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Africa, the denied right to mental health: one psychiatrist for every 500,000 inhabitants

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Africa, the denied right to mental health: one psychiatrist for every 500,000 inhabitants

Lunacy act, the law on “lunatics”. This was the name of the provision approved in 1958 in Nigeria, at the end of British colonialism, to regulate the treatment of patients suffering from psychiatric disorders. The principle of treatment was that, in fact, there shouldn’t be any: the law did not contemplate therapeutic interventions and prescribed the detention of “idiots”, the other definition adopted to describe anyone affected by intellectual disabilities or psychosis. It took over half a century for Abuja to supersede the text, replacing it in 2023 with the Mental Health Act: the first mental health law passed in Africa’s most populous country, after a double flop of reform attempts launched in 2003 and 2013.

The Nigerian Mental Healthan organization that pushed on the overhaul, acknowledged the outgoing president Muhammadu Buhari of “making history” by signing a law that protects patients and prohibits discrimination on home, work or access to medical care. But the fear is that the provision will remain on paper, running aground on the material and cultural limits of the right to mental health in the country: from the lack of financial resources to the taboos that hinder the recognition of mental disorders suffered by growing portions of the population. In Nigeria and the rest of sub-Saharan Africa, a region that has re-emerged with even more alarming numbers from the Covid crisis and its repercussions on mental health. Especially that of adolescents and children, underlines the World Health Organization.

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In Africa, one psychiatrist for every 500,000 inhabitants

Resource limits are the most visible. Throughout Nigeria there are 300 psychiatrists for a population of over 200 million people, a proportion that is further aggravated on a continental scale. The WHO itself estimates that in Africa there is one psychiatrist available for every 500,000 inhabitants, an average 100 times lower than the recommendations expressed by the Geneva organisation. African governments, according to an estimate released by the World Economic Forum, invest on average 1% or less of their budget on mental health, with an average spending of 46 US cents per person in 2022: not even a quarter of the 2 US dollars recommended by WHO. In addition to specialists in the strict sense, there is a lack of healthcare personnel and reception facilities, a vacuum that has been growing in the years prior to the Covid pandemic.

A study published by Journal of Global Health, a scientific journal, has recorded that the median rate of beds for psychiatric patients in sub-Saharan Africa has dropped from 3.2 per 100,000 people in 2000 to 2.2 per 100,000 people in 2020. Before the health emergency, estimates the ‘WHO, there were at least 116 million Africans in conditions of mental illness. The years of the pandemic have increased cases of depression and anxiety by 25% on a global scale, with tangible effects also on a continent that has also officially suffered fewer infections than the international average. The most alarming data comes from suicides. Joseph Caboredirector of the programme management of the WHO African office, said that the continent has the highest suicide rate in the world: 11 per 100,000 inhabitants each year, above the world average of 9 per 100,000 inhabitants. An epidemic within the epidemic that is not tackled, except with the tools of political repression. Precisely in Nigeria, which is celebrating the new Mental Health Act, the attempt to commit suicide is punishable by one year in prison.

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Cultural stigma and the removal of the problem

The second limit is the cultural one, the prolonged removal of the right to mental health itself. Olugbenga A. Owoeye, director of the neuropsychiatric hospital of Yaba, in the same Nigerian Lagos, declared that 25% of the national population could suffer from some form of mental disorder: the equivalent of 50 million people with a disorder that does not it has almost never been diagnosed, from the mildest forms of stress or phobia to cases of schizophrenia. “There is a great historic neglect of mental health in Africa, because there has never been the political will to address it,” he told Il Sole 24 Ore Ben Weobong, senior lecturer in the Department of Social and Behavioral Sciences at the University of Ghana. On the other hand, adds Weobong, «if you don’t understand something, it’s easy to underestimate the problem. And the stigma towards those suffering from mental disorders also comes from here, even if it is not a characteristic only of Africa”.

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