Depression is a word that embodies profound pain, despair and societal stigma. Despite growing mental health awareness, mental illness remains misunderstood as a sign of personal weakness. The reality is that depression can lead to suicide, which claims more than 700,000 lives worldwide every year. Treatment-Resistant Depression (TRD), a subset of major depressive disorder unresponsive to at least two treatments, affects approximately one-third of depression sufferers, raising suicide risk and posing a global concern.

In Africa, the situation is particularly acute. The continent has the highest suicide rate in the world, at 11 per 100,000 people, compared to nine globally. It is estimated that more than 20 million individuals in Africa have depression, representing 9% of the global burden. North, West and Central Africa are particularly affected, grappling with fragile health care systems, conflicts, stigma and limited mental health services.

The Central African Republic (CAR) has one of the highest suicide rates worldwide, often linked to untreated depression. In contrast, Nigeria has more than seven million sufferers. Even in better-resourced countries like Egypt, Tunisia and Morocco, depression rates remain high.

Africa’s Mental Health Crisis

Mental health systems in Africa are underfunded. African governments allocate less than $0.50 per person annually to mental health. This is far below the recommended $2 per capita for low-income countries. In 2020, only 94 mental health outpatient visits were recorded per 100,000 people compared to 2,001 worldwide, indicating a lack of formal treatment access for most Africans with mental health issues.

In West and Central Africa, psychiatric hospitals are scarce and located in large cities. The situation is further complicated by conflicts in Mali, the Democratic Republic of Congo (DRC), CAR and Libya, where many health facilities have been destroyed or are difficult to access. On average, sub-Saharan Africa has just one psychiatrist per million people. Specialists are often concentrated in capitals or major cities, leaving rural populations underserved. Patients usually face long-distance travel costs to tertiary hospitals, which are cost-prohibitive for many and rely on general practitioners with limited psychiatric training.

Furthermore, antidepressants and psychotropic drugs are often out of stock or unaffordable for many patients. According to the WHO, more than 75% of people with mental disorders in low- and middle-income countries, including most of Africa, receive no treatment for depression. Second-line TRD treatments, such as atypical antipsychotics and dopaminergic drugs, are rarely stocked in public health facilities or private clinics in Sudan, South Sudan, Niger, Mali and CAR. Even in Nigeria, Uganda and Ghana, which have better health care infrastructures, access to these treatments remains limited to tertiary referral hospitals in major cities, with frequent shortages.

Initiatives Addressing Mental Health in Africa

Despite challenges, promising efforts are underway, from policy reforms to community-led interventions.

• Policy Reforms. Several countries have begun updating policies to prioritize mental health. Nigeria, for example, passed its first national Mental Health Act in 2023, replacing the colonial-era lunacy law. The legislation aims to improve access to mental health services and protect patients’ rights. It includes the creation of a Mental Health Department within the Ministry of Health and integrating mental health services into primary care. The Act also prohibits discriminatory and outdated practices like chaining or arbitrarily detaining individuals with mental disorders.
• Community-Led Initiatives. StrongMinds, an NGO operating in Uganda and Zambia, uses group interpersonal therapy led by trained lay counsellors to address depression, particularly among women in low-income communities. Since 2013, StrongMinds has treated more than one million people. Addressing untreated depression helps break cycles of poverty, food insecurity, trauma and disruption. Strongminds also works with governments and other NGOs to incorporate mental health services into food security, health care and education programs. It intends to expand across Africa over the next decade. The International Medical Corps (IMC) also plays a crucial role. In Mali, IMC supports more than 100 health facilities and mobile clinics across northern and central regions. The IMC provides primary and mental health care. It offers psychosocial support alongside services for gender-based violence and nutrition. In CAR, IMC provides mental health consultations through health centers and mobile clinics in underserved areas, trains local health workers and community leaders to support those in distress and publishes educational booklets on mental health. IMC also collaborates with National Ministries of Health and Community-Based Organizations, ensuring its integrated Mental Health and Psychosocial Support (MHPSS) efforts respond to crises and build long-term resilient communities.

Conclusion

Depression in Africa is not just a personal struggle but a public health emergency driven by limited funding, poor access to care and deep-rooted stigma. With suicide rates among the highest globally and millions untreated, the call for action is urgent. Expanding community care, improving mental health training and ensuring access to essential medications are critical.

– Juliette Delbarre

Juliette is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr