Voir page 480 le resume en francais. En la pagina 481 figura un resumen en espanol.
Africa is a large continent, prone to strife, especially south of the Sahara. Most of its countries are characterized by low incomes, high prevalence of communicable diseases and malnutrition, low life expectancy, and poorly staffed services (1, 2). Mental health issues often come last on the list of priorities for policy-makers (3). Where mortality is still mostly the result of infectious diseases and malnutrition, the morbidity and disablement due to mental illness receive very little attention from the government. Health in general is still a poorly funded area of social services in most African countries (1), and compared to other areas of health, mental health services are poorly developed. Indeed, most African countries have no mental health policies, programmes or action plans (4, 5).
In 1988 and 1990 the Member States in the African Region of WHO adopted two resolutions (AFR/RC39/R1 and AFR/RC40/R9) to improve mental health services, and each state was expected to formulate mental health policies, programmes and action plans. A survey was conducted two years later to see if the countries that had adopted these resolutions had done anything to implement them. Despite some modest achievements, the situation of mental health programmes in most countries was found to be unsatisfactory (4). In addition, compelling evidence shows that a large proportion of the global health burden is due to mental disorders, and this proportion is projected to rise in many African countries (6). What does this mean for policy?
The development of mental health policy in Africa should be guided by a set of goals. These goals must aim to change the negative perception of mental disorders by the public, reduce the incidence and prevalence of mental disorders, including those associated with inappropriate use of addictive substances, and provide adequate care for the mentally ill. Policies must aim to maximize scarce public resources and support families in the provision of the best possible care for the mentally ill. The goals must recognize the need for clear strategies to reduce the disablement associated with mental illness and to promote research on mental illnesses and how to prevent or treat them.
Attitudes to mental illness
In most parts of the continent, people's attitudes towards mental illness are still strongly influenced by traditional beliefs in supernatural causes and remedies (7). This belief system often leads to unhelpful or health-damaging responses to mental illness, to stigmatization of mentally ill persons and those who attempt suicide, and to reluctance or delay in seeking appropriate care for these problems (8). Such beliefs also affect the provision of mental health care services for the needy; thus, policy-makers are often of the opinion that mental illness is largely incurable or, at any rate, unresponsive to orthodox medical practices (3).
The education of the public should be given prominence in the development of mental health policies in Africa because many aspects of mental health care require the active collaboration of the community. Community rehabilitation of the mentally ill is an important example. Community understanding is also important in actions aimed at reducing stigma and discrimination. In most parts of the continent, the family remains an important resource for the support and care of patients with mental disorders (9). Families with mentally ill persons can only be strengthened in this role if they are not made to suffer rejection and lack of understanding by the community.
Provision and delivery of health and social services
An important consideration in the development of mental health policy in Africa is the close relation between the level of mental health in the community and the general level of social well-being. …