The tumultuous years of the COVID-19 pandemic sparked a long-overdue shift in mental health conversations across Africa. For decades, mental health had been a taboo subject on the continent. It was only whispered about in private family conversations, rooted in colonial-era myths of African intellectual inferiority that wrongly suggested Africans were less prone to mental illness. These harmful stereotypes, shaped policies and perceptions, with mental health laws even being weaponized to suppress dissent.
In Kenya for example, anti-colonial activists were unjustly detained in mental health facilities under colonial rule. Post-independence Kenya, the association of mental illness with oppression and control made open dialogue around the subject nearly impossible. Untreated mental health cases were often mislabeled as spiritual disorders, witchcraft, or moral failings, further cementing the stigma that existed around the subject and leaving countless individuals to suffer in silence. Presently, as Africa’s 1.5 billion population confronts these deep-seated biases, the post-COVID era offers a pivotal moment to redefine mental health as a shared human experience, not a source of shame. The conversation has begun, but the work to dismantle centuries of stigma is far from over.
To understand the extend of the issue, we need numbers, but data limitations on the continent hamper efforts to paint an accurate picture on effects and costs of mental health. However, we will do our best with the information available. Pre-pandemic figures by Africa CDC showed more than 116 million people were living with mental conditions on the continent. Post-pandemic, those numbers represent a fraction of the true burden, due to underreporting and lack of data in many regions. Mental health remains one of the most neglected areas of public health in Africa.
Why is mental health important? It is a crucial part of our well-being, affecting how we think, feel, and act. Mental health influences our relationships, work, and ability to enjoy life. In the big picture, mental illness has a direct negative impact on a country’s economic strength. The opposite is also true; poverty is a contributing factor that translates to higher incidence of mental illness.
Globally, the economic burden of mental illness was estimated to be $2.5 trillion in 2010, a number that is projected to rise 240% by 2030. Depression, for example, reportedly affects more than 264 million people globally, costing the global economy $1 trillion with 12 billion workdays lost annually in productivity.
However, there is hope. The World Health Organization (WHO) estimates that for every $1 invested in scaling up treatment for depression and anxiety, there is a return of $4 in improved health and productivity.
In Africa, the benefits of these returns remain unrealized. In Rwanda, for example, studies suggest that 32% of workers have attempted suicide, and 63% miss work due to mental health issues. This crisis is made worse by the fact that mental health remains a low priority for many African governments. These governments allocate on average 1% of their national budgets to mental health initiatives.
Investing in mental health is not just a moral obligation for governments but a sound economic decision. As a basic human right, healthy minds contribute to healthier societies and stronger economies, making access to high-quality mental health services paramount.
Two things are critical in combatting the crisis; access for all to mental health care, and funding to train more professionals.
In 2022, WHO reported that Africa is home to 6 of the top 10 countries with the highest suicide rates in the world. South Africa, which reported a suicide crisis that same year, joins Kingdom of Lesotho, Kingdom of Eswatini, Zimbabwe, Mozambique, and Central African Republic as countries with the highest suicide rates. Also ranking high on the list with rising suicide rates are Egypt, Nigeria, and Kenya.
The Kenyan Ministry of Health reports that one in every four Kenyans will suffer from a mental disorder in their lifetime. Clinical psychologists in this East African country put the cost of treating mental illness between Sh50,000 and Sh100,000 (roughly $400-$800 USD) before factoring in the doctors’ consultation fee of Sh10,000 (about $80).
These costs are beyond reach for many, considering African governments allocate less than 50 cents US per capita to mental health, well below the recommended $2 per capita for low-income countries.
Kenya allocates 0.001 of the national health budget – an equivalent of $0.12 per capita – toward mental health. Millions in the country and the continent are left to live with untreated disorders. In 2020, the annual mental health outpatients visits in Africa were only 94 per 100,000 people compared to the global norm of 2,001 per 100,000.
A reprieve for many would be to access these services through the public health structure in their countries. But a UNICEF report reveals that there is only 1 psychiatrist per 1,000,000 people in Sub-Saharan Africa. This shortage of trained professionals and lack of – or poor – mental health systems in the region hinder access, leaving most needing psychological support unattended. Africa has fewer than 1.4 mental health workers per 100,000 people, compared to a global average of 9 per 100,000.
