São Tomé and Príncipe is a small island located off Central Africa’s west coast, near the equator, with a population of roughly 230,000. Nearly 60% of the population lives below the national poverty line and there are numerous health inequities. Mental health is an ongoing crisis in São Tomé and Príncipe, negatively impacted by poverty, a lack of services and limited infrastructure.

Challenges Facing Mental Health Services

There is a lack of awareness and data surrounding mental health in São Tomé and Príncipe. However, many residents face common mental health issues such as anxiety, depression, substance use and, in some cases, trauma from poverty and isolation.

Barriers to care include a severe shortage of mental health professionals. There are only 4.6 doctors per 10,000 residents, with even fewer trained in mental health. Infrastructure is weak and there are no specified mental health facilities or consistent and constant access to medication. Stigma also plays a major role, leaving many affected individuals misunderstood and unsupported.

The public health care system offers limited mental health support through a few hospitals. Only one outpatient mental health facility is linked to a hospital and just one psychiatric unit exists within a general hospital. As of 2017, there were 706 treated cases of severe mental disorders nationwide, equivalent to 361 cases per 100,000 people.

How Poverty Fuels Mental Health Challenges

Poverty also takes a toll on the mental health of São Tomé and Príncipe’s residents. Around a quarter of the population lives on less than $1.90 daily, one of the highest poverty rates among comparable countries. This is due to unemployment and low labor force participation. In 2020, the unemployment rate jumped from 13% to 20%.

Living in poverty often means daily stress over essentials like food, water and housing, things that can trigger or worsen depression and anxiety. With a chronically underfunded health care system, there is limited access to mental health professionals and affordable support remains extremely limited for those in need.

Women and children in São Tomé and Príncipe are especially vulnerable to mental health challenges due to limited economic and educational opportunities. In 2018, the birth rate for girls aged 15–19 was 0.4 per 1,000, an indicator of deeper social and health disparities. Mental health struggles among these groups are often linked to substance abuse and domestic violence. Yet, access to mental health services remains limited, further compounding the crisis.

Support From International Organizations

The United Nations Children’s Fund (UNICEF) is one of the organizations working to combat the poverty and mental health crisis in São Tomé and Príncipe. One serious problem in the country is violence against children. This occurs frequently; about 70% of children are exposed to psychological aggression and one in seven experience severe physical punishment. To address this, UNICEF developed a protocol for care and follow-up for adolescent victims of violence, sexual abuse or mistreatment. Indeed, this is a major factor in the mental health struggles many residents of São Tomé and Príncipe face.

The World Health Organization (WHO) is also working to strengthen health systems in São Tomé and Príncipe by improving working conditions and boosting staff motivation. Its efforts have significantly impacted both the more than 9,000 island residents and the 97 professionals working at the hospital. While emphasizing preventive health, the organization focuses on reducing deaths from preventable diseases and promoting long-term care and sustainability.

Conclusion

Mental health in São Tomé and Príncipe is often overlooked, yet neglecting it undermines education, productivity and overall well-being. Breaking the cycle of poverty requires addressing mental health. Spreading awareness is essential to ensure local communities can access the necessary services.

– Madyn Lewis

Madyn is based in Chicago, IL, USA and focuses on Good News and Global Health, Celebs for The Borgen Project.

Photo: Wikimedia Commons