Mental health in Africa: findings from the mental health and poverty project.

This issue of the International Review of Psychiatry draws attention to the neglected priority of mental health in Africa. While substantial resources have beenmobilized by the international donor community to provide support for HIV/AIDS, tuberculosis and malaria on the African continent, the growing burden ofmental, neurological and substance abuse disorders remains largely ignored. This is reflected in the priorities of African ministries of health. The majority of African countries (70%) spend less than 1% of their meagre health budgets on mental health (WHO, 2005a), and most of those budgets are consumed in large, colonial-era custodial psychiatric institutions, contrary to growing evidence for cost-effective community-based interventions (Patel et al., 2007). Against this disturbing trend, in 2005 the Department for International Development (DfID) funded a large research programme consortium (RPC) to address mental health in Africa over a 5year period. This consortium, the Mental Health and Poverty Project (MHaPP), set out to examine mental health policy development and implementation in Ghana, South Africa, Uganda and Zambia (Flisher et al., 2007). In doing so, it hoped to build the evidence base for policy level interventions that could address the vicious cycle of poverty and mental ill-health evident in many lowand middleincome countries (LMICs) (Lund et al., 2010). In this issue we are happy to report some of the findings from MHaPP, pertaining to a diverse range of themes. These include depleted human resources and mental health systems in Zambia; opportunities for drawing on local resources, such as traditional healers in Ghana; human rights and mental health in Uganda; perceptions of the causes of women’s mental illness in Ghana; the integration of mental health into primary health care in Ghana, South Africa and Uganda; the involvement of mental health service users in policy development in South Africa; the extent of inter-sectoral collaboration for mental health in South Africa; and the links between mental health and the United Nations’ Millenium Development Goals (MDGs) in sub-Saharan Africa. Most of the studies gathered data through semi-structured interviews and focus group discussions with a wide range of stakeholders in the study countries, and some also made use of the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.1 (WHO, 2005b) and secondary data analysis. In a study of Zambian mental health services, Alice Sikwese and her colleagues report on the shocking depletion of human resources for mental health care in Zambia. There are currently three psychiatrists for a population of approximately 12,000,000 people, and these specialists are based largely in the country’s only psychiatric hospital. Of great concern is that there are currently no training programmes for psychiatrists or psychologists in Zambia, and very limited training of general nurses and clinical officers in mental health. Kenneth Ae-Ngibise and his colleagues explore the potential for collaboration between traditional healers and public sector mental health services in Ghana. Traditional healers are widely used in Ghana, due to the congruence between local beliefs regarding the causes of mental illness and the explanations provided by traditional and faith healers, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. Although appealing in principle, collaboration may be difficult due to human rights and safety concerns, scepticism by traditional healers regarding the effectiveness of ‘conventional’ treatments, and traditional healer solidarity. Nevertheless Ae-Ngibise et al. argue that collaboration may be possible, for example in the form of cross-referrals, provided both formal and traditional service providers are open to engagement and learning from each other. In the same theme of mobilizing sectors beyond the health sector to address mental health, Sarah Skeen and her colleagues document the extent of