Mental health facilities are scarce on the continent. In some African countries, there are fewer than 0.5 beds available per 100,000 people in psychiatric hospitals. Antipsychotic and antidepressant medications are often unavailable or unaffordable. Only 25% of low-income African countries have these medicines available in primary health-care facilities.
Access to mental health services in public hospitals is still the most critical void. A performance audit report on provision of mental health by Kenya’s auditor general revealed that mental health care services are only available at 29 of the 284 hospitals in Level 4 and above of the referral chain in the country. This represents just 10% of the total facilities in Level 4 and above, and 0.7% of the 3,956 government-owned health facilities.
Patients in the areas that do not have mental health care facilities have to bear the cost of seeking services in the nearest towns or cities that have a psychiatric unit. Add to that lost productivity due to care giving and the high cost of medication and other logistics, and it is usually too much to bear for (mostly) low-income Africans. It comes as no surprise when the Kenyan government admits that 75% of Kenyans do not have access to mental health services, adding that integration of mental health services in primary care in Kenya would save 190 lives every year.
Across the border to Uganda, the issue of access to adequate mental health care includes a different challenge. In Uganda, which boasts the most refugees on the continent, there are only 53 psychiatrists; approximately one psychiatrist per 1 million population. According to the Lancet journal, the majority of trained mental health professionals in Uganda are concentrated in urban areas (e.g., Kampala, Mbarara, Gulu), and only a few are posted in government regional mental health referral hospitals.
Refugees bear the brunt of mental health issues, having experienced trauma during conflict. In fact, countries affected by conflict, such as South Sudan, Somalia, and the Democratic Republic of Congo, experience higher rates of mental health disorders. For example, in South Sudan, it is estimated that up to 30% of the population suffers from trauma-related mental health issues.
Among refugees in countries including Uganda, prevalence of post-traumatic stress disorder (PTSD) can be as high as 30-40%. With most of these refugees having no gainful employment, access to public health services for mental care remains the only light.
Government involvement and new legislation could drive necessary change. Recognition that mental well-being for the world’s youngest continent (average age of 19) is vital to its economic development should spark urgent action.
There has been progress. In 2022, Kenya’s Mental Health (Amendment) Act, 2022 was assented by the president. The law works toward preservation of dignity and respect of the rights of persons with mental health issues. It brought the human rights element into the discussion of mental health service provision.
This legislation and other initiatives will increase focus on community-based mental health care, requiring the state to provide services in close proximity to the population, including in rural areas with options similar to what you would see in urban centres. The moves have also brought into the discussion after-care services – where mental health patients who have spent time in institutions can be reintegrated effectively in society.
After the act was assented, Kenya included mental health care in its public health insurer (NHIF), covering up to Sh60,000 (around $465). This has been boosted to Sh139,000 (about $1,070), according to government data under the controversial new health insurer (SHIF).
In 2024, the Kenyan High Court made a landmark ruling that criminalizing attempted suicide is unconstitutional. Before that judgment, the law (Section 226 of Kenya’s penal code) which dates back to the colonial era, stipulated that any person attempting to take their own life is guilty of a misdemeanor and is subject to imprisonment of up to two years, a fine, or both, with the minimum age of prosecution set at eight years old. Criminalizing attempted suicide fueled stigma and discouraged victims from seeking help. But this decision aligned with Kenya’s Mental Health (Amendment) Act, 2022 in prioritizing prevention, treatment, and dignity over punishment.
After funding, access, and legislation, the final piece of the mental health puzzle is changing perception; the cultural/societal aspect of the crisis. Studies suggest that up to 60% of people with mental health issues seek help from traditional healers rather than formal health services.
Integrating community and involving cultural norms are part of the healing process. South Africa, Ghana, Kenya, and Uganda have recently incorporated culturally competent practitioners to help bridge the gap between traditional medicine and western medicine while using a culture-focused approach in reaching those far from hospitals. Zimbabwe’s Friendship Bench model has been a success for the last two decades. The community-based mental health intervention model uses trained community health workers who set up safe community spaces and offer structured problem-solving talk therapy to community members looking for mental health support.
This model, established in 2006, is an innovative, simple, cost-effective, and successful approach to mental health care in under-resourced settings.
As work continues, progress in mental health services on the continent remains a key component in unlocking the vast potential for Africa.
(George Mutero – BIG Media Ltd., 2025)
