Why we should invest in mental health in Africa

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Sean Mayberry, CEO, StrongMinds

• Africa has the lowest mental health expenditure globally, with depression impacting women 1.5 times more than men, yet mental health conditions impose a high cost to the economy.
• The benefits of treating conditions affecting women, such as depression, can filter down to households and improve children’s educational outcomes.
• StrongMinds has successfully adapted the Group Interpersonal Therapy model to provide community-based depression treatment to low-income women and adolescents in sub-Saharan Africa.

Depression is the leading cause of disability worldwide. As many as 300 million experience depression globally, with the World Bank considering it “the greatest thief of productive economic life.” Nowhere is this issue more under-prioritized than in Africa, which accounts for the lowest mental health expenditure globally and up to 85% of individuals have no access to effective treatment.

If left untreated, the results of depression can be devastating. Depression can recur over a lifetime, with long-term implications for the individual’s quality of life, economic productivity, physical health and ability to participate in community life. In Africa, women are affected at 1.5 times the rate of men. Women with depression work less, experience more physical illness and experience social exclusion.

Mental health conditions are projected to cost the global economy $6 trillion by 2030. At the business level, individuals with depression are more likely to experience absenteeism and poor job performance, which leads to reduced productivity and higher turnover worldwide.

Individuals with depression can also face stigmatization, victimization and discrimination. They are particularly vulnerable to human rights violations such as abuse, neglect and denial of access to education and work opportunities. Investments in evidence-based mental healthcare can help ensure the necessary safeguards are in place for those in need of care and help normalize seeking treatment.

Without addressing these concerns, the current global burden of disease associated with mental health disorders puts economic growth and social welfare at high risk.

“

StrongMinds estimates that for every woman treated for depression through our IPT-G model, up to four members of her household are positively impacted.”— Sean Mayberry, CEO, StrongMinds

Mental health in Africa compounds harms

Research shows that mental health has a bi-directional relationship with many of the African continent’s most significant challenges. For example, mental health disorders, such as depression, can put people – particularly adolescent girls – at greater risk of HIV infection while inhibiting the ability of those living with HIV to adhere to treatment. In addition, poverty, poor nutrition and lack of education can exacerbate depression while interfering with an individual’s ability to earn an income, achieve food security or finish school.

Innovative and affordable treatment options are in high demand to meet the growing need for mental health services, particularly in low-resource communities. By training lay community health workers to deliver group interpersonal psychotherapy (IPT-G), StrongMinds successfully brings high-quality, low-cost depression treatment to tens of thousands of individuals in sub-Saharan Africa. It currently costs us roughly $105 to treat one woman with depression and we continue to work toward reducing this cost each year.

IPT-G is well-studied in low- and middle-income countries and is recommended by the World Health Organization (WHO) as a first-line depression intervention in resource-poor settings. The approach is simple yet efficient, with high rates of success. Here’s how it works:

• Clients are screened before, during and after therapy using the Patient Health Questionnaire (PHQ-9) to continually measure the presence and severity of depression.
• Over eight group sessions, counsellors guide structured discussions to help participants identify the underlying triggers of depression and examine how their current relationships may be linked.
• From there, group members discuss solutions to their problems, learn coping mechanisms and identify support systems they can lean on after therapy.
• Participants feel understood, empowered and less alone as a result.

Trickle-down effect

When a woman is no longer depressed, she and her family benefit. StrongMinds estimates that for every woman treated for depression through our IPT-G model, up to four members of her household are positively impacted. Our data also shows that 16% of women treated report an increase in work attendance, 13% report an increase in family food security and 30% say their children attend more school.

The recent “Transforming Mental Health For All” report cited the StrongMinds’ depression treatment model as an example of the integrated, community-based mental healthcare needed to meet the core objectives of the WHO’s 2013 to 2030 Comprehensive Mental Health Action Plan. The plan aims to achieve equity through universal health coverage and recognizes the essential role of mental health in achieving health for all people.

Findings from a recent Happier Lives Institute (HLI) study also suggest that investing in mental healthcare can increase the impact of philanthropic giving. The study concluded that, for people in low-income countries, treating depression in one individual is nine times more cost-effective than direct cash transfers in terms of improving a person’s subjective well-being (how the person rates the quality of their life).

Therapy doesn’t just address acute depressive episodes. Through our IPT-G model, women learn how to identify the symptoms and triggers of depression and deploy self-help skills to mitigate and prevent future depressive episodes. They also share their knowledge with their family and community, spreading the benefits of good mental health to others.

This challenges existing thinking in philanthropy about how donors can maximize the impact of their giving. The reality is we can only continue to scale and deliver these services if we have the funding available to reach every woman in need of mental health resources across Africa.

We need cross-sectoral collaboration to fully assess the impact of mental health disorders globally. We can work with stakeholders to deepen global understanding of and commitment to mental health. Such cooperation can help us reshape the environments that influence mental health and strengthen access to the quality of care needed, even in the most remote regions.