Implementing Community Care in Large Cities and Informal Settlements: An African Perspective

Reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)

Abstract

Africa, the poorest World Bank region, is a continent with high levels of migration and rapid urbanization. In a transitional state, a growing middle class and changes in traditional culture are taking place alongside the persistence of severe poverty and underdeveloped rural areas. Cities absorb migrants into sprawling informal settlements. In the southern sub-Saharan region, the escalating prevalence of interpersonal violence and substance use compounds other public health concerns. With pressing public health issues, mental health care is largely neglected.

Community mental health care, together with promotive and preventative mental health care, is central to the objectives of the World Health Organization’s Mental Health Action Plan for low- and middle-income countries. Although African countries have adopted the principles of community-based care in mental health policy and legislation, implementation is poor. There are multiple competing priorities, particularly in the cities with their rapidly expanding informal settlements and lack of basic infrastructure. Multiple urgent health conditions take priority, together with an increasingly fragmented society.

This chapter explores the provision of mental health service in Africa, with a focus on urbanization and community mental health care. Finally, the mental health services of three African cities, Lagos, Kinshasa, and Johannesburg, are discussed.

Keywords

Mental health services Africa Urban Community care 

References

  1. Abdulmalik J, Kola L, Gureje O (2016) Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement. Glob Ment Health 3:e9. doi:10.1017/gmh.2016.2CrossRefGoogle Scholar
  2. Adeosun II, Adegbohun AA, Adewumi TA, Jeje OO (2013) The pathways to the first contact with mental health services among patients with schizophrenia in Lagos. Niger Schizophr Res Treat 2013:769161Google Scholar
  3. Adewuya AO, Ola BA, Coker OA, Atilola O, Zachariah MP, Olugbile O et al (2016) Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey. Niger BJPsych Open 2(6):385–389Google Scholar
  4. Alem A, Jacobsson L, Hanlon C (2008) Community-based mental health care in Africa: mental health workers’ views. World Psychiatry 7(1):54–57CrossRefPubMedPubMedCentralGoogle Scholar
  5. BasicNeeds Mental health and development model (2017) (cited Jan 2017). Available from: http://www.basicneeds.org
  6. Campbell-Hall V, Petersen I, Bhana A, Mjadu S, Hosegood V, Flisher AJ et al (2010) Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services. Transl Psychiatry 47(4):610–628CrossRefGoogle Scholar
  7. de Menil V, Ndetei D, Waruguru M, Knapp M, McDaid D (2014) A hidden face of community mental health care in Africa: specialist care from private providers in Kenya. World Psychiatry 13(1):100CrossRefPubMedPubMedCentralGoogle Scholar
  8. de Menil V, Knapp M, McDaid D, Raja S, Kingori J, Waruguru M et al (2015) Cost-effectiveness of the mental health and development model for schizophrenia-spectrum and bipolar disorders in rural Kenya. Psychol Med 45(13):2747–2756CrossRefPubMedGoogle Scholar
  9. Disease Control Priorities 3rd Edition (2015) Mental, neurological and substance use disorders. Available from: http://dcp-3.org/mentalhealth
  10. Dixon A, McDaid D, Knapp M, Curran C (2006) Financing mental health services in low- and middle-income countries. Health Policy Plan 21(3):171–182CrossRefPubMedGoogle Scholar
  11. DOH (2015) National Health Insurance for South Africa, White Paper. Department of Health, South Africa, PretoriaGoogle Scholar
  12. EMERALD (2017) Emerging mental health systems in low- and middle-income countries (cited Jan 2017). Available from: https://www.emerald-project.eu
  13. Esan O, Esan A (2016) Epidemiology and burden of bipolar disorder in Africa: a systematic review of data from Africa. Soc Psychiatry Psychiatr Epidemiol 51(1):93–100Google Scholar
  14. Flisher A, Lund C (2011) Resources for mental health services in Africa: situation analysis and way forward. In: Ndetei DM, Szabo CP (eds) Contemporary psychiatry in Africa: a review of theory, practice and research. Acrodile Publishing Limited, KenyaGoogle Scholar
  15. GBD 2015 DALYs and Hale Collaborators (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388(10053):1603–1658CrossRefGoogle Scholar
  16. Gureje O (2011) The challenge of mental health service in Africa: the role of partnerships and networks. In: Ndetei DM, Szabo CP (eds) Contemporary psychiatry in Africa: a review of theory, practice and research. Acrodile Publishing Limited, KenyaGoogle Scholar
  17. Gureje O, Lasebikan VO, Kola L, Makanjuola VA (2006) Lifetime and 12-month prevalence of mental disorders in the Nigerian survey of mental health and well-being. Br J Psychiatry 188:465–471CrossRefPubMedGoogle Scholar
  18. Gurney K (2017) The real issue is not poverty, it is inequality 2012 (cited Jan 2017). Available from: https://www.urbanafrica.net/news/real-issue-not-poverty-it-inequality/
  19. Hanlon C, Fekadu A, Jordans M, Kigozi F, Petersen I, Shidhaye R et al (2016) District mental healthcare plans for five low- and middle-income countries: commonalities, variations and evidence gaps. Br J Psychiatry 208(Suppl 56):s47–s54CrossRefPubMedPubMedCentralGoogle Scholar
