Mental Health in Africa: Looking Beyond the Swiss Cheese View
By Njinga Kankinza Edited by Remona Jutha.
The current literature on mental health in Africa is like listening to that friend or family member who shares the same story over and over again. It’s a broken record of the same issues:
Poor health care infrastructure, understaffed of mental health specialists,
"neglected on Africa’s health and development policy agenda",
"huge gaps in access to decent, dignified and affordable care", and
With all these colourful descriptions used to portray the mental health in Africa story, is it any wonder we see the holes for the cheese?
As much as I have read these well-written narratives several times and know they lack depth, I must admit I have often caught myself repeating it to others! One would think that with my experience and having been enlightened about the epidemiology, social determinants, impact of health conditions and treatment gaps surrounding mental health on the continent, I would be immune to these contradictory feelings and reflections. Unfortunately, it is not easy to separate them into two neat little compartments. On one hand, I have been struck with what I see as overindulgence in mental ill-health with a heavy focus on aspects of mental health which have to do with what sociologists term the political-administrative environment. That basically consists of our national systems, regulations, and cultures. On the other hand, I am a mental health practitioner born and bred on the continent. I know first-hand through my work experience that despite some of these accurate descriptions, the mental health picture painted by the current narrative is not all there is to our stories. Mental health in Africa has layers we have not even begun to explore.
Before we can even unpack the layers, we need to get back to basics – what is mental health? According to the World Health Organization's classic definition of health, yes - let us say it together- “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition also applies to mental health. Mental health is not simply the presence or the absence of mental illness. We’re human, so naturally, it is not black and white. Mental health is all about the various shades of grey, mental illness lies on a continuum. Our mental state fluctuates across our ability and inability to realise our capabilities, manage regular stresses of life, work efficiently, and contribute to society. After all, any human being can experience minor symptoms of mental health problems from difficulty sleeping and a sense of unreality to low mood, no confidence or feeling isolated and struggling to relate to other people. We know that some of these problems do not require medication, therapy, or other major mental health treatments. However, if not addressed, the reality is that it could result in serious mental ill-health such as a panic disorder.
In my view, the current mental health in Africa narrative has paid little attention to the symptoms that lead to a break/ disconnect in the mental wellbeing of our people. I am not saying that every African is in a mental health crisis. However, there are Africans who are, without a doubt, suffering in silence or just making it through the day while others are thriving and excelling. Often, we associate mental health problems in Africans only with experiences of poverty, war, and conflict. The story of Africans languishing is not all there is. Africa has her fair share of well-fed, privileged, educated, privileged, diaspora Africans and many have what we call “champagne” problems (problems that pale in comparison to poverty, war or natural disasters – the mozzarella cheese of problems).
The described inconsistency in African life experiences and lifestyles often determines the level of mental health of all Africans at any point in time. Mental ill-health could manifest in the sadness and isolation of a rich, single woman battling the pressures of not being married in a society where all women her age are expected to be married. It can be present in the anxiety that is experienced by a person with Albinism living in a semi-rural area because they fear being a victim of a ritual killing. To further complicate this mental health picture, we have 55 African states, who despite their similarities are very diverse and will present with a different mental health picture on the continuum. Add the COVID-19 pandemic into the mix and the differences become even greater.
In my opinion, the limited stories (untold and unknown stories) on the opposite pole of the mental ill-health continuum must be included in the overall mental health in Africa agenda. One can argue that it might be best we focus on the repeated stories I alluded to as we still have a long way to go in addressing the named challenges. I mean, it is not the greatest hardship to listen to a story for the hundredth time especially when the story is gripping, right? My counterargument is that a complete picture of mental health looks at both mental wellbeing and ill health. Therefore, the proposed view is complimentary and has its advantages. For example, enhancing the well-being of Africans who don’t fall under the “require treatment” gap is a preventative strategy with the potential to reduce the burden of work on the opposite pole of the continuum.
In conclusion, there is more to mental health in Africa than the current narrative highlighted so eloquently in these repeat stories. So, let us give a complete picture and start to address mental health in totality along with all its complexities. Are you ready to start the journey of plugging the necessary holes in our Swiss cheese?
Note: This is the first piece of a series of mental health-related articles which will discuss various stories about mental health in Africa, under the umbrella of the mental health continuum.
Njinga Kankinza is a Zambian Clinical Psychologist in her final year of training on the University College of London’s doctorate programme. Njinga is passionate about mental health issues, especially on the African continent. She mostly focuses on effective and ethical evidence-based practises that inform the policy, teaching, consultancy, and advocacy at all levels in Africa while also contributing to the field on a global scale. Her approach to work has been largely informed by the standards of her training as well as a curiosity about human behaviour that was first sparked by her multicultural upbringing.