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Mental Health in Africa

Mental Health is defined by the World Health Organization as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community."[1] "Successful mental-health interventions require the collaboration and support of those for whom they are intended. In order for an intervention to be acceptable,the target population first must agree that there is a mental-health problem in the community,and that addressing that problem is a priority".[4] "In recent years, there has been a debate within the international mental-health community between: (1) those who advocate community-based, psychosocial interventions promoting well-being, while being wary of applying Western mental-health concepts to other cultures; and (2) those who would include a more Western and clinical approach that identifies and targets individuals with specific needs".[4]

Africa is considered by most [paleoanthropologists] to be the oldest inhabited territory on Earth, with the human species originating from that continent. Africa is the world's second largest and second most populous continent, after Asia, and consists of 54 countries speaking over 3000 languages and is prone to strife, especially south of the Sahara.[2]

Africa
Area	30,221,532 km2 (11,668,598.7 sq mi)
Population	1,022,234,000 (2010, 2nd)
Population density	30.51/km2 (about 80/sq mi)
Demonym	African
Countries	54
Dependencies	Template:Voidd Mayotte Réunion Canary Islands Ceuta Madeira Islands Melilla Saint Helena
Languages	List of languages
Time zones	UTC-1 to UTC+4
Largest cities	List of cities

Map of Africa

Common Disorders

Mass Trauma

There seems to be a general lack of awareness concerning the mental health consequences of mass trauma on the heath of communities in Africa. Neither the general public nor the political powers appreciate the causes or effects of the chronic warfare that persists in Africa. Many African communities are afflicted by chronic war and/or conflicts with overwhelming traumatization of their general populace, but there is very little information on the mental health consequences of this mass trauma on these communities. Worldwide, there have been three main approaches to the study of severe mass trauma. The first approach involves interviewing representative samples of a given community. Such studies only give us the prevalence rates of PTSD and associated disorders in the general population. The second is to interview those individuals who have actually been traumatized and are at risk of developing PTSD. The third approach is the collection of individual case studies of traumatized individuals. These studies give us information about the effects of trauma on an individual and on the concept of PTSD, but not much epidemiological data.[6]

Depression

Research of AIDS related home based care givers in the North West Province and Mpumalanga in South Africa was presented in January, 2008 at the World Federation for Mental Health in Cape Town, South Africa. It showed that 89% were depressed or showed signs of depression. Another study that showed the growing need for access to mental health care for people infected or affected by the HIV epidemic was conducted by the South African Depression and Anxiety Group and Wits University South Africa. Caregivers experience high levels of stress that can take a physical toll on them as they care for the physical, emotional and economic needs of those suffering with HIV or AIDS. According to a study of pregnant women who tested positive for HIV in Zambia, 85% had episodes of major depression and many had suicidal thoughts. A study in East and Southern Africa showed an increase in depression and suicide among AIDS orphans.[9]

Culture Bound Syndromes

North Africa

Zar (Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and the Middle East) experience of spirit possession. Symptoms may include dissociative episodes with laughing, shouting, hitting the head against a wall, singing, or weeping. Individuals may show apathy and withdrawal, refusing to eat or carry out daily tasks, or may develop a long-term relationship with the possessing spirit. [5]

Subsaharan Africa

Brain fag or brain fog

(West Africa) a condition experience by high school or university students. Symptoms include difficulties in concentrating, remembering, and thinking. Additional symptoms center around the head and neck and include pain, pressure, tightness, blurring of vision, heat, or burning.[5]

Boufée deliriante (West Africa and Haiti) sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It may sometimes be accompanied by visual and auditory hallucinations or paranoid ideation. [5]

Obstacles to Mental Health Care

Most of its countries are characterized by low incomes and low life expectancy due to high rates of infectious diseases and malnutrition.[3] It is difficult for most individuals to get needed medical care for a physical illness in Africa. It is much more difficult to get help for mental disorders. The first obstacle that stands in the way of the mentally ill receiving care is poverty. Either the ill are too poor to pay for care, or the governments are too poor to provide it and sometimes its both.[8]

With poorly staffed services for health in general, the morbidity and disablement due to mental illness receives very little attention from the government. In fact, most of these countries have no mental health policies at all. Even though compelling evidence shows that a large proportion of the world’s health burden is from mental disorders and this is expected to increase in many African countries so the African Region of the World Health Organization (WHO) adopted two resolutions, one in 1988 and another in 1990, to improve mental health services. However, when a survey was conducted two years later, they found that the countries that had adopted these two resolutions had done nothing to implement them.[3]

