Social isolation, direct experiences with illness, and economic uncertainty emboldened by COVID-19 has worsened the pandemic’s impact on mental health. Limited access to crucial mental health support in the Sub-Saharan African Region has exacerbated systemic failures to integrate mental health within primary care (Tucci et al, 2017).
Research into the impact of mental health due to COVID-19 in Africa is still limited in scope. This brief is part of a series to further highlight lessons learned from the COVID-19 experience.
Mental Health Services at the onset of COVID-19: An overview
Limitations to mental health services in Africa reached its crisis point well before the World Health Organization (WHO) declared COVID-19 a pandemic. When comparing suicide rates, South Africa and Lesotho are among the top 10 countries with the highest suicide rates per 100,000 people (World Population Review, 2019). Further, mental health disorders in adolescents were among the highest globally, particularly in low-middle income countries (LMIC). In sub-Saharan Africa, 14.3% of youth experience early onset psychological challenges, whereas 10% meet the criteria for a mental illness diagnosis (Jorns-Presentati, 2021).
The February 2020 Strategic Preparedness Response Plan (SPRP) for the WHO African region did not identify mental health as a primary risk factor (WHO, 2020). As the pandemic became increasingly entrenched in the daily lives of Africans, there was a need to reassess mental health services. A survey conducted by the WHO in October 2020 concluded that 37% of African countries reported partial funding for a COVID-19 response in regional mental health services, and 37% percent reported no funding whatsoever (WHO, Brazzaville, 2020). Regions with partial funding focused on virtual platforms for mental health services, which disproportionately remained inaccessible to rural Africa.
Globally, mental health indicators applied to the pandemic include: i) Direct impact of contracting COVID-19 ii) COVID-19 restrictions and their impact on social support structures, such as churches and community centers iii) Economic disparity/loss of livelihoods (Semo & Frissa, 2020).
In Sub-Saharan Africa, where 68% of people depend on the informal economy for survival, social structures and communities are intertwined with economic livelihoods (Semo and Frissa, 2020). Moreover, the stigmatization of mental health has restrained the capacity of healthcare services to work alongside community networks to expand mental health support (ibid).
Where is Africa today?
Following this report, the WHO Regional Office conveyed, “The COVID-19 pandemic has shown, more than ever, how mental health is integral to health and well-being and must be an essential part of health services during outbreaks and emergencies.” (UN, 2020) As part of the WHO’s 2021 SPRP for the African Region, mental health funding was included within the ninth pillar for response and recovery (WHO, 2021). The WHO’s response precedes a study of 14,847 participants which found that mental health challenges have been experienced by 39% of Africans since the outbreak was declared (Chen et al., 2021).
To compare country-specific analyses of the pandemic, a survey of 12 000 women identifying as low income in Uganda and Zambia found a correlation between the onset of COVID-19 and increased levels of depression, anxiety, and stress (WHO, Brazzaville, 2020). Comparative studies in 2021 surveying 1,797 working adults in Burkina Faso, Nigeria, and Ethiopia found a similar correlation. Respondents were asked whether the onset of COVID-19 has resulted in added psychological distress. Of the total respondents, 21%, 6%, and 1% reported mild, moderate, and severe psychological distress as a result of COVID-19 respectively (ARISE, June 2021).
Middle-High Income Countries (MHIC) have responded to the pandemic’s impact on mental health through funding and employing social media, virtual resources, counselling, and economic recovery to mitigate long-term consequences of the crisis. In Africa, particularly the sub-Saharan region, lack of access to the internet has limited the capacity of health networks to employ cost-effective mental health services, whereas pre-existing social resources in communities have been inaccessible due to pandemic restrictions. This is particularly noticeable when comparing rural vs. urban communities (for an example of rural-urban difference in healthcare, see Ugochukwu, et al, 2016; for a survey on rural vs. urban mental health stigmatization, see Forthal et al, 2019)
While insomnia is a common symptom of mental illness in MHIC’s, in Sub-Saharan Africa, anxiety and depression account for most mental health symptoms during the pandemic (Semo and Frissa, 2021). Semo and Frissa (2021) do not necessarily reflect the impact of COVID-19 on both conditions, but rather demonstrate how the pandemic has highlighted the prevalence of depression and anxiety.
What is next?
The limited research currently available on the response to COVID-19’s impact on mental health is focused on lessons learned in MHIC’s and how African countries can target risk populations using conventional media tools. Moreover, there are growing discussions highlighting the need to integrate healthcare services with community mental health supports.
Our future briefs within this series will seek to spotlight grassroots initiatives that have offered mental health support since the pandemic’s onset. Additionally, we will speculate on both lessons learned from success stories within grassroots efforts, and how healthcare networks can better partner with traditional social structures to reduce the stigma experienced by people with mental health challenges, and the hesitancy to access mental health services.
About the Author - Anthony Lerno is a Public Policy researcher specialising in sustainable rural development throughout Central and Eastern Africa. His research interests focus on the intersection of multi-stakeholder rural governance and regulatory harmonisation, with respect to sustainable development best-practices.