  20. Iazzolino G (2017) Kinshasa, megapolis of 12 million souls, expanding furiously on super-charged growth 2016 (cited Jan 2017). Available from: http://mgafrica.com
  21. Kapungwe A, Cooper S, Mwanza J, Mwape L, Sikwese A, Kakuma R et al (2010) Mental illness – stigma and discrimination in Zambia. Afr J Psychiatry (Johannesburg) 13(3):192–203Google Scholar
  22. Mental Health and Poverty Project: Outputs and Activities (cited Jan 2017). Available from: http://www.who.int/mental_health/policy/development/mhapp/en/
  23. Mental Health Innovation Network (2017) A global community of mental health innovators (cited Jan 2017). Available from: http://www.mhinnovation.net
  24. Movement for Global Mental Health (cited Jan 2017). Available from: http://www.globalmentalhealth.org/
  25. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223CrossRefPubMedGoogle Scholar
  26. National Department of Health (2012) National mental health policy framework and strategic plan 2013–2020. Government of South Africa, PretoriaGoogle Scholar
  27. Nsereko JR, Kizza D, Kigozi F, Ssebunnya J, Ndyanabangi S, Flisher AJ et al (2011) Stakeholder’s perceptions of help-seeking behaviour among people with mental health problems in Uganda. Int J Ment Heal Syst 5:5CrossRefGoogle Scholar
  28. Okunlola P (2017) The power and the heartbeat of Africa’s biggest urban jungle: UN-Habitat; Undated (cited Jan 2017). Available from: http://unhabitat.org/
  29. Oni T, Smit W, Matzopoulos R, Hunter Adams J, Pentecost M, Rother HA et al (2016) Urban health research in Africa: themes and priority research questions. J Urban Health 93:722–730CrossRefPubMedPubMedCentralGoogle Scholar
  30. Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T et al (2016) Addressing the burden of mental, neurological, and substance use disorders: key messages from disease control priorities, 3rd edition. Lancet 387(10028):1672–1685CrossRefPubMedGoogle Scholar
  31. Petersen I, Ssebunnya J, Bhana A, Baillie K, Mha PPRPC (2011) Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda. Int J Ment Heal Syst 5:8CrossRefGoogle Scholar
  32. PRIME, the Programme for Improving Mental health carE: evidence on scaling up mental health services for development (cited Jan 2017). Available from: http://www.prime.uct.ac.za
  33. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al (2007) No health without mental health. Lancet 370(9590):859–877CrossRefPubMedGoogle Scholar
  34. Reddy SP, James S, Sewpaul R, Koopman F, Funani NI, Sifunda S et al (2010) Umthente Uhlaba Usamila – the South African national youth risk behaviour survey 2008. Medical Research Council of South Africa, Cape TownGoogle Scholar
  35. Robertson LJ, Szabo CP (2017) Community mental health services in Southern Gauteng, South Africa; an audit using data routinely collected by the District Health Information Systems. Submitted for publication to the South African Journal of PsychiatryGoogle Scholar
  36. South African Society of Psychiatrists (2015) Membership database. JohannesburgGoogle Scholar
  37. Statistics South Africa (2011) Gauteng Provincial profile. Report No. 03–01-76. Available from: http://www.statssa.gov.za/publications/Report-03-01-76/Report-03-01-762011.pdf
  38. Szabo CP (2010) Should state sector community psychiatry be hospital based? A local, and personal, perspective. Afr J Psychiatry (Johannesburg) 13(1):1Google Scholar
  39. Thornicroft G, Deb T, Henderson C (2016) Community mental health care worldwide: current status and further developments. World Psychiatry 15(3):276–286CrossRefPubMedPubMedCentralGoogle Scholar
  40. United Nations Economic Commission for Africa (2016) Contribution to the 2014 United Nations Economic and Social Council (ECOSOC) Integration Segment (cited July 2016). Available from: http://www.un.org/en/ecosoc/integration/pdf/economiccommissionforafrica.pdf
  41. Université de Kinshasa: Centre neuro psycho pathologique (cited Jan 2017). Available from: http://cnpp.e-monsite.com/
  42. UrbanAfrica.Net: Communicating about African cities (cited Jan 2017). Available from: https://www.urbanafrica.net
  43. WHO (2011) Mental health atlas-2011 country profiles. World Health Organisation, Geneva. Available from: http://www.who.int/mental_health/evidence/atlas/profiles/en/
  44. WHO (2013) Mental health action plan 2013–2020. World Health Organisation, GenevaGoogle Scholar
  45. WHO (2014) The health of the people: the African regional health report. Regional Office for Africa: World Health Organisation, GenevaGoogle Scholar
  46. WHO (2015) Mental health atlas, 2014. World Health Organisation, GenevaGoogle Scholar
  47. Williams DR, Herman A, Stein DJ, Heeringa SG, Jackson PB, Moomal H et al (2008) Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychol Med 38(2):211–220CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  • Lesley Jane Robertson
    • 1
    • 2
  • Christopher Paul Szabo
    • 1
    • 3
  1. 1.Department of Psychiatry, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  2. 2.Sedibeng District Health ServicesJohannesburgSouth Africa
  3. 3.Charlotte Maxeke Johannesburg Academic HospitalJohannesburgSouth Africa

Personalised recommendations