Mental health policy in Africa.

81 In 2007, a landmark series of papers on mental health appeared in The Lancet. 1 Some of the key messages emerging from the series were that mental disorders are inextricably linked with other concerns: there can be " no health without mental health " ; mental disorders affect people in all societies, but especially the disadvantaged, vulnerable and poor; mental disorders are a leading cause of disability, mortality and loss of productivity; global mental health resource allocation is characterised by scarcity, inequity and inefficiency (with a disproportionate amount allocated to psychiatric hospitals); low cost treatments are feasible, affordable and effective for many disorders in developing countries; and the treatment gap between those that need treatment and those that receive it is enormous. However, despite the compelling arguments for addressing this egregious scenario, action tends to be limited in scope and inappropriate in nature. An example of the latter is when a large proportion of limited resources are allocated to constructing new mental hospitals, as opposed to strengthening the capacity of the health system to provide cost effective services at primary health care (PHC) level. One approach to addressing this situation is the development and implementation of mental health policies. When based on sound evidence, and a thorough consultation process with all relevant stakeholders, these policies can harness the resources required to systematically address the mental health needs of a country. In Africa, very few countries have mental health policies, and many of the existing policies are more than two decades old. This is a very important limitation because these old policies tend to focus on processes of involuntary admission, and do not reflect recent developments in the recognition of the rights of those suffering from mental illnesses, nor modern approaches to the treatment of mental disorders. Finally, many existing policies are not informed by recent understandings of the relationship between mental illness and poverty. There are many myths about this relationship, for example that those suffering the effects of poverty are less affected by mental disorders, and once they have a disorder they are more likely to recover owing to more supportive social networks, less stigma and fewer social demands. It has now been established that those suffering from poverty are at increased risk for mental disorders, and furthermore that those suffering from mental disorders are at increased risk for poverty or deepening poverty, resulting in a vicious cycle. …