Brazzaville – Access to mental health services in the African region is still inadequate despite recent progress. While countries have made advancements including increasing the number of mental health specialists, investment and policy development, challenges ranging from poor awareness to stigma and insufficient services continue to undermine effective mental health care. Dr Naeem Dalal, a mental health emergency response consultant for WHO in the African Region, discusses some of the common barriers to this critical care.

What are the workplace-related mental health trends in Africa?

Recognition of the negative impacts of mental health disorders on workplace productivity, especially depression, anxiety and stress, is improving. But the response is significantly complicated by the multilayered nature of the challenge in African countries, where factors like poverty and inequality are significant contributors to mental health concerns in the workplace. This is especially concerning in the informal sector, where these systemic hurdles disproportionately disadvantage vulnerable groups like women and young people, who frequently occupy low-paid jobs, with associated poor working conditions.

Organizational factors are the next hurdle, in both the private and government sectors, with overwhelming workloads, safety concerns and other occupational hazards commonly worsening mental health outcomes in individuals. South Africa, for example, has multiple wellness programmes focused on reducing workplace stress and improving work-life balance. But these are very much confined to the formal private sector, and much less evident in the government, informal or community service organization sectors, leaving a significant gap.

Individual factors, such as personality traits, learned behaviours, and cultural influences play a crucial role in shaping mental health and wellness. In African workplaces, spirituality and religious beliefs are significant influences, often driving individuals to take on extra responsibilities and endure stress due to ingrained cultural practices. These learned behaviours are deeply rooted in the local context and cannot simply be addressed with Western-style interventions. The interplay of these factors creates a complex mental health landscape in Africa, requiring culturally-tailored and sensitive approaches for effective support and intervention.

What is the status of investment by employers in proactively creating mental health-friendly workplace environments in Africa?

Despite Kenya being a very good example of a country where high-level political commitment is translating into progress, the majority of African employers, especially those in the informal sector, have yet to appreciate the long-term benefits of investing in workplace mental health interventions. While Kenya has a government-driven workplace mental health policy to guide both the formal and informal sectors to institute relevant structures, workplace mental health instead falls under the labour laws of many other countries on the continent. Within these labour laws, the concept of what workplace mental health would look like is still in the developmental stages, unfortunately.

Mostly then, the well-being of staff falls to trade unions or labour organizations who represent individuals in the workplace, resulting in a major lag that is even more pronounced in the informal sector. Optimal productivity and mental health go hand in hand, but without a full understanding of the overall importance of mental health and wellness, we are not going to make many strides in workplace mental health either.

What are the common barriers to accessing mental health care in workplaces in Africa, and especially in the informal sector?

The biggest barrier is stigma, and most African countries really need to rip off the band aid and make people understand that mental health is real, and that is it important. There is currently a big generational divide in African workspaces, with the younger populations much more aware of their mental health needs, and demanding access. 

Lack of awareness, however, remains a major hurdle, with mental health literacy on the continent still very poor. Too many people simply do not understand how to communicate their own feelings and emotions, so their conditions often go unrecognized and untreated. This is especially true for the informal sector, where people have added concerns about their job security being threatened if they reveal their struggles.

Thirdly, resource constraints severely hinder the implementation of mental health support systems in many workplaces. Even in the formal sector, structured mental health programmes are rare, as employers often prioritize physical health and safety over mental well-being. This was evident during the COVID-19 pandemic, when community health workers played a critical role in the health response, yet due to the semi-formal nature of their employment, were not afforded the support and protections they rightfully deserved.

Similarly, in the African context there are the daily wage earners, like street hawkers or domestic workers, who work in high-stress environments, often with little job security and few, if any benefits. So, who should be responsible for them? These are the difference nuances impacting the mental health response on the continent and need to be clearly highlighted.

How can mental health care interventions in various workplace environments be scaled up?

Primarily, interventions need to be culturally-relevant and stigma-free, and should start from government level. As the government of Kenya has done so successfully, it starts with policy reform and the implementation of comprehensive workplace mental health policies applicable to both formal and informal work environments.

Next, mental health needs to be integrated into occupational health frameworks. The majority of African countries do have occupational health frameworks, but they’re very much related to easily identifiable risks. So they’ll be focused on physical health in the mining sector, for example. Instead, mental health services need to be affordable and accessible to all, including the people who sit at a desk from 9am to 5pm every day.

The unique challenges posed by the continent’s very large informal work sector cannot be ignored and require tailored support. The same goes for the increasing volunteerism that is evident in the African context. Not all organizations can offer full-time employment, but structures need to be put in place to ensure that mental health support can be provided in these sectors.