Mental health and African Witchcraft. Most indigenous cultures seem to have, at least in their primitive or early stages of development, a form of traditional healing done by someone in their gathering places. In America, the Native American had Medicine Men, in rural China the healers used massage as well as herbs; in Africa the traditional healers are sometimes referred to as Witch Doctors. This term may have been enhanced and defined by Europeans more than from the Native Africans. The Europeans would sometimes use the term “Mumbo Jumbo” in their explanations of the ceremonies performed by the Africans, and it was clear they found little use for the craft. Today, however, some people in the health care profession have found that some of the techniques used by the Nganga or traditional healers may actual be helpful at least from a mental health perspective. The term used by many modern Africans for witchcraft or traditional healing is called “Icobasco” or Illness Cognition Based on Social Conflict. Psychology is at the forefront of most Africans minds when there is an illness. Thoughts such as “I am ill because my work mates betwitched me, or my wife’s played magic, on me, or because I have behaved badly towards my in-laws.” Western medicine and psychological counseling is used throughout Africa, but even the well educated Africans still hold on to their traditional beliefs. With less than 10 hospital beds per 100,000 population it is unlikely that most Africans will discard their witchcraft beliefs all together for Western Medicine since the traditional healers are more plentiful. Psychological issues may be caused by issues so engrained in tribal beliefs that Icobasco healers may actually play a strong and helpful role in their treatments. (1) “The African Illness Cognition Based on Social Conflict (Icobasco) cannot be a substitute nor a panacea for all illness that inflict Africans all the time. As a conceptual tool it should help the proper diagnosis of illness, provide a rationale, and increase the appreciation for some of the origins of African taboos and beliefs, especially those relating to illness and well-being. The concept also should help increase the options for treatment for African patients at a time that Western medical facilities are not adequate for the vast majority of Africans.” Tembo, Mwizenge, Ph. D., The Witchdoctors are not wrong: The Future Role and Impact of African Psychology on Individual Well-Being., December 2, 1993: Paper Presented at the Annual Meeting of the African Studies Association held in Boston, December 4-7,1993 Mwizenge S. Tembo, Ph.D. Assistant Professor of Sociology Bridgewater College, Virginia

Another obstacle is the social stigma that still exists in some areas. The mentally ill are often treated harshly and accused of being cursed or possessed.[8]

Future

The Africa Mental Health Foundation (AMHF) supports local and international research students as they study the whole life-spectrum from the health of the fetus in the mothers’ wombs through children in and out of school to old age. It provides internships for data collection and entry and analysis of data. It also encourages students to publish their work by assisting with the duplication of materials and providing research facilities and tools. It also gives charitable support to the survivors of the August 1998 bomb blast at the American Embassy and several other [charitable organizations]]. It focuses on individual mental health, as well as the community, institutional and environmental determinants of mental health and the biological and spiritual aspects of mental health.[7]

References

1. World Health Organization. (2005). Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization (Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne). World Health Organization, Geneva.

2.

Notes

2. http://en.wikipedia.org/wiki/Africa

3. World Psychiatric Association. Mental Health in Africa: The Role of the WPA. World Psychiatry. 2002 February; 1(1): 32–35. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489826/

4. Bolton P, Tang AM: Using ethnographic methods in the selection of post-disaster mental-health interventions. Prehospital and Disaster Medicine 2004;19(1):97-101. pdm.medicine.wisc.edu/Volume_19/issue_1/bolton.pdf

5. Index of Culture-Bound Syndromes By Culture. page was created for the class ANRG 170: Traditional Chinese Society, during February 1998. It was moved to this location on 22 October 2006. Last updated 03 April 2000. http://homepage.mac.com/mccajor/cbs_cul.html#NAfrica

6. Musisi, S., Department of Psychiatry Makerere University Medical School & Mulago Hospital. “Mass trauma and mental health in Africa.” Afr Health Sci. 2004 August; 4(2): 80–82. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2141620/

7. Africa Mental Health Foundation. “Promoting Mental and Neurological Health and Healthy Behavior.” http://www.africamentalhealthfoundation.org/

8. Mental Health in Africa http://povertynewsblog.blogspot.com/2009/03/mental-health-in-africa.html

9. UNAIDS-Joint United Nations Programme on HIV/AIDS. “Getting support for HIV and mental health in Africa”. 02 February 2008 http://www.unaids.org/en/resources/presscentre/featurestories/2008/february/20080202hivmentalhealth/