Mental health a human right, but only 1 psychiatrist per 1,000,000 people in sub-Saharan Africa – UNICEF/WHO

BRAZZAVILLE/DAKAR/NAIROBI, 10 October 2023 – On this World Mental Health Day, UNICEF and WHO reaffirm their joint commitment to support member states and all our partners across the region to ensure that “Mental Health is a Universal Human Right”; the theme for this year’s commemoration.

Mental health – though often neglected – is an intrinsic component of good health. It is a key requisite for the healthy and holistic development of children, for their present well-being, and for helping them to become capable and functioning adults. Human resources for child and adolescent mental health services are dire in many parts of the world, with an average of 0.3 psychiatrists per 100,000 population at the global level and 0.1 per 100,000 for the 47 countries across WHO African Region.

“The right to mental health is a necessity not a luxury in Africa,” said the UNICEF Regional Director in West and Central Africa, Felicité Tchibindat. “The only way we can enable greater realisation of this right is through more significant investment in mental health and psychosocial support. This includes better policies and systems, including in the community, and integration of mental health services into education, protection and health interventions.”

The 1989 UN Convention on the Rights of the Child, ratified by 189 countries, outlines children’s rights as including the right to life, health, clean drinking water, survival and development. Despite this, a recent UNICEF report Centring Child Rights in the 2023 Agenda released on 18 September 2023, presents a bleak view of progress being made on realising children rights. Two-thirds of child-related Sustainable Development Goals indicators are off-pace to meet their targets. Progress is slowest for low- income countries, with countries in the African Region being the most affected.

A key part of the right to mental health is access to quality mental health services.

“The severe shortage of professionals is among the major barriers to adequate mental health services in our region. To address this challenge, we are supporting countries to enhance mental health worker training, including at the lowest level of care. We are also supporting the efforts to improve availability of essential psychotropic medicines as well as promote and protect the rights of people with mental health conditions,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

Despite a large population of children and adolescents in the region, there is a severe shortage of child and adolescent mental health services in the continent. According to the WHO Mental Health ATLAS 2020 report, only 11 out of the 47 countries of the WHO African Region provided information on child and adolescent mental health policies, and only three of these countries reported that they have such policies. Less than 50 per cent of the mental health policies and plans in the African Region comply with human rights standards.

There is a link to the number of harms children face, the huge gap in services and poor mental health outcomes. These harms include, amongst others, child marriage, female genital mutilation, sexual and physical violence (both male and female), intimate partner violence, child labour and violent discipline. To achieve tangible progress towards achieving the Sustainable Development Goals, efforts to protect children from harm need to be doubled, as well as treatment for both physical and mental impacts of such harms.

Moreover, the multiple crises contexts (such as political instability, armed conflicts and disease outbreaks) – which many countries in sub-Saharan Africa face – not only jeopardize the already scarce access to mental health care, but they also have dire negative impacts on the mental health of the overall populations and in particular children and adolescents.

“We cannot afford to ignore the concerning number of children and young people across the region who experience mental health challenges, exacerbated by multiple shocks, violence and humanitarian crises, with devastating impacts on their well-being and on communities as a whole,” said Etleva Kadilli, UNICEF Regional Director for Eastern and Southern Africa. “Now is the time to increase investment in mental health services and provide children and young people with the essential tools and resources for them to develop to their full potential. Change is long overdue, and no child should have to carry invisible scars alone.”

How can countries advance the rights of children, especially in relation to mental health?

• First, it is to strengthen data collection on child and adolescent wellbeing and mental health.
• Second is to prevent harm, which is a key determinant of mental health. While some progress has been made, low-income countries still need to redouble efforts. It is fundamental to understand that preventing harm will also prevent the need to treat physical and mental impacts later on.
• Thirdly, there must be greater investment in mental health services, including in training skilled health and social care professionals specialised in supporting children and young people.

There are signs of progress in the continent. Côte d’Ivoire and Mozambique are being jointly supported by UNICEF and WHO to engage across three key sectors – health, education and social protection, to develop action plans to be implemented at the country level. There is a lot to be gained from working together, synergistically, to ensure the mental health and wellbeing of children and adolescents in the Africa Region is not left behind.

References

1. UNICEF (2023) Progress on Children’s well-being: Centring child rights in the 2023 Agenda
2. UN News webstory “New UN guidance affirms children’s right to a clean, healthy environment”
3. WHO (2020) Mental Health ATLAS 2020
4. UNICEF (2021) The State of the World’s Children 2021 On my mind: Promoting, protecting and caring for children’s mental health
5. UNICEF (2023) Adolescent health dashboard: Regional Dashboard