It is clear that the stresses on Sub-Saharan women as they go through life are intense, even in the most traditional societies. In the many parts of the region where disruption, famine, war, and forced migration prevail, the pressures are all the greater. The customs and expectations of women’s roles, although variable among African societies, can also lead to stress and mental health challenges in women, even where there is no disaster or disruption of family and social ties.
As women age, they are faced with a range of health issues that decrease physical and cognitive functioning. Examples of such health issues include mental health issues such as, depression, and dementia. These diseases are somewhat neglected and are increasingly a burdensome problem, affecting elderly women in Africa.
Women’s mental health: The global facts
• Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men.
• Leading mental health problems of the older adults are depression, organic brain syndromes and dementias. A majority are women.
• An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.
• Lifetime prevalence rate of violence against women ranges from 16% to 50%.
• At least one in five women suffer rape or attempted rape in their lifetime.
Mental Health as defined by the WHO is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. In Africa, mental illness is considered a silent epidemic. An estimated 100mn people in Africa suffer clinical depression, more than 25% are African women with 85% having no access to effective mental health treatment.
It is estimated that only 1% of most African governments budget is spent on mental illnesses with governments finding it challeging to prioritise these services due to lack of resources, lack of funding and no or ineffective mental health policies.2,4 There are also barriers such as inadequate health care infrastructures, insufficient number of mental health specialists and lack of access to all levels of care.
Mental disorders affect most societal sectors, and, while not clearly recognised in the SDGs, mental health intersects with and influences most of the other SDGs. Poverty eradication (SDG 1), nutrition (SDG 2), health (SDG 3), education (SDG 4), women’s empowerment (SDG 5), decent work (SDG 8), sustainable cities (SDG 11), sustainable consumption (SDG 12), climate change and disaster recovery (SDG 13), peaceful and just societies (SDG 16) and partnerships (SDG 17) — all of these are linked to mental health.
However, until recently, many people in Africa – both women and men – suffering from mental health problems have only had two options: traditional or religious healing methods; and psychiatric hospitals that are unable to provide modern and new treatments. With only one psychiatrist per million people in sub-Saharan Africa, more evidence-based treatment has been out of reach for the vast majority. In many countries, the majority of people with mental illness have no access to treatment. The challenge is compounded by the fact that in most societies, mental illness is still widely stigmatised, inhibiting both sufferers and their families from admitting the condition and seeking help.
It is estimated that only 1% of most African governments budget is spent on mental illnesses with governments finding it challeging to prioritise these services due to lack of resources, lack of funding and no or ineffective mental health policies.2,4 There are also barriers such as inadequate health care infrastructures, insufficient number of mental health specialists and lack of access to all levels of care.
Mental disorders affect most societal sectors, and, while not clearly recognised in the SDGs, mental health intersects with and influences most of the other SDGs. Poverty eradication (SDG 1), nutrition (SDG 2), health (SDG 3), education (SDG 4), women’s empowerment (SDG 5), decent work (SDG 8), sustainable cities (SDG 11), sustainable consumption (SDG 12), climate change and disaster recovery (SDG 13), peaceful and just societies (SDG 16) and partnerships (SDG 17) — all of these are linked to mental health.
However, until recently, many people in Africa – both women and men – suffering from mental health problems have only had two options: traditional or religious healing methods; and psychiatric hospitals that are unable to provide modern and new treatments. With only one psychiatrist per million people in sub-Saharan Africa, more evidence-based treatment has been out of reach for the vast majority. In many countries, the majority of people with mental illness have no access to treatment. The challenge is compounded by the fact that in most societies, mental illness is still widely stigmatised, inhibiting both sufferers and their families from admitting the condition and seeking help.
There is a Need to Prioritise Women’s Mental Health
Depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men across different countries and different settings. Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women’s poor mental health in Africa.
