Mental health in Africa, the missing link

^{By Prof Bassirou Bonfoh, Director, Afrique One-Aspire}

The death of a colleague challenged Togolose veterinarian, Prof Bassirou Bonfoh, to extend the remit of his research to encompass mental health. Now he leads a mental health working group of the AAS Fellows and is a co-convener of the Africa Scientific prioritization programme (ASP)’s Mental Health Priority Area. In this tête-à-tête, he discusses the state of mental health among pastoralists and initiatives that could enable stakeholders in government, public health, funders to prioritize and offer solutions to Africa’s mental health challenges.

You are a veterinarian working in mental health, how did this come about?

Although I am a veterinarian working on food safety, zoonotic diseases and with pastoral communities, the death of a close researcher from a mental health disorder challenged me to think beyond my field. I am also the Director of a DELTAS Africa funded programme, Afrique One, which includes a colleague, Prof Dixon Chibanda, who leads a mental health programme, AMARI, that has been transformative in closing the capacity gap in Africa and the Friendship Bench, which is helping to provide much needed mental health interventions to communities in Zimbabwe and has also been expanded to other countries in the globe.

These two factors propelled me to create and lead a mental health research component and to recruit a student to investigate the impact of mental health in the pastoral production system. This study conducted in Ghana found that the lack of livestock services to pastoralists led to a significant loss of this livestock due to the impacts of climate change and conflict, and in turn impacted the mental health of the pastoralists.

We set up the project to observe how the improvement of veterinary services can help to mitigate anxiety and depression among the pastoral communities. These two scenarios set the stage for me to look keenly into mental health disorders as a big challenge on the continent. The process exposed the lack of adequate literature and data in Africa on mental health.

I look back and reflect that prioritizing this topic was timely given the COVID-19 pandemic which equally left many people depressed due to lockdowns.

What are you learning about mental health in pastoral communities?

The droughts in the 1970s and ’80s led to pastoralists in a country like Mali losing their livestock. Many of the pastoralists committed suicide and these incidents haven’t been well recorded, communicated or researched.

Sadly, pastoralists continue to commit suicide, but no research has ever been done to examine the levels of anxiety and depression since mental health is not a priority on the continent. I am hoping to contribute to closing the research gap.

In Togo, my country of origin, farmers commit suicide due to price fluctuations of crops caused by droughts, which often leave them unable to service their loans.

Prices for agricultural products are sometimes decided without considering the production costs so farmers make losses. This in turn, leads to anxiety and depression as they can’t recoup production costs and make ends meet.

You are now involved in the ASP programme where you co-convene the Mental Health Priority Area. How has your work on the mental health of pastoralists influenced your participation in this priority-setting process?

Our study in Ghana highlighted how the change in agricultural productivity affected the mental wellbeing of pastoralists. We used the results to improve veterinary services, which highlighted the need for interdisciplinary collaboration as bringing together varying expertise helped us to understand the root causes of the disorders and to provide a solution. This should be translated to a continental scale with the public health system going beyond the biomedical discipline to include other disciplines for better delivery of public health.

The aim of the priority-setting work is to highlight the status of mental health in Africa together with providing priority areas which funders and governments can prioritise to effectively address mental health challenges on the continent.

What progress has been made so far?

We had an experts’ consultative roundtable last year to identify priorities for mental health that will inform engagement with donor communities, governments, and other policymakers at the national, regional, and global level.

The outcome of the webinar discussions is an outcome report that will inform a policy document, which is currently being drafted.

This was followed by an in-depth synthesis of available literature and a survey with mental health experts to identify a set of research priorities.

What are the priorities for mental health emerging from this work?

We need to target specific areas where we can have the greatest impact, such as investments in mental health R&D in national budgets by governments, the implementation of interventions that narrow the mental health treatment gap, reducing the stigma surrounding mental health and strengthening mental health systems at local, national, and regional level.

What are the next steps?

Once the priority-setting exercise is completed; we shall publish a policy paper addressing these priority questions. Thereafter, we need high level engagement with African leaders so that they can provide their input and equally prioritise mental health. My call to action based on the priorities is the need to mobilise funding for two calls— one for research and another for interventions — in mental health. This will go a long way not only in supporting researchers but equally NGOs doing similar work as well.

ASP is an initiative of the Alliance for Accelerating Excellence in Science in Africa (AESA) which is a platform of the African Academy of Sciences (AAS) and the African Union Development Agency (AUDA-NEPAD), is a five-year programme which is engaging Africa’s science leaders, policy stakeholders and partners to identify top scientific priorities that, if addressed, offer the highest return on investment for Africa’s sustainable development. The programme will be developing, publishing, and disseminating key policy papers on STI priorities for Africa.