implementing such interventions in order to ensure that the members of those regions are able to receive unimpeded access to mental health care services.
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.