Up to 20% of those attending primary health care suffer from anxiety and/or depressive disorders. In most centres, these patients are not recognised and therefore not treated. Communication between health workers and women patients is extremely authoritarian in many countries, making a woman’s disclosure of psychological and emotional distress difficult, and often stigmatised. When women dare to disclose their problems, many health workers tend to have gender biases which lead them to either over-treat or under-treat women.
In 2007, the WHO developed a project called the Mental Health Improvements for Nations’ Development (MIND) to assist countries in creating and implementing national health policies. In 2013, the World Health Assembly approved a Comprehensive Mental Health Action Plan 2013-2020 which was further extended in 2019 until 2030. This plan sets out clear actions that member states must take to promote mental health and well-being for all, prevent mental health conditions for those at risk and to achieve universal coverage for mental health services.
Up to 20% of those attending primary health care suffer from anxiety and/or depressive disorders. In most centres, these patients are not recognised and therefore not treated. Communication between health workers and women patients is extremely authoritarian in many countries, making a woman’s disclosure of psychological and emotional distress difficult, and often stigmatised. When women dare to disclose their problems, many health workers tend to have gender biases which lead them to either over-treat or under-treat women.
In 2007, the WHO developed a project called the Mental Health Improvements for Nations’ Development (MIND) to assist countries in creating and implementing national health policies. In 2013, the World Health Assembly approved a Comprehensive Mental Health Action Plan 2013-2020 which was further extended in 2019 until 2030. This plan sets out clear actions that member states must take to promote mental health and well-being for all, prevent mental health conditions for those at risk and to achieve universal coverage for mental health services.
One organisation that is providing life-changing mental health services to impoverished African women is called StrongMinds. They provide group talk therapy sessions which are delivered by community health workers and are the only organisation scaling a cost-effective solution to the depression epidemic in Africa. Currently they are working in Uganda and Zambia, but such an initiative and collaboration by non-governmental organisations (NGOs), the public and private sectors and developmental partners in various countries on the continent is vital in addressing the burden caused by mental illness.
Dementia
In Africa, where the rate of increase of elderly persons is the fastest in the world, dementia is normally dismissed as a part of normal ageing. The lack of awareness means that many patients are suffering undiagnosed – putting an additional burden on women as they age.
Dementia is a broader term used to describe several diseases that progressively affect memory, cognitive abilities and behaviour and significantly interfere with a person’s ability to maintain the activities of daily living.5 The impact of dementia does not only cause a significant burden financially but also represents substantial human costs to countries, societies, families, and individuals.
A common misconception around dementia and the associated conditions is that it is a natural and inevitable part of ageing rather than been seen as a disease process.5 This results in barriers to seeking diagnosis and care and with the lack of understanding around the condition it causes fear, stigmatisation and discrimination especially so in the African continent. In 2015 it was estimated that 2.13 million people were living with dementia in sub-Saharan Africa (SSA), this number set to reach 3.48 million by 2030.
In May 2017, the WHO’s Global action plan on the public health response to dementia (GAPD) was adopted at the 70th session of the World Health Assembly. This plan provided specific actions, indicators and targets to evaluate levels of implementation, progress and impact for Member states, international, regional and national level partners. The plan had key areas of action for governments such as increasing prioritization and awareness of dementia, reducing the risk of dementia, diagnosis, treatment and care for those suffering from dementia and providing support for dementia carers.6 It also called to strengthening information systems for dementia as well as research and innovation.
Although this plan was set out only a few countries such as Ethiopia, Ghana, Kenya and South Africa have drafts of a national dementia strategy, though not yet operation whilst the other sub-Saharan countries have none. Few countries have tried to incorporate some of the targets of this plan within their national mental health policy and strategy but again it is unclear whether it has been comprehensive enough.
Dementia is a broader term used to describe several diseases that progressively affect memory, cognitive abilities and behaviour and significantly interfere with a person’s ability to maintain the activities of daily living.5 The impact of dementia does not only cause a significant burden financially but also represents substantial human costs to countries, societies, families, and individuals.
A common misconception around dementia and the associated conditions is that it is a natural and inevitable part of ageing rather than been seen as a disease process.5 This results in barriers to seeking diagnosis and care and with the lack of understanding around the condition it causes fear, stigmatisation and discrimination especially so in the African continent. In 2015 it was estimated that 2.13 million people were living with dementia in sub-Saharan Africa (SSA), this number set to reach 3.48 million by 2030.
In May 2017, the WHO’s Global action plan on the public health response to dementia (GAPD) was adopted at the 70th session of the World Health Assembly. This plan provided specific actions, indicators and targets to evaluate levels of implementation, progress and impact for Member states, international, regional and national level partners. The plan had key areas of action for governments such as increasing prioritization and awareness of dementia, reducing the risk of dementia, diagnosis, treatment and care for those suffering from dementia and providing support for dementia carers.6 It also called to strengthening information systems for dementia as well as research and innovation.
Although this plan was set out only a few countries such as Ethiopia, Ghana, Kenya and South Africa have drafts of a national dementia strategy, though not yet operation whilst the other sub-Saharan countries have none. Few countries have tried to incorporate some of the targets of this plan within their national mental health policy and strategy but again it is unclear whether it has been comprehensive enough.
Collaboration Is Key
To be able to overcome these challenges and develop sustainable solutions for the continent, comprehensive and holistic planning and development is required.4 Governments need to work in collaboration with key stakeholders, both public and private to come up with policies that integrate mental health into primary care settings – including screening, assessment and treatment by health workers. In addition, governments must invest in the training of healthcare workers who will be able to diagnose, assess and treat patients – including understanding differences in mental health issues in women and men.
Governments and key stakeholders must work to increase awareness around dementia as well as educate both health care workers and professionals as well as the general population. This will not only help them understand the condition better but will reduce stigma and discrimination that is associated with having the condition and allow healthcare workers and professionals to deliver better treatment and care. The awareness campaigns and programs can also be tailored to the cultural contexts and needs of a community. In addition, the programs that are introduced can be linked to policies and campaigns linked to NCD risk reduction and health promotion as these modifiable risk factors can also reduce or delay the progression for dementia. Governments must also ensure they provide efficient and co-ordinated care pathways for those that suffer from mental health issues and that they are embedded in the health and social care system including long term care for patients whilst also providing support for their carers.
Another key area where focus must be put on is for governments to develop, implement and improve national surveillance and monitoring systems as well as capturing the appropriate data which can be used to map patients to available services and resources at both regional and national levels which will improve service delivery. Most importantly, data and research specific to women’s mental health are lacking. It is therefore a need for age and sex disaggregated data to monitor women’s health status across age categories. It is vital that policy makers improve information management systems for women’s health by shifting from manual to electronic data collection and by conducting multipurpose national household surveys on a regular basis. In the long term, this will create age friendly environments and allow the elderly to live with peace, dignity and respect.
Governments and key stakeholders must work to increase awareness around dementia as well as educate both health care workers and professionals as well as the general population. This will not only help them understand the condition better but will reduce stigma and discrimination that is associated with having the condition and allow healthcare workers and professionals to deliver better treatment and care. The awareness campaigns and programs can also be tailored to the cultural contexts and needs of a community. In addition, the programs that are introduced can be linked to policies and campaigns linked to NCD risk reduction and health promotion as these modifiable risk factors can also reduce or delay the progression for dementia. Governments must also ensure they provide efficient and co-ordinated care pathways for those that suffer from mental health issues and that they are embedded in the health and social care system including long term care for patients whilst also providing support for their carers.
Another key area where focus must be put on is for governments to develop, implement and improve national surveillance and monitoring systems as well as capturing the appropriate data which can be used to map patients to available services and resources at both regional and national levels which will improve service delivery. Most importantly, data and research specific to women’s mental health are lacking. It is therefore a need for age and sex disaggregated data to monitor women’s health status across age categories. It is vital that policy makers improve information management systems for women’s health by shifting from manual to electronic data collection and by conducting multipurpose national household surveys on a regular basis. In the long term, this will create age friendly environments and allow the elderly to live with peace, dignity and respect.